Prise en charge à long terme du grêle court : spécificités de l'enfant

Short bowel syndrome is defined as the malabsorptive state that follows massive resection of the small intestine (remaining intestinal length < 80 cm). This definition implies that a significant malabsorption of nutrients, water and electrolytes is present, leading to long-term dependence on parenteral nutrition. The management goals in short bowel syndrome are to maintain growth and development, promote intestinal adaptation, prevent complications, ensure a good quality of life, and establish enteral nutrition. Children treated with long-term parenteral nutrition require the expertise of a multi-disciplinary nutritional care team in order to reach the best balance between the constraints of parenteral nutrition and a normal social and familial lifestyle. All the aspects of the disease (medical, social, educational and psychological) have to be taken into account to achieve weaning from parenteral nutrition. Intestinal transplantation is indicated in patients who are likely to die because of irreversible TPN-induced liver disease (associated with liver transplantation), recurrent sepsis or difficult vascular access.     

Etiology and Management of Pediatric Intestinal Failure: Focus on the Non-Digestive Causes

Background: Intestinal failure (IF) is defined as reduction in functioning gut mass below the minimal amount necessary for adequate digestion and absorption. In most cases, IF results from intrinsic diseases of the gastrointestinal tract (digestive IF) (DIF); few cases arise from digestive vascular components, gut annexed (liver and pancreas) and extra-digestive organs or from systemic diseases (non-digestive IF) (NDIF). The present review revised etiology and treatments of DIF and NDIF, with special focus on the pathophysiological mechanisms, whereby NDIF develops. Methods: We performed a comprehensive search of published literature from January 2010 to the present by selecting the following search strings: “intestinal failure” OR “home parenteral nutrition” OR “short bowel syndrome” OR “chronic pseudo-obstruction” OR “chronic intestinal pseudo-obstruction” OR “autoimmune enteropathy” OR “long-term parenteral nutrition”. Results: We collected overall 1656 patients with well-documented etiology of IF: 1419 with DIF (86%) and 237 with NDIF (14%), 55% males and 45% females. Among DIF cases, 66% had SBS and among NDIF cases 90% had malabsorption/maldigestion. Conclusions: The improved availability of diagnostic and therapeutic tools has increased prevalence and life expectancy of rare and severe diseases responsible for IF. The present review greatly expands the spectrum of knowledge on the pathophysiological mechanisms through which the diseases not strictly affecting the intestine can cause IF. In view of the rarity of the majority of pediatric IF diseases, the development of IF Registries is strongly required; in fact, through information flow within the network, the Registries could improve IF knowledge and management.     

Providing the Best Parenteral Nutrition before and after Surgery for NEC: Macro and Micronutrients Intakes

Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency of preterm infants for whom bowel rest and parenteral nutrition (PN) is essential. Despite the improvements in neonatal care, the incidence of NEC remains high (11% in preterm newborns with a birth weight <1500 g) and up to 20–50% of cases still require surgery. In this narrative review, we report how to optimize PN in severe NEC requiring surgery. PN should begin as soon as possible in the acute phase: close fluid monitoring is advocated to maintain volemia, however fluid overload and electrolytes abnormalities should be prevented. Macronutrients intake (protein, glucose, and lipids) should be adequately guaranteed and is essential in each phase of the disease. Composite lipid emulsion should be the first choice to reduce the risk of parenteral nutrition associated liver disease (PNALD). Vitamin and trace elements deficiency or overload are frequent in long-term PN, therefore careful monitoring should be planned starting from the recovery phase to adjust their parenteral intake. Neonatologists must be aware of the role of nutrition especially in patients requiring long-term PN to sustain growth, limiting possible adverse effects and long-term deficiencies.     

