The Effect Of Early Parenteral Nutrition On Preventing Electrolyte Imbalance During72h After Birth In Extremely Low Birth Weight Infants

Extremely Low Birth Weight Infants (ELBWI) are the premature neonates with birth weight<1000g, gestational age usually less than28weeks. Due to very immature organs, ELBWI are associated with a long hospital stay in the NICU, high mortality and disability rate, and higher incidence of complications and long-term neurological sequelae than term infants. As the dramatically development of Perinatology during the last3decades, the survival rate and quality of life of ELBWI have reached a even higher level than before.Background:Dramatic advances in neonatal medicine over recent decades have resulted in deceased mortality and morbidity rate for extremely low birth weight infants. In developed countries, approximately80%of infants born at24weeks of gestation will survive to discharge, compared to50%just15years ago. However, the survival of these infants is associated with significant short and long term morbidity, including severe intraventricular hemorrhage, periventricular leukomalacia, nosocomial infection and necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity and adverse long term neurodevelopmental sequelare.Objective: To explore the effect of early parenteral nutrition (PN) on preventing life threatening electrolyte imbalance during the first72hours after birth in extremely low birthweight infants (ELBWI).Methods:Retrospective comparative analysis was performed for all the ELBWI who was admitted from January1st,2010to December31st,2011to the NICU of a tertiary hospital in south China (Shenzhen Maternity&Child Healthcare Hospital), to explore the effect of early parenteral nutrition (PN) on preventing life threatening electrolyte imbalance during the first72hours after birth in extremely low birthweight infants (ELBWI).All the ELBWI received parenteral nutrition through umbilical venous catheter (UVC) or peripherally inserted central catheter (PICC). The infants in early parenteral nutrition (EPN) group started PN within the first4h after delivery, including1.6g/kg/d aminoacids(AA) with a increment of1.0g/kg/d (Total fluid intake in day1is70-80cc/kg/d), lipid was given by1g/kg/d within the first24hours, with a increment of1.0g/kg/d.The preterm infants in late parenteral nutrition (LPN) group received PN during8-24h of age after birth, including0.5g/kg/d aminoacids(AA) with a increment of1.0g/kg/d, lipid was started on day2by0.5g/kg/d with a incrment of0.5g/kg/d. Oral feedings were started when the vital signs in ELBWI were stable.Serum electrolytes were examined in both groups at24hr,48hr and72hrs of age after birth, respectively. The incidence of electrolytes imbalance, severe arrhythmia or mortality rate were compared in the two groupl.Results:55cases of ELBWI were admitted to the NICU during the study period. The exclusion criteria includes congentital anomalies, death in first24h and withdrawal due to social reason, Finally43cases of ELBWI were enrolled in this study (EPN group25 cases and LPN group18cases). There were no significant differences for the demographic features such as gestational age, birth weight, gender or delivery mode between the two group; The daily fluid intake, urine output, pH of the arterial blood gas and blood glucose levels between the two group was also similar. Nevertheless, the incidence of hyperkalemia and hypocalcemia in72h was higher in infants of LPN group compared to EPN group (3.6%:33.3%and10.7%:80.0%respectively. P<0.05).Conclusions:It was safe and necessary for the extremely-low-birth-weight infants to start TPN as early as4hours after birth. ELBW infants in early initiated parenteral nutrition group showed a lower incidence of life threatening electrolyte imbalance during72h after birth, especially a lower rate of early non-oliguric hyperkalemia. Active early parenteral nutrition is even important to improve the survival rate and to decease the neurodevelop-ment sequelae of extremely-low-birth-weight infant.