The Study Of Neonatal Energy Expenditure Of Gastrointestinal Disease

Background:Neonatal period is the fastest growth and development stage, which needs a large nutritional demand but with relatively few body reserves. Especially for the perioperative newborns for gastrointestinal surgery, ensuring reasonable nutrition intake is very important, even if the reasonable standard is hard to measure. Newborns for gastrointestinal surgery, as a special group which is different from the ordinary newborns, and the physical activity energy expenditure changed during gastrointestinal surgery for newborns need further investigate. So far, there are few reports involved in the energy expenditure in pre-operative and post-operative newborns in China and abroad. Besides, there is no unified reference standard for evaluating the energy supply for the post-operative newborns. Therefore, the research of the energy expenditure in pre-operative and post-operative newborns is contributed to providing theoretical basis for the reasonable nutrition intake of future perioperative newborns.Objective:The aim of this study was to investigate the energy expenditure of newborns who under the intestinal surgery,24 hours pre-operation and post-operation for three days, and the difference of the energy expenditure and heart rate variability between healthy newborns and perioperative newborns, providing the theoretical basis for reasonable nutrition intake of perioperative newborns.Methods:From June 2014 to June 2015 period, The neonatal surgery department, Affiliated Children Hospital of Medical College of Zhejiang University gastrointestinal surgery child were selected for observer group, and Affiliated Hospital of Medical College of Zhejiang University healthy newborn children were selected as control group, and established a database according to the inclusion and exclusion criteria.After obtaining informed consent, the newborn general situation questionnaire and the maternal situation questionnaire during pregnancy and delivery will be completed by the mother. Actiheart (Camntech, United States) based on heart rate combined acceleration sensor was employed to measure energy expenditure and heart rate variability (HRV). The study eventually collected a total of 57 samples, but we finally got 44 samples as valid data for eliminating the lost data, such as the falling of the instruments, early discharging from hospital during test. Total of 151 samples, including 57 samples of full term infants and 52 samples of premature infants were as control group. Advanced Energy Expenditure mode was employed to measure energy expenditure 24 hours before operation, and last for 3 days post-operation, including energy expenditure indicators such as Physical Activity Energy Expenditure (PAEE), Total Energy Expenditure (TEE), Metabolic equivalent of energy (MET) and heart rate (HR). Short-term mode was employed to measure heart rate variability, such as Standard diviation of average NN intervals (SDNN), Standard diviation of NN intervals (SDANN), Root mean square of successive differences (RMSSD), Low frequency/High frequency (LF/HF) ratio and heart rate (HR). The exported data were statistically analyzed by SPSS22.0.Results:1. Energy expenditure results:(1) The PAEE value of premature infants, full term infants, perioperative newborns before operation, on the first postoperative day, on the second postoperative day and on the third postoperative day were (53.87±15.91), (14.21±4.41), (43.07±9.9), (41.35± 12.07), (42.43±10.07) and (43.59±11.01) kj/kg/d, respectivily. the TEE value of premature infants, full term infants, perioperative newborns before operation, on the first postoperative day, on the second postoperative day and on the third postoperative day were (175.66±35.02), (236.73±33.35), (221.03±30.02), (201.41±29.03), (211.23 ±27.05) and (223.53±34.03) kj/kg/d, respectively.(2) The premature PAEE value (53.87±15.91) kj/kg/d was significantly higher than the full term PAEE value (14.21±4.41) kj/kg/d, but the TEE value of premature infants (175.66±35.02) kj/kg/d was lower than full term infants (236.73±33.35) kj/kg/d, and the difference was statistically significant (P<0.05).(3) The PAEE value and TEE value of newborn post-operation compared with pre-operation, have no significantly increase.2. Heart rate variability results(1)The heart rate of premature group (148.01±14.21)/min was significantly higher than the full term group (128.53±9.95)/min (P<0.05), while the LF/HF ratio (1.81±0.65) was significantly lower than the full term group (2.57±0.82) (P<0.05). There was no significant difference of SDNN, SDANN, RMSSD between the two groups.(2) The RMSSD、BPM、LF/HF ratio of perioperative newborns on the first postoperative day was significantly lower than the value of pre-operation, and the difference was statistically significant (P<0.01). However, the RMSSD、BPM、LF/HF ration of perioperative newborns on the second postoperative day has no statistically significant difference from the value of pre-operation.Conclusion:1. The PAEE value of premature infants for 24 hours was (53.87±15.91) kj/kg/d, the TEE value was (175.66±35.02) kj/kg/d; the PAEE value of full term infants for 24 hours was (14.21±4.41) kj/kg/d, the TEE value was (236.73±33.35) kj/kg/d; The PAEE value of perioperative newborns before operation was (43.07±9.9) kj/kg/d, the TEE value was (221.03±30.02) kj/kg/d; The PAEE value of perioperative newborns on the first postoperative day was (41.35±12.07) kj/kg/d, the TEE value was (201.41±29.03) kj/kg/d; The PAEE value of perioperative newborns on the second postoperative day was (42.43±10.07) kj/kg/d, the TEE value was (211.23±27.05) kj/kg/d; The PAEE value of perioperative newborns on the third postoperative day was (43.59±11.01) kj/kg/d, the TEE value was (223.53±34.03) kj/kg/d. The data could be used as a reference for neonatal nutrition intake in future.2. The LF/HF ratio of premature infants was lower than the full term infants, which made us speculate the sympathetic-vagus balance of the premature infants was relatively weaker than the full term infants. The RMSSD and LF/HF of perioperative newborns on the first postoperative day was significantly lower than the value of pre-operation, and the value of the second postoperative day was higher than the first postoperative day, for the reason of surgical stress, effect on the sympathetic-vagus balance of perioperative newborns obviously.3. There was little influence in energy expenditure and heart rate variability with different gender.