| Objectve:To investigate the early nutrition support treatment in very/extremely low birth weight infants (VLBWI/ELBWI), assess the growth status, explore the relationship between early nutrition and EUGR and analysis whether BUN can be used to monitor AA intake. In order to reduce the incidence of EUGR, improve the cure rate, reduce long-term complications, and improve the quality of VLBWI/ELBWI survival.Method:Hospitalized VLBWI/ELBWI from September2011to December2013was involved in the retrospective research. Information such as daily nutrition intake and weight, head circumference (HC) of admission and discharging and BUN of each week was recorded. Analysis the nutrition support treatmen, growth status, linear regression was used to analysis the risk factors of EUGR and correlation factors of BUN.Result:(1)Early nutrition:The average time of starting enteral feeding was3d (2d,5d), while time to reach full enteral feeding was (42.8±11.6) d; AA intake in PN reached the peak in the2nd week (2.5±0.4g/kg·d), while average intake of lipid emulsions each week was larger than2.5/kg·d since the2nd week.(2)growth and development monitor:Linear regression showed that gender, GA, average BW gain, BW in the1st week, respiratory failure were linear correlated to EUGR(weight)(F=12.S95, P<0.001); while average HC gain, PIH, IUGR(HC) were linear correlated to EUGR(HC)(F=20.981, P<0.001).(3)the relatishiop between BUN and AA:In the first week, there was linear correlation between BUN and AA intake in EN and PN, weight gain in the1week, calorie of PN in the1week(F=11.73, P=10.001); in the2nd week, there was no linear correlation was found (F=0.93, P>0.05); in the3rd week, there was linear correlation between BUN and weight gain in the3rd week (F=11.98, P=0.001); in the4th week, there was linear correlation between BUN and total AA intake in the4th week (F=17.08, P<0.001); in the5thweek, there was linear correlation between BUN and weight gain in the5th week (F=4.994, P<0.05).Conclusion:(1)In this research, the average time of starting enteral feeding was appropriate, while the time to reach full enteral feeding was slightly delayed; and the AA and lipid emulsions in PN intake was lower than the recommended amount.(2) EUGR (weight) was correlated with gender, GA, average BW gain, BW in the1st week, respiratory failure; while EUGR(HC) was correlated to average HC gain, PIH, IUGR(HC).(3) Although there is a certain relationship between BUN and AA intake, BUN was affected by many factors, thus BUN may not a useful index in monitoring the adequacy of protein intake.Part1Clinical Analysis of Early Nutrition Support in Very/Extremely Low Birth Weight InfantsObjective:To investigate the early nutrition support treatment in very/extremely low birth weight infants (VLBWI/ELBWI), and monitor related complicants, in order to provide the theoretical basis for adjustment of nutritional strategies.Method:VLBWI/ELBWI in the Second Xiangya Hospital of Central South University from September2011to December2013was included in the retrospective study. The nutrition used was recorded daily. PN and EN of each week was also analysed.Result: (1) General information:91cases were involved in the study, the average birth weight was (1288±150)g and the average gestational age was (30.7±1.9)w. The priority neonatal diseases were neurological disease (98.9%), infection/sepsis (97.8%) and digestive system disease (89.0%);(2) EN:The average time of starting enteral feeding was3d (2d,5d), which were significantly different in the GA group (p<0.05); and time to reach full enteral feeding was (42.8±11.6) d, and time to reach full feeding as GA increased. And there is significantly different in the each GA group except (32-34wVS34w-)(P<0.05);(3) PN:AA intake in PN reached the peak in the2nd week(2.5±0.4g/kg·d) and the difference was significant when compare to3.5g/kg·d in each week(P<0.01), average intake of lipid emulsions was larger than2.0g/kg·d, and the difference was significant when compare to3.0g/kg·d in each week(P<0.01);(4) PNAC:The incidence of PNAC was20.9%, there was significantly different in time of starting enteral feeding、time of PN use■the average intake of lipid emulsions(P<0.05),while no difference in BW and GA(P>0.05).Conclusion:(1) In this research, the average time of starting enteral feeding was appropriate, while the time to reach full enteral feeding was slightly delayed;(2) The AA and lipid emulsions in PN intake was below the recommended amount.