【阅读理解】早期肠外脂肪和大剂量氨基酸可增强极低出生体重儿白蛋白合成

Clin Nutr. 2016 Apr;35(2):344-50.

Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration.

Vlaardingerbroek H, Schierbeek H, Rook D, Vermeulen MJ, Dorst K, Vermes A, van Goudoever JB, van den Akker CH.

  • Sophia Children's Hospital, Rotterdam, The Netherlands.

  • Emma Children's Hospital, Amsterdam, The Netherlands.

  • Erasmus Medical Center, Rotterdam, The Netherlands.

  • VU University Medical Center, Amsterdam, The Netherlands.

BACKGROUND & AIMS: Albumin is one of the most important plasma proteins and plays a key role in many physiologic processes, such as preserving colloid osmotic pressure, scavenging radicals, and binding and transporting bilirubin, hormones, and drugs. However, albumin concentrations are often low in preterm infants during the first days of life. We hypothesized that early parenteral lipid and high-dose amino acid (AA) administration to very low birth weight (VLBW) infants from birth onwards increases hepatic albumin synthesis rates.

METHODS: Inborn VLBW infants were randomized to receive from birth onwards either 2.4 g amino acids/kg/d (control group), 2.4 g amino acids/kg/d plus 2 g lipids/kg/d (AA + lipid group), or 3.6 g amino acids/kg/d plus 2 g lipids/kg/d (high AA + lipid group). On postnatal day 2, infants received a primed continuous infusion of [U-(13)C6,(15)N]leucine. Mass spectrometry was used to determine the fractional and absolute albumin synthesis rates (FSR and ASR, respectively).

RESULTS: In total, 28 infants (median gestational age 27 weeks (IQR 25-28), median birth weight 810 g (IQR 679-998) were studied. The median FSR was 6.5%/d in the control group, 10.6%/d in the AA group, and 12.3%/d in the high AA + lipid group, while the median was 84 mg/kg/d in the control group, 138 mg/kg/d in the AA group, and 160 mg/kg/d in the high AA + lipid group.

CONCLUSION: A group of VLBW infants given parenteral nutrition containing lipids and high-dose amino acids showed a higher rate of albumin synthesis compared to infants receiving no lipids and standard amounts of amino acids during the first two days of life.

PMID: 26028361

DOI: 10.1016/j.clnu.2015.04.019

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