Pediatric parenteral amino acid mixture in low birth weight infants.
Pediatric parenteral amino acid mixture in low birth weight infants.
复制标题
低出生体重婴儿的儿科肠外氨基酸混合物。
作者：
W. Heird;W. Hay;R. Helms;M. Storm;S. Kashyap;R. Dell
在28名需要肠外营养的低出生体重（LBW）婴儿（出生体重，750至1750 g;出生后年龄，1至4周）中评价了旨在维持需要肠外营养的婴儿和儿童正常血浆氨基酸浓度的氨基酸混合物，以获得最佳营养管理。16名婴儿只接受了5至21天的肠外营养。其中10例接受了外周静脉典型给药方案（1.91 +/- 0.16 g/kg/d氨基酸和44.7 +/- 4.4 kcal/kg/d），6例接受了中央静脉典型给药方案（2.39 +/- 0.11 g/kg/d氨基酸和95.9 +/- 14.5 kcal/kg/d）。外周静脉亚组的平均增重为10.3 +/- 10.6 g/kg/d;平均氮平衡为230 +/- 66 mg/kg/d。中心静脉亚组的平均体重增加率（17.2 +/- 5.1 g/kg/d）和平均氮潴留率（267 +/- 49 g/kg/d）均与宫内率相似。在这两个亚组以及总人群中，除苯丙氨酸外的所有氨基酸的血浆浓度均在喂养足量人乳的LBW婴儿中观察到的血浆浓度的95%置信限内，以导致体重增加率与宫内率相似。然而，尽管血浆酪氨酸和半胱氨酸浓度在血浆浓度目标的95%置信限内，但LBW婴儿使用N-乙酰-L-酪氨酸和盐酸半胱氨酸的能力似乎甚至低于足月婴儿和较大儿童。总之，这些数据支持氨基酸混合物对LBW婴儿的疗效评价。同样重要的是，他们认为LBW婴儿使用胃肠外输送的氨基酸的能力并不像通常认为的那样有限。
A mixture of amino acids designed to maintain normal plasma amino acid concentrations in infants and children requiring parenteral nutrition was evaluated in 28 low birth weight (LBW) infants (birth weight, 750 to 1750 g; postnatal age, 1 to 4 weeks) who required parenteral nutrients for optimal nutritional management. Sixteen babies received only parenteral nutrients for five to 21 days. Ten of these received a typical regimen by peripheral vein (1.91 +/- 0.16 g/kg/d of amino acids and 44.7 +/- 4.4 kcal/kg/d) and six received a typical regimen through a central vein (2.39 +/- 0.11 g/kg/d of amino acids and 95.9 +/- 14.5 kcal/kg/d). Mean weight gain of the peripheral vein subgroup was 10.3 +/- 10.6 g/kg/d; mean nitrogen balance was 230 +/- 66 mg/kg/d. Both the mean rate of weight gain (17.2 +/- 5.1 g/kg/d) and the mean rate of nitrogen retention (267 +/- 49 g/kg/d) of the central vein subgroup were similar to intrauterine rates. In these two subgroups as well as the total population, plasma concentrations of all amino acids except phenylalanine were within the 95% confidence limits of the plasma concentrations observed in LBW infants fed sufficient amounts of human milk to result in a rate of weight gain similar to the intrauterine rate. However, although plasma tyrosine and cyst(e)ine concentrations were within the 95% confidence limits of the plasma concentrations goals, the LBW infant's ability to use N-acetyl-L-tyrosine and cysteine HCl appears to be even less than that of the term infant and older child. In toto, these data support the efficacy of the amino acid mixture evaluated for LBW infants. Of equal importance, they suggest that the LBW infant's ability to use parenterally delivered amino acids is not as limited as commonly thought.