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... daily recommended allowances for the parenterally fed infant should be less overall, as intravenous feeding bypasses the gut; the American Academy of Pediatrics (Mauer et ul. 1985) and the European Society of Paediatric Gastroenterology and Nutrition (ESPGAN;Wharton, 1987) statements, however, provide useful guidelines (Table 1). ...
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... ESPGAN guidelines for the nutritional requirements of preterm infants fed enterally (Wharton, 1987) make no specific recommendations for the nutritional management of infants fed by the parenteral route. The values (Table 1) for total parenteral nutrition (TPN) are estimates based on recent published studies and on the authors' experience. The usual practice is to establish full psrenteral feeding (both in volume and nutrient concentration) in a stepwise progression over a number of days Gilbertson et al. 1991) in an attempt to minimize metabolic overload in the physiologically immature infant. ...
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... are a number of ways in which protein (amino acid) requirements in the LBW infant on TPN can be estimated, including the factorial approach; fetal accretion rates (whole body analysis ;Widdowson & Dickerson, 1964), and protein balance and turnover studies. Protein requirements suggested by various sources are given in Table 1. The effect of type of feeding route on protein metabolism in the neonate has been extensively reported elsewhere (Duffy & Pencharz, 1986;Pencharz et al. 1989). ...
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... VLBW infants had significant negative nitrogen balance until intravenous nitrogen was introduced (Fig. 3) ; this loss was equivalent to 2.5 g protein over the first 3 postnatal days (3 YO of the body's protein each day), whereas those in the early group were in positive nitrogen balance from d 1. In neither group of infants were energy intakes of greater than 210 kJ/d (50 kcal/d) achieved in the postnatal period (Fig. 2), which is well below the current recommendations (Table 1). The difficulties in achieving both energy and protein targets in the early stages of life in this and other studies are well documented. ...
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... After birth, the supply of nutrients through the placenta ceases, while the high demand for nutrients persists. However, there may be difficulties in supplying low-birth babies due to their relative enzymatic suppression, multi-organ immaturity, in particular functional deficiency of the gastrointestinal tract 3 . The birth of a child is accompanied by profound metabolic changes of an adaptive nature. ...
Until now in the information resources data on the reference values of the concentration of this essential trace element in biological fluids in low birth weight (LBW) newborns are absent. The purpose of our study was to study the copper content in serum in various categories of LBW children during the neonatal period. This prospective study included 173 newborns with LBW, including babies with intrauterine growth retardation (IUGR). The dynamic monitoring of copper concentration in the blood serum, as well as the analysis of these parameters depending on the birth weight has been performed. Quantitative determination of serum copper was carried out by the method of emission spectral analysis. When analyzing the level of copper in the blood serum on the 10th and 25th days of life, a lower content of this element was noted in extremely LBW children with (8.10±1.16 and 6.99±0.41, on the 10th and 25th days of life, respectively) and without IUGR (7.49±1.07 and 7.19±0.91, respectively). On the 25th day of life, serum copper levels were reduced in all groups of children (P<0.001). All LBW newborns and especially in children with IUGR has a deficiency of this micronutrient throughout the observation period. In newborns with ELBW or VLBW, there is a deficiency of serum copper throughout the neonatal period. © 2018 Oriental Scientific Publishing Company. All Rights Reserved.
... Furthermore, preterm neonates who were started on early nutrition support reached full enteral feedings significantly sooner than those who received delayed nutrition support 5 . Parenteral feeding may be more appropriate than enteral feeding in preterm neonates due to simulating intrauterine feeding 6 . Optimal nutrition of these neonates should meet the changing nutrient requirements and support growth that mimics normal fetal growth 7 . ...
Parenteral nutrition allows preterm neonate’s nutritional requirement for growth and development to be met. This retrospective study was conducted to assess weight gain and complications of parenteral nutrition in low birth weight (LBW) neonates, very low birth weight (VLBW) neonates and extremely low birth weight (ELBW) neonates.A total of 82 patients received parenteral nutrition. Patients received parenteral nutrition at mean age of 4.63 ± 3.87 days. There were no significant difference in the weight gain between three different birth weight group (ELBW, VLBW and LBW) (p>0.05). There was a significant association between birth weight group and complications related to parenteral nutrition (p=0.00009). ELBW neonates had a higher percentage of parenteral nutrition complication (93.3%) compared to VLBW (85%) and LBW (33.3%). Complications observed were mostly electrolyte disturbances across all three groups. Findings from this study were able to provide information regarding parenteral nutrition in promoting weight gain and risks of complications in preterm neonates between ELBW, VLBW and LBW. Closer monitoring of effectiveness and safety of parenteral nutrition must be performed to ensure that complications can be reduced in the clinical setting.
... Individuals were given up to 2 to 3 g/kg per day of Intralipid, conforming to Intralipid administration practice at that time. 9,17,18 Follow-up of the children had been performed at 18 months 19 and 7 years, 20 with a substudy at 15 years. 16 The initial preterm cohort consisted of 927 subjects (Figure 1). ...
Intravenous lipid use is associated with an acute hyperlipidemia, but long-term consequences have not been studied. We investigated whether elevated lipids in humans during the critical period of preterm neonatal life have a long-term impact on aortic and myocardial function relevant to adult disease.
