Effect Of Different Doses Of Nutrients In Parenteral Nutrition Supplementation On The Outcome In Very Low Birth Weight Infants

Objective To provide the clinical evidence for enhancing the safety and validity of parenteral nutrition by comparing the effect of two different doses of parenteral amino acid and lipid emulsion supplementation on the parenteral nutrition related metabolic complications and outcome in very low birth weight infants.Methods Totally 328 very low birth weight infants who were taken into the neonatal intensive care unit of Shanghai Children's Medical Center affiliated to Shanghai Jiao tong University School of Medicine were enrolled into the study. Their admission time ranged from January 2005 to December 2014. The parenteral nutrition support started within 72 hours after birth and lasted more than 5 days. These infants were assigned into two groups. In Group 1, the infants were given lower dose of nutrients on PN(2005.1.1~ 2012.12.31) and in Group 2, the dosage was higher(2013.1.1~2014.12.31). To find the difference in the incidence of PN related metabolic complications, the complications of premature infants and the extrauterine growth restriction and at the same time analyzing the relevant factors.Results Compared with Group 1, patients in Group 2 had faster average weight growth rate [19.003±6.669(g/kg·d) vs. 15.728±11.969(g/kg·d)],needed more time to total enteral nutrition(26.23±12.785 d vs. 20.51±11.481d), had a lower incidence of both complications of prematures in hospital(52.42% vs. 65.69%) with the most markedly decrease in intracranial hemorrhage(9.68% vs. 40.69%) and extrauterine growth retardation(EUGR)(27.45% vs. 57.35%) when discharged, but had a higher incidence of PN related complications(70.97%vs. 52.45%) including higher incidence of electrolyte disorders,hyperglycemia and cholestasis while decreased the incidence of hypoglycemia(5.65% vs. 20.10%).These comparisons were all statistically significant((49) <0.05).The two group had no statistical significance in the rates of complications – live damages, hyperbilirubinemia, necrotizing enterocolitis and retinopathy of prematurity.Conclutsions Very low birth weight infants could tolerate the use of high doses of nutrients in parenteral nutrition, and had better growth outcome. However the earlier more aggressive administration of AA and fat could increase the incidence of PN related complications. We need to pay attention to the biochemical index while using parenteral nutrition, so that measures could be taken in time to decrease the negative effect on the outcome.