Growth and Neurodevelopmental Outcomes of Early,High‐Dose Parenteral Amino Acid Intake in Very Low Birth Weight Infants: A Randomized Controlled Trial

Background: Administration of high‐dose parenteral amino acids (AAs) to premature infants within hours of delivery is currently recommended. This study compared the effect of lower and higher AA administration starting close to birth on short‐term growth and neurodevelopmental outcomes at 18–24 months corrected gestational age (CGA). Methods: Infants <1250 g birth weight (n = 168) were randomly assigned in a blinded fashion to receive parenteral nutrition providing 1–2 g/kg/d AA and advancing daily by 0.5 g/kg/d to a goal of 4 g/kg/d (standard AA) or 3–4 g/kg/d and advancing to 4 g/kg/d by day 1. The primary outcome was neurodevelopmental outcomes measured by the Bayley Scales of Infant and Toddler Development, Third Edition at 18–24 months CGA. Secondary outcomes were growth parameters at 36 weeks CGA among infants surviving to hospital discharge, serum bicarbonate, serum urea nitrogen, creatinine, AA profiles in the first week of life, and incidence of major morbidities and mortality. Results: No differences in neurodevelopmental outcome were detected between the high and low AA groups. Infants in the high AA group had significantly lower mean weight, length, and head circumference percentiles than those in the standard AA group at 36 weeks CGA and at hospital discharge. These differences did not persist after controlling for birth growth parameters, except for head circumference. Infants in the high AA group had higher mean serum urea nitrogen than the standard group on each day throughout the first week. Conclusion: Current recommendations for high‐dose AA starting at birth are not associated with improved growth or neurodevelopmental outcomes.     

Aluminum Exposure in Neonatal Patients Using the Least Contaminated Parenteral Nutrition Solution Products

Aluminum (Al) is a contaminant in all parenteral nutrition (PN) solution component products. Manufacturers currently label these products with the maximum Al content at the time of expiry. We recently published data to establish the actual measured concentration of Al in PN solution products prior to being compounded in the clinical setting [1]. The investigation assessed quantitative Al content of all available products used in the formulation of PN solutions. The objective of this study was to assess the Al exposure in neonatal patients using the least contaminated PN solutions and determine if it is possible to meet the FDA “safe limit” of less than 5 μg/kg/day of Al. The measured concentrations from our previous study were analyzed and the least contaminated products were identified. These concentrations were entered into our PN software and the least possible Al exposure was determined. A significant decrease (41%–44%) in the Al exposure in neonatal patients can be achieved using the least contaminated products, but the FDA “safe limit” of less than 5 μg/kg/day of Al was not met. However, minimizing the Al exposure may decrease the likelihood of developing Al toxicity from PN.     

极低出生体重儿早期静脉营养的疗效观察

目的探讨极低出生体重儿早期静脉营养的耐受性和疗效。方法按入院先后将60例极低出生体重儿随机配对分为早期静脉营养组(早期组)和晚期静脉营养组(晚期组)。早期组于出生后24h内即给予静脉营养供给,晚期组于出生后3d开始静脉营养供给,两组均应用6%小儿氨基酸和20%脂肪乳,用量均从1.5g/(kg·d)开始,每日递增0.5g/(kg·d)直至3.0g/(kg·d)。同时,均根据病情尽早经口微量喂养。于入院后72h内和1周后检测肝功能、总胆红素、三酰甘油、总胆固醇和尿素氮,每日监测体质量、微量血糖,比较两组患儿恢复出生体质量的时间、体质量下降幅度、第3天热量、第7天热量、静脉营养时间、住院天数、过渡到全肠道营养的时间以及并发症发生例数。将资料输入SPSS软件进行统计分析。结果早期组患儿恢复至出生体质量时间较晚期组短(P0.01),第3天热量、第7天热量较晚期组高(P0.01),体质量下降幅度,两组差异有统计学意义(P0.05)。结论极低出生体重儿早期积极、规范和足量的肠外静脉营养是安全有效的。     

Use of biocidal products (insect sprays and electro-vaporizer) in indoor areas – Exposure scenarios and exposure modeling