(3)The incidence of PNAC was correlated to time of starting enteral feeding, time of PN use, the average intake of lipid emulsions.Part2Clinical Analysis of Growth in Very/Extremely Low Birth Weight InfantsObjective:Investigate the morbidity of EUGR, and explore the relative factors ofEUGR. Method:91cases were included in the retrospective study. All cases were divide into EUGR group and non-EUGR group according to weight (HC). Daily weight and HC of admission and discharging were recorded. All cases were devided into EUGRgroup and non-EUGR group according to weightVHC, risk factors of EUGR was analysed by linear regression.Result:(1) Incidence of IUGR and EUGR:The incidence of IUGR was35.2%(weight),34.1%(body length),24.2%(HC); while the incidence of EUGR was74.7%(weight) and49.5%(HC).(2)Analysis of EUGR(weight):There was significantly different in delivery way, PROM, PIH, GA, average weight gain, gender, IUGR (weight), admission HC, average HC gain, weight gain in the first week, respiratory failure and PS use between EUGR(weight) and non-EUGR (weight) group(.P<0.05); Linear regression showed that gender, GA, average BW gain, BW in the1st week, respiratory failure were linear correlated to EUGR(weight)(F=12.895, P<0.001);(3)Analysis of EUGR(HC):There was significantly different in delivery way, PIH, GA, IUGR(HC), IUGR(weight), average HC gain, PS use between EUGR(HC) and non-EUGR(HC) group(p<0.05), while average HC gain, PIH, IUGR(HC) were linear correlated to EUGR(HC)(F=20.981, P<0.001).Conclusion:(1) The incidence of EUGR was high than abroad.(2) According to weight, EUGR was correlated with gender, GA, average BW gain, BW in the1st week, respiratory failure.(3) According to HC, EUGR was correlated to average HC gain, PIH, IUGR (HC).Part3Relationship between Protein Intake and Blood Urea NitrogenObjectives:Investigate the intake of AA and the tendency of BUN of VLBWI, and explore the relationship between protein intake and BUN.Method:All cases were divide into L group (initiation AA intake<1.0g/kg-d) and M group (initiation AA intake was1.0～2.0g/kg·d). Daily AA intake, BUN and electrolyte of each week were recorded. BUNof the two groups was compared. Analysis of BUN and AA intake,weight gain and weight in the end of each week was also involved.Results:(1) Tendency of BUN:BUN decreased as time went on except1st week.(2)Comparison between L group and M group:There was significant difference in the average weight gain and time to reach full enteral feeding between L group and M group (P<0.05).(3) Comparison of electrolytesand BUN:There was no significant difference in the level of electrolytes and BUN at the time of7d,14d and21d between M and L group (P>0.05);(4) Correlation factor of BUN:In the first week, there was linear correlation between BUN and AA intake in EN and PN, weight gain in the1st week, calorie of PN in the1st week(F=11.73, P=0.001); in the2nd week, there was no linear correlation was found (F=0.93,P>0.05); in the3rd week, there was linear correlation between BUN and weight gain in the3rd week (F=11.98,P=0.001); in the4th week, there was linear correlation between BUN and total AA intake in the4th week (F=17.08,P<0.001); in the5thweek, there was linear correlation between BUN and weight gain in the5th week (F=4.994,P<0.05).Conclusions:(1) Early and high amount of AA intake in early period can shorten the time to full enteral nutrition and promote the average weight gain during hospitalization.(2) Elevate the early AA intake appropriately was safe.(3) Although there is a certain relationship between BUN and AA intake, BUN was affected by many factors, thus BUN may not a useful index in monitoring the adequacy of protein intake. |
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