We followed up 102 subjects born prematurely and now aged 23 to 28 years. Eighteen received intravenous lipids as neonates and were matched to controls with equivalent perinatal characteristics. Global and regional aortic stiffness and left ventricular function were assessed by cardiovascular magnetic resonance. Those who received intravenous lipids had greater aortic stiffness in early adulthood (P=0.0002), with greater stiffness in the abdominal aorta (P=0.012). The relationship was graded according to the elevation in neonatal cholesterol induced by intravenous lipids (P<0.0001) but not other metabolic parameters altered by the infusion. Peak systolic circumferential strain was also reduced in the lipid group (P=0.006), which, again, was proportional to neonatal cholesterol level (P<0.01).
Aortic and myocardial function in young adulthood is associated with intralipid exposure during neonatal life for preterm infants, in a graded manner related to the rise in cholesterol. Circulating cholesterol during critical developmental periods may have long-term impacts on the human cardiovascular system.
... 2,5,6,25 In circulation, MCFA are not as tightly bound to albumin as are longchain fatty acids (LCFA, carbon chain length greater than 14), a theoretical benefit in newborns given that LCFA can displace bilirubin from albumin, thereby exacerbating neonatal hyperbilirubinemia. 20 The rapid uptake and metabolism of MCFA results in increased production of acetyl-CoA and subsequently the ketone bodies acetoacetate and D-(-)-3-hydroxybutyrate (3HB). Ketonemia in newborn infants (blood concentrations of 3HB up to approximately 0.5 mmol/L) during fasting is common if endogenous fat is available. ...
Premature newborn infants are born with limited stores of glycogen and fat. Energy, such as medium-chain triglycerides (MCT), which can spare the use of body protein as metabolic energy, may be beneficial. This study compares MCT containing C8, C9, or C10 fatty acids as oral sources of energy for newborn rhesus monkeys (Macaca mulatta). On day 1 of life, 4 groups of 5 monkeys were given a single dose of water or MCT by nasogastric tube. The dose provided approximately 80% of the expected energy requirement. Plasma C8:0, C9:0, and C10:0 fatty acids and whole-blood D-(-)-3-hydroxybutyrate (3HB) concentrations were measured at 0, 1, and 3 h after dosing. Concentrations of free fatty acids (C8, C9, or C10) and ketone (3HB) increased with time after the dose. At 1 and 3 h, concentrations of C8 and C9 did not differ, but C9 was greater than C10. At 1 h, blood 3HB concentrations due to C8 triglyceride were higher than C9 or C10 (503 versus 174 and 225 μmol/L respectively). As MCT chain length increased from C8 to C10, blood concentration of 3HB decreased. Odd-chain MCT (C9 versus C8) resulted in lower whole-blood ketone (3HB), perhaps due to C9 metabolism or the rate of release or uptake of fatty acids. These results have implications for the use of MCT in nutritional supplements for preterm infants.
The aim of this study was to determine the energy expenditure and respiratory quotient (RQ) of ventilated and non-ventilated low birthweight infants during the first five days of life, in order to determine optimal feeding regimens. Eighty six infants, of birthweight less than 1750 g, were grouped according to whether they were artificially ventilated or breathing air spontaneously, and whether they were parenterally or enterally fed at the time of study. Energy expenditure and respiratory quotient were measured during days 1-5 and the relation of energy expenditure to several explanatory variables was investigated using multiple regression analysis. The energy expenditure of ventilated infants was less than that of spontaneously breathing infants; the differences were significant on days 1-3. The respiratory quotient (mean (SE)) was greater in intravenously fed infants compared with milk-fed--0.99 (0.03) v 0.92 (0.01) (P < 0.05), with 42% of studies of infants receiving total parenteral nutrition (TPN) producing an RQ of > 1.0 compared with 16.6% of milk-fed infants (P < 0.01). There was a significant correlation between glucose intake and RQ (r = 0.39, P < 0.001). The activity scores were measured during 75 studies and scores were significantly higher in spontaneously breathing milk-fed infants compared with ventilated parenterally fed infants. Factors independently related to energy expenditure were: postnatal age (P < 0.01); milk feeds (P < 0.01); and physical activity (P < 0.05). A mix of carbohydrate and fat from day 1 may not only meet energy needs but may also reduce respiratory quotient.
This study compares the clearing and metabolism of three different lipid emulsions. They had the same phospholipid emulsifier and similar particle sizes. In one (LLL) the core component was long-chain triglycerides (TG), the second (MMM/LLL) contained equal molar amounts of medium- and long-chain TG, the third (MLM) contained synthetic TG with medium-chain (M) fatty acids in the 1,3-positions and a long-chain (L) fatty acid in the 2-position. In model experiments with bovine lipoprotein lipase, the MMM component was hydrolyzed preferentially in the MMM/LLL emulsion so that the initial products were M fatty acids and M monoglycerides. The MLM emulsion, in contrast, gave M fatty acids and formation of L-MG (monoglyceride) throughout hydrolysis. For in vivo studies [3H]oleic acid was incorporated into the emulsion TG as marker for the long-chain component. After bolus injection to rats, the MMM/LLL and MLM emulsions were cleared more rapidly than the LLL emulsion. This was true at all TG loads studied (4-64 mg for a 200 g rat). The labeled oleic acid was oxidized somewhat more rapidly when administered in the MLM emulsion compared to the MMM/LLL emulsion. There were only slight differences in tissue distribution of label. Hence, differences in in vivo metabolism of the long-chain fatty acids were small compared to the marked differences in TG structure and in patterns of product release during in vitro lipolysis.