Five commercially available insect sprays were applied in a model room. Spraying was performed in accordance with the manufacturers’ instructions and in an overdosed manner in order to simulate worst-case conditions or an unforeseeable misuse. In addition, we examined electro-vaporizers. The Respicon™ aerosol monitoring system was applied to determine inhalation exposure. During normal spraying (10 seconds) and during the following 2–3 minutes, exposure concentrations ranged from 70 to 590 μg/m³ for the pyrethroids tetramethrin, d-phenothrin, cyfluthrin, bioallethrin, and the pyrethrins. Calculated inhalable doses were 2–16 μg. A concentration of approximately 850 μg chlorpyrifos/m³ (inhalable dose: approximately 20 μg) was determined when the “Contra insect fly spray” was applied. Highest exposure concentrations (1100–2100 μg/m³) were measured for piperonyl butoxide (PBO), corresponding to an inhalation intake of 30–60 μg. When simulating worst-case conditions, exposure concentrations of 200–3400 μg/m³ and inhalable doses of 10–210 μg were determined for the various active substances. Highest concentrations (4800–8000 μg/m³) were measured for PBO (inhalable: 290–480 μg).By applying the electro-vaporizer “Nexa Lotte” plug-in mosquito killer concentrations for d-allethrin were in the range of 5–12 μg/m³ and 0.5–2 μg/m³ for PBO while with the “Paral” plug-in mosquito killer concentrations of 0.4–5 μg/m³ for pyrethrins and 1–7 μg/m³ for PBO were measured.Potential dermal exposures were determined using exposure pads. Between 80 and 1000 μg active substance (tetramethrin, phenothrin, cyfluthrin, bioallethrin, pyrethrins, chlorpyrifos) were deposited on the clothing of the total body surface area of the spray user. Highest levels (up to 3000 μg) were determined for PBO. Worst-case uses of the sprays led to 5–9 times higher concentrations.Also a 2-hour stay nearby an operating electro-vaporizer led to a contamination of the clothing (total amounts on the whole body were 450 μg d-allethrin and 50 μg PBO for “Nexa Lotte” plug-in mosquito killer and 80 μg pyrethrins and 190 μg PBO for “Paral” plug-in mosquito killer).Human biomonitoring data revealed urine concentrations of the metabolite (E)-trans-chrysanthemum dicarboxylic acid ((E)-trans-CDCA) between 1.7 μg/l and 7.1 μg/l after 5 minutes of exposure to the different sprays. Also the use of electro-vaporizers led to (E)-trans-CDCA concentrations in the urine in the range of 1.0 μg/l to 6.2 μg/l (1–3 hours exposure period).The exposure data presented can be used for performing human risk assessment when these biocidal products were applied indoors.The airborne concentrations of the non-volatile active chemical compounds could be predicted from first principles using a deterministic exposure model (SprayExpo).     

The Influence of Sport Nutrition Knowledge on Body Composition and Perceptions of Dietary Requirements in Collegiate Athletes

Sport nutrition knowledge has been shown to influence dietary habits of athletes. The purpose of the current study was to examine relationships between sport nutrition knowledge and body composition and examine potential predictors of body weight goals in collegiate athletes. Participants included National Collegiate Athletic Association Division III women (n = 42, height: 169.9 ± 6.9 cm; body mass: 67.1 ± 8.6 kg; fat-free mass: 51.3 ± 6.6 kg; body fat percent: 24.2 ± 5.3%) and men (n = 25, height: 180.8 ± 7.2 cm; body mass: 89.2 ± 20.5 kg; fat-free mass: 75.9 ± 12.2 kg; body fat percent: 13.5 ± 8.9%) athletes. Body composition was assessed via air displacement plethysmography. Athletes completed a validated questionnaire designed to assess sport nutrition knowledge and were asked questions about their perceived dietary energy and macronutrient requirements, as well as their body weight goal (i.e., lose, maintain, gain weight). Athletes answered 47.98 ± 11.29% of questions correctly on the nutrition questionnaire with no differences observed between sexes (men: 49.52 ± 11.76% vs. women: 47.03 ± 11.04%; p = 0.40). An inverse relationship between sport nutrition knowledge scores and body fat percentage (BF%) (r = −0.330; p = 0.008), and fat mass (r = −0.268; p = 0.032) was observed for all athletes. Fat mass (β = 0.224), BF% (β = 0.217), and body mass index (BMI) (β = 0.421) were all significant (p < 0.05) predictors of body weight goal in women. All athletes significantly (p < 0.001) underestimated daily energy (−1360 ± 610.2 kcal/day), carbohydrate (−301.6 ± 149.2 grams/day [g/day]), and fat (−41.4 ± 34.5 g/day) requirements. Division III collegiate athletes have a low level of sport nutrition knowledge, which was associated with a higher BF%. Women athletes with a higher body weight, BF% and BMI were more likely to select weight loss as a body weight goal. Athletes also significantly underestimated their energy and carbohydrate requirements based upon the demands of their sport, independent of sex.     

