The Clinical Study On Parenteral Nutrition Support During The Early Postnatal Time Of EPI And ELBWI

Background:The effect of optimized nutrition management on the prognosis of premature infants is effective and controllable.Since the early promotion of positive nutrition and effective implementation of parenteral nutrition,many premature infants have achieved good catch-up growth,its effectiveness is beyond doubt.With the emergence of adverse events such as metabolic acidosis,hyperazemia and parenteral nutrition-associated cholestasis,some scholars have raised concerns on the safety of "aggressive" supply of amino acids,fatty acids and carbohydrates.Currently,there are limited monitoring methods for parenteral nutritional tolerance.Blood urea nitrogen over 10 mmol/L is generally considered to be a sign of intolerance to amino acids.When serum or plasma triglyceride concentrations exceed 3 mmol/L(265 mg/dL)during fatty acids infusion,it is suggested that reducing the dose of fatty acids may be considered.Whether blood urea nitrogen and triglyceride can better guide clinical parenteral nutrition monitoring needs further study.Objectives:This study proposed by evaluating the correlation of the blood urea nitrogen concentrations and the intake of amino acids,and the correlation between the triglyceride concentrations and and fatty aicds emulsion,to explore the effect on physical growth and the incidence of complications during hospitalization,to assess the validity as a tolerance evaluation index.A better patenteral nutrition support during the postnatal time is to discussed,to provide clinicians with greater diagnosis and treatment ideas in nutrition management of premature infants.Methods:We retrospectively studied 102 cases of EPI and ELBWI admitted to our NICU from January 2020 to June 2021.Preterms were assigned to group A(BUN>10mmol/L)and B(BUN≤10mmol/L)by BUN concentration,and to group C(TG>3mmol/L)and D by TG(TG≤3mmol/L)concentration.The general condition,parenteral nutrition data within 1 week after birth,physical growth data,tolerance assessment data(microbiochemistry,blood gas analysis),and incidence of complications during hospitalization were compared between groups.Spearman correlation and Logistic regression were used to analyze the influencing factors of BUN and TG concentrations.Results:1.The incidence of hyperbunemia(BUN>10mmol/L)was 27.5%.The concentration of BUN had no apparent correlation with amino acids intake,but was negatively correlated with gestational age.The the total amino acids intake,fatty acids intake,energy intake and the peak intake of amino acids,in the BUN elevated group were significantly lower than those in the normal BUN group,and had no significant effect on the physical growth and incidence of complications.2.The incidence of hypertriglyceridemia(TG>3mmol/L)was 59.8%,and positive correlation was found between TG concentration and fatty acids intake.Logistic regression suggested that birth weight was a protective factor of hypertriglyceridemia.The intake of fatty acids decreased in the TG elevated group,but not the intake of amino acids and energy.Adjustment to fatty acids intake according to TG concentrations didn’t cause significant influence on the physical growth and the incidence of complications(except PNAC).Hypertriglyceridemia and time of intravenous nutrition support were risk factors for PNAC.Conclusions:Elevated BUN can’t tip well the intolerance of amino acids,due to increased BUN cut the accumulation of amino acids,resulted in the deprivation of protein and energy intake is missing,only according to the high value of BUN limiting amino acids intake may not be desirable.1.Triglyceride concentration was positively correlated with fatty acids intake,which is a risk factor for the development of PNAC.Early monitoring of TG concentration and timely adjustment of fatty acids intake will not have adverse effects on physical growth,and avoiding long-term and severe hypertriglyceridemia may be beneficial to improve the occurrence of complications.