超早産児の生後28日間における非経口栄養から経腸栄養への移行と出生後の成長

Transition From Parenteral to Enteral Nutrition and Postnatal Growth in Very Preterm Infants During Their First 28 Days of Life.

抄録

背景:

生後数週間の早産児の栄養摂取は、非経口栄養（PN）期、経腸栄養（EN）期、移行期（TN）期に分けられ、TN期にはPNとENの両方が含まれます。我々の目的は、TN期の超早産児の栄養実践と生後28日間の乳児の成長との関連性を分析することである。

Background: Nutrition practices for preterm infants during the first few weeks of life can be divided into three phases: the parenteral nutrition (PN), enteral nutrition (EN), and transition (TN) phases; the TN phase includes both PN and EN. Our purpose was to analyze nutrition practices for very preterm infants during the TN phase and their association with the infants' growth during the first 28 days of life.

調査方法:

6つの新生児集中治療室から得られた生後32週未満の超早産児268人のデータをレトロスペクティブに分析した。TN期は30～120ml/kg/日の経腸栄養とした。出生後成長不全（PGF）は28日目の成長速度が15 g/kg/d未満と定義された。TN期におけるPGF群と非PGF群のタンパク質およびエネルギー摂取量の差を算出し、多変量回帰分析によりPGFの危険因子を同定した。

Methods: Data from 268 very preterm infants <32 weeks old from six neonatal intensive care units were analyzed retrospectively. The TN phase was defined as enteral feedings of 30-120 ml/kg/d. Postnatal growth failure (PGF) was defined as a 28-day growth velocity <15 g/kg/d. Differences in protein and energy intake between the PGF and non-PGF groups during the TN phase were calculated, and risk factors for PGF were identified using multivariate regression analysis.

結果:

TN期の総タンパク質摂取量（非経口＋経腸）は3.16（2.89、3.47）g/kg/dであり、TN期の経腸栄養量の増加とともに徐々に減少した。TN期の総エネルギー摂取量（非経口＋経腸）は115.72（106.98、122.60）kcal/kg/dであった。PGF群は非PGF群よりも総タンパク質摂取量（非経口＋経腸）が少なかった［3.09（2.85、3.38）g/kg/d vs 3.27（3.06 、3.57）g/kg/d、= 0.007 、それぞれ］。TN期におけるエネルギー摂取量に有意差は認められなかった。PGFと関連する変数は，総タンパク質（非経口＋経腸）摂取量が少ないこと，TN期終了時の日齢が小さいこと，出生時体重-スコアが高いことであった．

Results: The total protein (parenteral + enteral) intake during the TN was 3.16 (2.89, 3.47) g/kg/d, which gradually decreased as the enteral feeding volume increased in the TN phase. The total energy (parenteral + enteral) intake during the TN phase was 115.72 (106.98, 122.60) kcal/kg/d. The PGF group had a lower total protein intake (parenteral + enteral) than the non-PGF group had [3.09 (2.85, 3.38) g/kg/d vs. 3.27 (3.06, 3.57) g/kg/d, = 0.007, respectively]. No significant difference was found in energy intake during the TN phase. The variables associated with PGF included a lower total protein (parenteral + enteral) intake, a smaller day of age at the end of the TN phase, and a higher birth weight -score.

結論:

TN期間中に総タンパク質摂取量（非経口＋経腸）を増やすことで、PGFの発生を抑制できる可能性がある。

Conclusion: Increasing the total protein intake (parenteral + enteral) during the TN could reduce the incidence of PGF.