Dietary Intervention Effectiveness,Clinical Outcomes and Nutrient and Salicylate Intakes in Older Adults Living in Long-Term Care Homes: The Results from the Senior’s Plate Project

Optimal nutrition is an important part of the therapeutic process offered to patients in long-term care, as it can significantly influence their nutritional and health status. The aim of this study was to assess the impacts of a dietary intervention on the nutritional status, clinical outcomes and selected nutrient and salicylate intakes among older adults living in a long-term care nursing home. To achieve the research goal, a prospective, non-randomized, baseline-controlled intervention study was conducted. The study was conducted within the framework of the “Senior’s Plate Project”, a project established in 2018 by the Polish Society of Dietetics. Methods: A 3 month dietary intervention, which included one serving of supplementary food, served as a second breakfast (Nestle Sinlac). Energy, nutrients and salicylates intakes were estimated on the basis of the menus. Food and beverage intakes among residents were verified by health care personnel. Anthropometric measurements and clinical examinations were conducted according to standard procedures at baseline and after intervention. Results: Of the 38 residents qualified for the study, 29 completed the program. Residents’ body mass index (BMI) values ranged from 13.3 kg/m² to 34 kg/m². A BMI < 22 kg/m², indicating underweight, was found in 19 subjects. The dietary intervention resulted in increased body weight (57.8 ± 12.3 vs. 59.4 ± 12.6 kg), BMI (22.4 ± 4.0 vs. 23.0 ± 4.1 kg/m²) and body fat (19.2 ± 8.7 vs. 20.6 ± 8.9 kg). Significant changes in the levels of biochemical parameters, including serum calcium (8.7 vs. 9.5 mg/dL), potassium (4.1 ± 0.6 vs. 4.5 ± 0.5 mmol/L) and zinc (74.1 ± 10.9 vs. 109.0 ± 20.4 µg/dL), were observed. Energy, protein, fat and carbohydrate intakes were significantly higher in the third month of the intervention as compared to the baseline. The estimated medial daily intake of salicylates was low and ranged from 0.34 mg to 0.39 mg. Conclusions: The dietary intervention resulted in beneficial and significant changes in the nutritional status, biochemical parameters and nutrition of residents of the long-term care home. These results suggest that practical and individualized approaches are required to improve the nutritional status and clinical outcomes of nursing homes residents.     

Length of Nutritional Transition Associates Negatively with Postnatal Growth in Very Low Birthweight Infants

Very low birthweight (VLBW, <1500 g) infants may be predisposed to undernutrition during the nutritional transition phase from parenteral to enteral nutrition. We studied the associations among the length of the transition phase, postnatal macronutrient intake, and growth from birth to term equivalent age in VLBW infants. This retrospective cohort study included 248 VLBW infants born before 32 weeks of gestation and admitted to the Children’s Hospital, Helsinki, Finland during 2005–2013. Daily nutrient intakes were obtained from computerized medication administration records. The length of the transition phase correlated negatively with cumulative energy, protein, fat, and carbohydrate intake at 28 days of age. It also associated negatively with weight and head circumference growth from birth to term equivalent age. For infants with a long transition phase (over 12 d), the estimates (95% CI) for weight and head circumference z-score change from birth to term equivalent age were −0.3 (−0.56, −0.04) and −0.44 (−0.81, −0.07), respectively, in comparison to those with a short transition phase (ad 7 d). For VLBW infants, rapid transition to full enteral feeding might be beneficial. However, if enteral nutrition cannot be advanced, well-planned parenteral nutrition during the transition phase is necessary to promote adequate growth.     

