Prematüre bebeklerde erken agresif total parenteral nütrisyonun metabolik ve biyokimyasal parametreler üzerine etkilerinin araştırılması
Date
2018
Authors
Başak, Mehmet Fatih
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Prematüre bebek beslenmesinde esas amaç aynı gestasyonel haftadaki fetusun büyümesine eş değer büyümenin sağlanmasıdır. Bu bebeklerde doğumdan hemen sonra total parenteral nütrisyon (TPN) başlanması son derece önemlidir. Özellikle yüksek miktarda proteinin ilk gün başlanması ile büyüme ve nöromotor gelişimin olumlu etkilendiği bildirilmiştir. Yapılan randomize kontrollü çalışmalarda yüksek protein kullanımının iyi tolere edildiği ve ciddi metabolik sorunlara yol açmadığı gösterilmiştir. Ancak prematüre bebeklerde protein miktarının başta kalsiyum, fosfor, potasyum olmak üzere serum elektrolitlerini içeren biyokimyasal parametreler üzerine etkisini araştıran sınırlı sayıda çalışma bulunmaktadır. Bu çalışmanın amacı prematüre bebeklerde düşük ve yüksek doz protein uygulamasının metabolik ve biyokimyasal parametreler ve büyüme gelişme üzerine olan etkisinin araştırılması idi. Bu çalışmaya 2008-2015 yılları arasında 34 hafta ve altında doğup TPN başlanan prematüre bebekler dahil edildi. Olgular düşük (DP; ilk gün 1 g/kg/gün, günlük 1 g arttırarak maksimum 3 g/kg/gün) ve yüksek protein (YP; ilk gün 3 g/kg/gün, maksimum 3,5-4 g/kg/gün) alımlarına göre iki gruba ayrılarak antenatal ve postanatal özellikler, prematüriteyle ilişkili morbiditeler, biyokimyasal sonuçlar ve büyüme gelişmeleri bakımından karşılaştırıldı. YP grubunda 264, DP grubunda 100 olmak üzere çalışmaya toplam 364 hasta alındı. YP grubundaki olguların, gestasyon haftaları DP grubundan daha küçük olmasına rağmen; intraventriküler kanama, nekrotizan enterokolit ve prematüre retinopatisi oranlarının daha düşük olduğu görüldü. TPN süresinin YP grubunda daha kısa olduğu ve bu gruptaki bebeklerin tam enteral beslenmeye daha erken geçtikleri tespit edildi. Biyokimyasal belirteçler bakımından gruplar karşılaştırıldığında; YP grubundaki olgularda kan üre azotu (BUN) değerlerinin, protein alımı ile korele olarak arttığı görüldü, ancak böbrek fonksiyonlarında bozulma saptanmadı. Her iki grupta ciddi elektrolit bozukluğu açısından anlamlı farklılık gözlenmedi. YP grubu ile karşılaştırıldığında, DP grubunda ki olguların taburculuktaki ağırlık, boy ve baş çevresi persentillerinin daha fazla oranda 3 persentilin altında olduğu saptandı. Bu çalışma ile yüksek protein uygulamasının güvenli ve etkin olduğu gösterildi. Ayrıca postnatal büyüme üzerine olan olumlu etkileri dikkate alındığında, beslenmenin ana hedefinin sağlandığı gözlemlendi. Yüksek doz protein uygulamasının prematüre bebeklerde uzun dönem büyüme, gelişme ve nörolojik sonuçlar üzerine etkilerinin değerlendirildiği daha fazla sayıda hastayı içeren randomize prospektif çalışmalara ihtiyaç bulunmaktadır.
