Hilal ÖZKAN, Mehmet Fatih BAŞAK, Nilgün KÖKSAL, Bayram DORUM, Salih Çağrı ÇAKIR

Prematüre Bebeklerde Erken Agresif Total Parenteral Nütrisyonun Biyokimyasal Parametreler Üzerine Etkileri

GİRİŞ ve AMAÇ: Prematüre bebeklerde yüksek miktarda proteinin ilk gün başlanması ile büyüme ve nöromotor gelişimin olumlu etkilendiği bildirilmiştir. Ancak yüksek protein miktarının biyokimyasal parametreler üzerine etkisi tam olarak bilinmemektedir. Bu çalışmada prematüre bebeklerde düşük ve yüksek doz protein uygulamasının biyokimyasal parametreler üzerine olan etkisinin araştırılması amaçlanmıştır. YÖNTEM ve GEREÇLER: Bu retrospektif çalışmaya 34 hafta ve altında doğan prematüre bebekler dahil edildi. Olgular düşük (DP; ilk gün 1 g/kg/gün, günlük 1 g arttırarak maksimum 3 g/kg/gün) ve yüksek protein (YP; ilk gün 3 g/kg/gün, maksimum 3,5-4 g/kg/gün) alımlarına göre iki gruba ayrılarak antenatal ve postanatal özellikler, biyokimyasal sonuçlar ve büyüme gelişmeleri bakımından karşılaştırıldı. BULGULAR: YP grubunda 264, DP grubunda 100 olmak üzere çalışmaya toplam 364 hasta alındı. Biyokimyasal belirteçler bakımından gruplar karşılaştırıldığında; YP grubundaki olgularda kan üre azotu değerlerinin, protein alımı ile korele olarak arttığı görüldü, ancak böbrek fonksiyonlarında bozulma saptanmadı. Her iki grupta elektrolit bozukluğu açısından anlamlı farklılık gözlenmedi. YP grubu ile karşılaştırıldığında, DP grubunda ki olguların taburculuktaki ağırlık, boy ve baş çevresi persentillerinin daha fazla oranda 3 persentilin altında olduğu saptandı. TARTIŞMA ve SONUÇ: Bu çalışma ile yüksek protein uygulamasının güvenli ve etkin olduğu gösterildi. Ayrıca postnatal büyüme üzerine olan olumlu etkileri dikkate alındığında, beslenmenin ana hedefinin sağlandığı gözlemlendi.

Anahtar Kelimeler:

Prematürite, total parenteral nürtisyon

Effects of Early Aggressive Total Parenteral Nutrition on Biochemical Parameters Outcome in Preterm Infants

INTRODUCTION: Initiation of high protein, especially on the first day, was reported to positively affect growth and neuromotor development in premature infants. However the effect of high protein content on metabolic and biochemical parameters is unknown. The aim of this study was to investigate the effects of low and high dose protein administration on biochemical parameters in premature infants. METHODS: Premature infants born ≤34 gestational weeks were included in this retrospective study. The infants were divided into two groups as low protein (LP; first day of 1 g/kg/day, daily 1g increments up to max. 3 g/kg/day) and high protein (HP; first day 3 g/kg/day, max. 3,5-4 g/kg/day) and both groups were compared in terms of antenatal and postanatal characteristics, biochemical results, and growth. RESULTS: A total of 364 infants, 264 in HP and 100 in LP groups, were included in this study. When the groups were compared in terms of biochemical markers; blood urea nitrogen levels showed an increase in HP group in correlation with protein intake, however, no deterioration in renal functions occured. No electrolyte impairment was observed between two groups. Compared with HP group, more number of infants in LP group had weight, height, and head circumference of <3 percentile at the time of hospital discharge DISCUSSION and CONCLUSION: This study showed that high dose protein administration is safe and effective. Furthermore, when considering the positive effects on postnatal growth, it was observed that the main goal of the feeding was achieved.

Keywords:

Prematurity, total parenteral nutrition,

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