Effects of Perioperative Oral Nutrition Supplementation in Malaysian Patients Undergoing Elective Surgery for Breast and Colorectal Cancers—A Randomised Controlled Trial

This study aimed to investigate the effectiveness of preoperative and an extended 90-days postoperative use of ONS among patients undergoing elective surgery for breast and colorectal cancers. Ninety-one patients were randomised into (i) Group SS received ONS up to 14 days preoperatively and postoperatively up to discharge, (ii) Group SS-E received ONS up to 14 days preoperatively, postoperatively up to discharge and for an extended 90-days after discharge and (iii) Group DS received ONS postoperatively up to discharge. Preoperatively, SS had significantly higher body weight (66.1 ± 15.3 kg vs. 62.5 ± 12.0 kg, p = 0.010) and BMI (26.8 ± 6.8 kg/m² vs. 26.1 ± 6.7 kg/m², p = 0.022) than DS when adjusted for baseline values. Postoperatively, SS-E had significantly higher handgrip strength (26 ± 9 kgF vs. 24 ± 6 kgF, p = 0.044) than DS at 90-days post-discharge after adjusted for preoperative values. At 90-days post-discharge, the proportions of patients in SS with albumin < 35 g/d, CAR ≥ 0.1, mPINI ≥ 0.4, mGPS score 1 or 2 were significantly reduced while in SS-E, the reduction in proportions of patients with high hsCRP and mPINI ≥ 0.4 was significant compared to upon discharge. Preoperative ONS had modest benefits in attenuating weight loss whilst postoperative supplementation up to 90-days post-discharge improved handgrip strength and inflammatory prognostic markers.     

Nutrition du patient cancéreux : la pratique clinique

Malnutrition is common in patients with cancer and must be actively treated at the different steps of management, given its prognostic value. Several mechanisms are involved in the onset of malnutrition: food intake reduction (anorexia), metabolic disorders, therapies side effects. Consequences concern both the energetic balance disorder and the decrease of protein reserves, leading to a proteino-energetic malnutrition. The assessment of malnutrition must be systematically realised as soon as the diagnostic is done, and regularly repeated. The evaluation is performed with the loss of weight measure, the clinical examination and the serum levels of albumin and prealbumin, which are sufficient most of the time. The body mass index, the subjective global assessment scale and the Buzby's nutritional risk index can also be useful. In perioperative time, a patient exhibiting a severe malnutrition (loss of weight > 10 % or albumin < 30 g/l) must receive a perioperative renutrition, preferentially by the enteral route. The development of the enteral immunonutrition and of the glutamine supplementation in parenteral nutrition are clearly more efficient than standard solutions. During chemoradiotherapy, parenteral nutrition must remain uncommon, as its beneficial effect is not demonstrated. Enteral renutrition must be reserved to severely malnourished patients, in whom malnutrition can compromise the treatment course. In patients with cachexia, indications of artificial nutrition are very limited. Nutritional management, especially by oral or enteral route, takes place in a multidisciplinary approach of palliative care. New solutions targeted on the cancerous cachexia are now being developed and assessed.     

重症急性胰腺炎患者的代谢特点与营养支持

重症急性胰腺炎（SAP）是十分危险的急性全身消耗性疾病，死亡率高。机体处于高分解代谢和低合成代谢状态，蛋白质、糖与脂肪代谢呈持续紊乱性消耗，其中蛋白质消耗是静息状态消耗的1．5倍。在营养支持过程中，葡萄糖应不超过4mg／（kg·min），同时合理应用脂肪乳，避免出现脂肪超载综合征；蛋白质输入量应维持在1．2～1．5g／（kg·d），应用谷氨酰胺防止发生肠黏膜萎缩。在胃肠功能逐渐恢复后可通过鼻肠管进行肠内营养，使营养支持从肠外营养与肠内营养相结合的模式，逐渐过渡为肠内营养。     