Nutrition of preterm infants should result in growth similar to that of normally growing fetuses of the same gestational age. Therefore, it is very important to start total parenteral nutrition in these infants. Initiation of high protein, especially on the first day, was reported to positively affect growth and neuromotor development. Several randomized controlled trials showed that high protein intake was well tolerated and was not associated with severe metabolic problems. However, limited number of studies investigated the effect of protein on biochemical parameters including serum electrolytes, especially calcium, phosphorus, and potassium in preterm infants. The aim of this study was to investigate the effects of low and high dose protein administration on both metabolic and biochemical parameters and growth in premature infants. Premature infants born ≤34 gestational weeks and received TPN between 2008 and 2015 were included in this study. The infants were divided into two groups as low protein (LP; first day of 1 g/kg/day, daily 1g increments up to max. 3 g/kg/day) and high protein (HP; first day 3 g/kg/day, max. 3,5-4 g/kg/day) and both groups were compared in terms of antenatal and postanatal characteristics, prematurity related morbidities, biochemical results, and growth. A total of 364 infants, 264 in HP and 100 in LP groups, were included in this retrospective study. Although the mean gestational age of HP group were lower than LP group, the incidences of intraventricular hemorrhage, necrotizing enterocolitis and retinopathy of prematurity were also lower. The duration of TPN was shorter in the HP group and these infants achieved full enteral nutrition earlier. When the groups were compared in terms of biochemical markers; blood urea nitrogen (BUN) levels showed an increase in HP group in correlation with protein intake, however, no deterioration in renal functions occured. No severe electrolyte impairment was observed between two groups. Compared with HP group, more number of infants in LP group had weight, height, and head circumference of <3 percentile at the time of hospital discharge This study showed that high dose protein administration is safe and effective. Furthermore, when considering the positive effects on postnatal growth, it was observed that the main goal of the feeding was achieved. Prospective, randomized controlled studies including larger number of infants are required to evaluate the effect of high protein administration on long-term growth, development and neurological outcomes in preterm infants.
Nutrition of preterm infants should result in growth similar to that of normally growing fetuses of the same gestational age. Therefore, it is very important to start total parenteral nutrition in these infants. Initiation of high protein, especially on the first day, was reported to positively affect growth and neuromotor development. Several randomized controlled trials showed that high protein intake was well tolerated and was not associated with severe metabolic problems. However, limited number of studies investigated the effect of protein on biochemical parameters including serum electrolytes, especially calcium, phosphorus, and potassium in preterm infants. The aim of this study was to investigate the effects of low and high dose protein administration on both metabolic and biochemical parameters and growth in premature infants. Premature infants born ≤34 gestational weeks and received TPN between 2008 and 2015 were included in this study. The infants were divided into two groups as low protein (LP; first day of 1 g/kg/day, daily 1g increments up to max. 3 g/kg/day) and high protein (HP; first day 3 g/kg/day, max. 3,5-4 g/kg/day) and both groups were compared in terms of antenatal and postanatal characteristics, prematurity related morbidities, biochemical results, and growth. A total of 364 infants, 264 in HP and 100 in LP groups, were included in this retrospective study. Although the mean gestational age of HP group were lower than LP group, the incidences of intraventricular hemorrhage, necrotizing enterocolitis and retinopathy of prematurity were also lower. The duration of TPN was shorter in the HP group and these infants achieved full enteral nutrition earlier. When the groups were compared in terms of biochemical markers; blood urea nitrogen (BUN) levels showed an increase in HP group in correlation with protein intake, however, no deterioration in renal functions occured. No severe electrolyte impairment was observed between two groups. Compared with HP group, more number of infants in LP group had weight, height, and head circumference of <3 percentile at the time of hospital discharge This study showed that high dose protein administration is safe and effective. Furthermore, when considering the positive effects on postnatal growth, it was observed that the main goal of the feeding was achieved. Prospective, randomized controlled studies including larger number of infants are required to evaluate the effect of high protein administration on long-term growth, development and neurological outcomes in preterm infants.
Description
Keywords
Prematürite, Total parenteral nürtisyon, Aminoasit, Metabolik ve biyokimyasal parametreler, Prematurity, Total parenteral nutrition, Amino acid, Metabolic and biochemical parameters
Citation
Başak, M. F. (2018). Prematüre bebeklerde erken agresif total parenteral nütrisyonun metabolik ve biyokimyasal parametreler üzerine etkilerinin araştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.