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초기 고용량 아미노산 공급이 미숙아의 영양상태에 미치는 효과 평가

Effects of Early High-dose Amino Acid Supplementation on the Nutritional Status of Preterm Infants

병원약사회지 2021년 38권 1호 p.52 ~ 64
안혜림, 김미진, 권은영,
소속 상세정보
안혜림 ( Ahn Hye-Lim ) - Catholic University Seoul St. Mary’s Hospital Department of Pharmacy
김미진 ( Kim Mi-Jin ) - Catholic University Seoul St. Mary’s Hospital Department of Pharmacy
권은영 ( Kwon Eyn-Young ) - Catholic University Seoul St. Mary’s Hospital Department of Pharmacy

Abstract


Background : A previous study reported that supplying an initial high-dose amino acid supplement to premature infants was effective in improving the growth rate. However, other studies reported the occurrence of adverse effects associated with parenteral nutrients, raising concerns about aggressive nutritional support. We aimed to evaluate the effects of an initial high-dose amino acid supply on nutritional improvement and safety in premature infants in clinical practice.

Methods : This study was designed for premature infants who were administered parenteral nutrition (PN) for at least two weeks in neonatal intensive care units (NICUs) from January 2016 through December 2018. The biochemical and nutritional data were compared between premature infants who received low-dose (LD, 1 to <2 g/kg/day), medium-dose (MD, 2 to <3 g/kg/day), and high-dose amino acids (HD, ≥3 g/kg/day) within 48 hours after birth.

Results : The changes in weight, total protein levels, and albumin levels were not significantly different between the three groups. Also, the duration of the NICU stay, duration of PN, maximal weight loss rate, and recovery time to birth weight showed no significant differences. There were no significant differences in blood urea nitrogen (BUN), serum creatinine (Scr), capillary pH, capillary pCO2, blood glucose, aspartate transaminase (AST), alanine transaminase (ALT), direct bilirubin (DB), serum calcium, or serum phosphorus. However, the median BUN tended to increase in the high-dose group at both weeks 1 and 2 comparted to the LD and MD groups (week 1: LD 28.4 mg/dL, MD 29.2 mg/dL, HD 37.7 mg/dL, p = 0.455; week 2: LD 14.2 mg/dL, MD 17.7 mg/dL, HD 19.4 mg/dL, p = 0.139).

Conclusion : There was no difference in improvements in nutritional status or adverse effects in premature infants given more than 3 g/kg/day or 2 to <3 g/kg/day of amino acids compared to 1 to <2 g/kg/day. Monitoring renal function is required when administering high-dose amino acids, considering the tendency of the BUN to rise.

키워드

Parenteral nutrition; High-dose amino acid; Preterm infants; Nutritional support

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