Higher Doses of Fish Oil–Based Lipid Emulsions Used to Treat Inadequate Weight Gain and Rising Triene:Tetraene Ratio in a Severely Malnourished Infant With Intestinal Failure–Associated Liver Disease

Fish oil–based lipid emulsions (FOLEs) have been used to treat cholestasis in children with intestinal failure–associated liver disease (IFALD). When FOLEs are dosed at 1 g/kg/d, essential fatty acid (EFA) deficiency typically does not occur. We describe the clinical course of a severely malnourished parenteral nutrition–dependent infant with IFALD. Baseline EFA panels were normal upon starting FOLE at 1 g/kg/d. Despite biochemical improvement in IFALD, weight velocity was below target and biochemical EFA status worsened, even after correction for other factors affecting weight. The FOLE dose was increased to 1.5 g/kg/d, resulting in improvement of weight velocity and EFA status. This suggests that in severely malnourished infants being treated for IFALD, higher doses of FOLE may be required for adequate growth and to prevent EFA deficiency.     

Le concept d'intestin dépassé

After extensive small bowel resection, some patients develop a massive diarrhoea (daily faecal weight above 2 kg). Such massive faecal losses demonstrate that the residual absorptive capacities of the short bowel are overwhelmed. There is in each individual with a short bowel syndrome a correlation between daily faecal losses and daily enteral caloric intake. One can separate two different groups of patients: those who have massive faecal losses even when the enteral load is moderate (obligatory overwhelmed intestine syndrome) and those who develop massive faecal losses only when the enteral load is exceeding (induced overwhelmed intestine syndrome). In the latter patients autonomy via the enteral route is usual, whereas the former patients require prolonged or definitive parenteral nutrition.     

Effect of Liraglutide Treatment on Jejunostomy Output in Patients With Short Bowel Syndrome: An Open‐Label Pilot Study

Background: An impaired hormonal “ileo‐colonic brake” may contribute to rapid gastric emptying, gastric hypersecretion, high ostomy losses, and the need for parenteral support in end‐jejunostomy short bowel syndrome (SBS) patients with intestinal failure (IF). Liraglutide, a glucagon‐like peptide 1 receptor agonist, may reduce gastric hypersecretion and dampen gastric emptying, thereby improving conditions for intestinal absorption. Materials and Methods: In an 8‐week, open‐label pilot study, liraglutide was given subcutaneously once daily to 8 end‐jejunostomy patients, aged 63.4 ± 10.9 years (mean ± SD) and with small bowel lengths of 110 ± 66 cm. The 72‐hour metabolic balance studies were performed before and at the end of treatment. Food intake was unrestricted. Oral fluid intake and parenteral support volume were kept constant. The primary end point was change in the ostomy wet weight output. Results: Liraglutide reduced ostomy wet weight output by 474 ± 563 g/d from 3249 ± 1352 to 2775 ± 1187 g/d (P = .049, Student t test). Intestinal wet weight absorption tended to increase by 464 ± 557 g/d (P = .05), as did urine production by 765 ± 759 g/d (P = .02). Intestinal energy absorption improved by 902 ± 882 kJ/d (P = .02). Conclusion: Liraglutide reduced ostomy wet weight output in end‐jejunostomy patients with SBS‐IF and increased their intestinal wet weight and energy absorption. If larger, randomized, placebo‐controlled studies confirm these effects, it adds to the hypothesis that many ileo‐colonic brake hormones in conjunction may be involved in the process of intestinal adaptation. By identification of key hormones and addressing their potential synergistic effects, better treatments may be provided to patients with SBS‐IF. This trial was registered at clinicaltrialsregister.eu as 2013‐005499‐16.     

