A Study On The Administration Of The Individualized Parenteral Nutrition To Preterm Very Low Birth Weight Infant During Hospitalization

Objective:Nutrition and caloric intake,weight growth,biochemical parameters,immune function,complications and neurodevelopmental outcome of the preterm very low birth weight infant(VLBWI)were evaluated to analyze the individualized parenteral nutrition strategy carried out by the nutritional department during hospitalization,providing the theoretical evidence for the impact of the nutrition administration of preterm VLBWI.Methods:182 cases of preterm VLBWI(birth weight<1500g and gestational age<37 weeks)treated in neonatal intensive care unit(NICU)at Children's Hospital of Soochow University between May 2016 and November 2017 were selected as the objects of this study.The enrolled objects were randomly divided into the control group and experimental group.There were 120 cases in the control group and NICU was responsible for nutrition administration,while the nutritional department was responsible for administering nutrition of 62 cases in the experimental group.The following parameters were compared between the 2 groups such as the information of children patients,the general conditions of antenatal pregnant women,the enteral and parenteral nutrition and caloric intake in the 7th,14th and 21st day after birth,weight gain,the biochemical parameters in the 1st,7th,14th,21st day and prior to discharge,the immune condition within the first week and at the end of two weeks after birth,the incidence of complications,the prognosis of disease,the incidence of EUGR(extrauterine growth retardation)evaluated by weight,hospital expense and lengths of stay to study the impact of the individualized parenteral nutrition strategy on the preterm VLBWI during hospitalization in the nutritional department.Results:(1)The general conditions of two groups were compared in aspects of gender,gestational age,birth weight,small for gestational age,neonatal respiratory distress syndrome(NRDS),intrauterine infectious pneumonia and birth asphyxia without significant differences(P>0.05).(2)The general conditions of the antenatal pregnant women were compared in terms of maternal age,cesarean section,the application of antenatal hormone,premature rupture of fetal membranes,placenta previa,placental abruption,amniotic fluid pollution,gestational diabetes mellitus,gestational hypertension and prenatal cholestasis.The two groups had no statistical significance(P>0.05).(3)The nutrition conditions of two groups was studied.There were not significant differences between nutrition and caloric intake in the 7th and 14th days after birth in two groups(P>0.05).In the 21st day after birth,both the parenteral nutrition(PN)nutrition and caloric intake of the experimental group were lower than the control group,the enteral nutrition(EN)nutrient and calories intake were higher than the control group(P<0.05).(4)When comparing weight gain between the two groups,no significant difference of physiological weight loss was observed(P>0.05).The duration to regain birth weight,half the dose and the full dose enteral nutrition time of the experimental group were shorter than the control group,while the rate of weight gain was higher than the control group(both P<0.05).(5)The comparison of biochemical parameters between two groups:? Liver function:The level of alanine aminotransferase(ALT),?-GT,total bilirubin and direct bilirubin had no differences between the two groups inn the 1st day after birth(P>0.05),while ?GT,total bilirubin and direct bilirubin in the experimental group were apparently lower than the control group in the 7th,14th,21st and prior to discharge(p<0.05).ALT in the experimental group was apparently lower than the control group in the 7th,14th and 21st day(P<0.05),while there was no difference between two groups prior to discharge(P>0.05).? Protein index:The levels of albumin,prealbumin and globulin showed no difference in the 1st day between two groups(P>0.05).Though the experimental group had a higher prealbumin level than the control group in the 7th day after birth(p<0.05),the differences of albumin and globulin between the two groups were not significant(P>0.05).And the level of albumin,prealbumin and globulin in the experimental group were apparently higher than the control group in the 14th,21st day and prior to discharge(/p<0.05).? Electrolyte Index:The level of serum Na+,K+ and Ca2+ had no significant difference on the postnatal 1st day between the two groups(P>0.05)and serum Na+had no apparent difference in the 7th,14th,21st day and prior to discharge(P>0.05),while serum Ca2+in the experimental group was apparently higher than the control group(P<0.05).Serum K+in the experimental group was higher than the control group in the 7th and 14th day(P<0.05),while there was no apparent difference in the 21st day and prior to discharge(P>0.05).(6)Comparison of immune function:? Humoral Immunity Index:The levels of C3,C4,IgM and IgG between the two groups of newborns had no apparent difference within one week post partum(P>0.05).The level of C3 and IgG in the experimental group was apparently higher than the control group at the end of two weeks after birth(P<0.05)and the C4 and IgM had no apparent differences between the two groups(P>0.05).? Cellular Immunity Index:The levels of CD3+,CD4+,CD8+and CD4+/CD8+between groups had no apparent differences within one week after birth(P>0.05).The CD3+,CD4+and CD4+/CD8+levels in the experimental group were higher than the control group at the end of two weeks after birth(.P<0.05),while the level of CD8+had no apparent difference(P>0.05).(7)Comparison of complications between two groups:The incidence of parenteral nutrition associated cholestasis(PNAC),necrotizing enterocolitis(NEC),bronchopulmonary dysplasia(BPD),hypoglycemia,retinopathy of prematurity(ROP),late-onset septicemia and brain injury in premature infants(BIPI)in the experimental group were lower than the control group(P<0.05),with no difference for the incidence of anemia(P>0.05).(8)Comparison of clinical outcomes:There were no apparent difference(P>0.05)considering the clinical cure rate and improvements in treatment between the two groups.The incidence of EUGR was apparently lower compared with the control group,in which the lengths of hospital stay was apparently shorter and the hospital expense was higher(P<0.05).Conclusion:(1)The individualized parenteral nutrition strategy of the nutritional department could improve the growth of the preterm VLBWI,the rate of weight gain,and the duration to regain birth weight as well as the half dose and full dose of enteric nutrition time.(2)The individualized parenteral nutrition optimized the biochemical parameters,liver ftmction,protein replenishment and electrolyte balance.(3)The optimal nutrition would not cause adverse effect on humoral immunity,meanwhile it could improve cellular immunity and promote the immunologic function.(4)Given to the preterm VLBWI,the individualized parenteral nutrition relieved the incidence of PNAC,NEC,BPD,hypoglycemia,ROP,late-onset septicemia and BIPI which was a safe resolution with low EUGR incidence and short hospital stay.