Oleanolic Acid Improves Gut Atrophy Induced by Parenteral Nutrition

Background: Nutrition support with parenteral nutrition (PN) is associated with gut atrophy. Prior studies have shown improvement with enteral chenodeoxycholic acid, a dual agonist for the farnesoid X receptor (FXR) and bile acid receptor TGR5. We hypothesized that gut growth is induced by TGR5 activation, and gut atrophy during PN administration could be prevented with the TGR5‐specific agonist oleanolic acid (OA). Methods: Neonatal pigs were implanted with duodenal and jugular vein catheters. Animals were provided equi‐nutritious PN or enteral swine milk. A PN subgroup received enteral OA at 50 mg/kg/d. Results: PN caused marked gut atrophy compared with enterally fed (EN) control animals. OA treatment led to preservation of gut mass demonstrated grossly and histologically. The mean ± SD gut weight as a percentage of body weight was 4.30 ± 0.26 for EN, 1.92 ± 0.06 for PN (P < .05, EN vs PN), and 3.39 ± 0.79 for PN+OA (P < .05, PN+OA vs PN). Mean ± SD gut density (g/cm) was 0.31 ± 0.03 for EN, 0.18 ± 0.03 for PN (P < .05 EN vs PN), and 0.27 ± 0.01 for PN+OA (P < .05 PN+OA vs PN). Histologically, a markedly decreased villous to crypt ratio was noted with PN, and OA significantly prevented this decrease. The mean ± SD v/c ratio was 3.51 ± 0.59 for EN, 1.69 ± 0.10 for PN (P < .05, EN vs PN), and 2.90 ± 0.23 for PN+OA (P < .05, PN+OA vs PN). Gut TGR5 messenger RNA expression was significantly elevated with OA treatment compared with both PN and EN. Conclusion: The bile acid–activated G protein–coupled receptor TGR5 agonist OA prevented gut atrophy associated with PN.     

Association of First-Week Nutrient Intake and Extrauterine Growth Restriction in Moderately Preterm Infants: A Regional Population-Based Study

The purpose of this study was to determine the influence of first-week nutrition intake on neonatal growth in moderate preterm (MP) infants. Data on neonatal morbidity and nutrition intake on day of life 7 (DoL7) were prospectively collected from 735 MP infants (32^0/7–34^6/7 weeks gestational age (GA)). Multivariable regression was used to assess the factors associated with extrauterine growth restriction (EUGR) defined as a decrease of more than 1 standard deviation (SD) in the weight z-score during hospitalization. Mean (SD) gestational age and birth weight were 33.2 (0.8) weeks and 2005 (369) g. The mean change in the weight z-score during hospitalization was −0.64 SD. A total of 138 infants (18.8%) had EUGR. Compared to adequate growth infants, EUGR infants received 15% and 35% lower total energy and protein intake respectively (p < 0.001) at DoL7. At DoL7, each increase of 10 kcal/kg/d and 1 g/kg/d of protein was associated with reduced odds of EUGR with an odds ratio of 0.73 (95% CI, 0.66–0.82; p < 0.001) and 0.54 (0.44–0.67; p < 0.001), respectively. Insufficient energy and protein intakes on DoL7 negatively affected neonatal growth of MP infants. Nutritional support should be optimized from birth onwards to improve neonatal weight growth.     

进展期胃癌术后早期肠内-肠外营养联合应用与肠外营养的临床比较

目的探讨进展期胃癌术后早期肠内营养和肠外营养联合应用的可行性、安全性和临床效果。方法62例进展期胃癌患者术后第一天随机分为(1)肠外营养(PN)组;(2)肠内和肠外联合营养(EN-PN)组;(3)对照组。观察在治疗过程中3组患者并发症的发生率、术后肠功能恢复时间、平均住院天数及营养评定的各项指标,进行对比分析。结果对照组并发症发生率明显高于EN-PN组和PN组(P<0.05)。对照组术后胃肠功能恢复时间及平均住院天数较EN-PN组和PN组明显延长(P<0.05),而EN-PN组与其余两组比较显著缩短(P<0.05)。EN-PN组和PN组术后血清白蛋白、前白蛋白和转铁蛋白在营养支持后均明显升高(P<0.05),体重下降缓慢,负氮平衡均得到有效纠正。结论进展期胃癌术后早期肠内营养及肠外营养联合应用安全、可行,在改善机体营养状况方面与全肠外营养相似,并有促进和维护胃肠道功能的作用,同时费用较低。