Nitrogen, Fat and Minerals’ Balances in Premature Infants Fed Acidified or Nonacidified Half-skimmed Cow Milk

Senterre, J; Lambrechts, A.

doi:10.1159/000240453

“…O balanço nitrogenado foi positivo nos dois grupos, com retenção de nitrogênio no grupo C de 65,8% e no grupo A de 75,5% (do nitrogênio oferecido, em valores medianos). Isso comprova a avidez dos RN em reter nitrogênio, mesmo recebendo aporte protéico-calórico abaixo do recomendado, como no caso deste estudo, o que está de acordo com os achados da literatura 26 . Em nosso estudo, em uma semana, 97,7% dos pacientes estavam em estado anabólico, mesmo com oferta protéico-calórica ainda abaixo do recomendado; provavelmente por causa disso, não ocorreram modificações significativas na pré-albumina, RBP e peso.…”

Section: Variáveisunclassified

Exogenous human albumin supplementation in total parenteral nutrition of critically ill newborns

Porto¹,

Jorge²,

Assis³

2005

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Objective: In view of the controversies found in the literature, the present study was conducted to determine the effect of the use of exogenous human albumin on the nutritional status of newborn infants submitted to total parenteral nutrition.Methods: Thirty critically ill newborn infants weighing less than 2,500 g were divided into two groups: 15 infants receiving total parenteral nutrition without human albumin (C control group) and 15 with human albumin (group A). Total protein, albumin, prealbumin, and retinol-binding protein were determined at the beginning (3-4 days of postnatal age) and at the end of the study (10-11 days of postnatal age). On the seventh day of the study, nitrogen balance (retention) was measured. The following clinical parameters were evaluated: weight, age at the beginning of enteral nutrition, time to reach a full enteral volume, length of stay in the intensive care unit, total hospitalization time, and mortality. Results:The results showed a significant difference (p < 0.05) in serum albumin and total protein levels (p < 0.05) between groups at the end of the study. Median albumin levels were 2.95 g/dl in group C (2.71-3.16 g/dl), whereas group A showed median albumin levels of 4.10 g/dl, (3.76-4.66 g/dl). Total protein levels were 4.9 g/dl (4.4-5.2 g/dl) and 5.6 g/dl (5.5-6.3 g/dl), respectively, with no repercussions on any of the remaining parameters evaluated.Conclusions: On the basis of the results obtained in the present study, no benefits were derived from the use of human albumin in total parenteral nutrition in severely ill newborns; therefore its use cannot be recommended, unless the objective is exclusively to elevate albumin levels.J Pediatr (Rio J). 2005;81(1):41-6: Albumin, parenteral nutrition, newborn. ResumoObjetivo: Diante das controvérsias encontradas na literatura, procurou-se verificar a influência do uso de albumina humana exógena sobre o estado nutricional e a evolução de parâmetros clínicos de recém-nascidos em nutrição parenteral total.Métodos: Estudo caso-controle incluindo 30 recém-nascidos gravemente doentes com peso inferior a 2.500 g, divididos em dois grupos: 15 recém-nascidos recebendo nutrição parenteral total sem albumina (grupo controle C) e 15 com albumina humana (grupo A). Foram realizadas dosagens de proteínas totais, albumina, pré-albumina e proteína ligadora do retinol no início (3-4 dias) e no fim do estudo (10-11 dias de idade pós-natal). No sétimo dia de estudo, foi realizado balanço da retenção de nitrogênio. Foram avaliados os seguintes parâmetros clínicos: peso, idade de início da alimentação enteral, tempo para atingir volume enteral pleno, tempo de permanência na unidade de terapia intensiva, tempo total de internação e mortalidade.Resultados: Houve diferença significativa (p < 0,05) nos níveis séricos de albumina e das proteínas totais entre os grupos ao final do estudo. Para os níveis de albumina, o grupo C obteve mediana de 2,95 g/dl (2,71-3,16 g/dl), e o grupo A, mediana de 4,10 g/dl (3,76-4,66 g/dl). Para os níveis de prot...

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“…Points at the left side of minimal threshold line were con sidered as hypophosphatemia as sociated with phosphorus deple tion. Points at the right side of maximal threshold line were con sidered as hyperphosphatemia due to low GFR and relative phosphorus overload [from 6,8,9,22,25]. ever, it is not known whether the high plasma phosphate threshold for Tm/GFR in the preterm infant is due to a maturation in transport capacity or differences in the levels of many hormonal and other regulators of Tm/GFR of phosphates.…”

Section: Tubular Reabsorption and Physiological Hyperphosphatemiamentioning

confidence: 99%

“…Renal handling of calcium and phosphate in chronic metabolic acidosis or alkalosis may, however, involve other mechanisms. In pre term infants fed acidified cow's milk, we have observed that chronic metabolic acido sis is associated with an increased urinary excretion of calcium and phosphate [22], Phosphate is the urinary buffer substance that normally accounts for the majority of potential titrable acidity. We have shown that preterm infants with chronic metabolic acidosis are quite able to acidify urine below pH 5 so that titratable acid is directly related to urinary excretion of phosphate ( fig.…”

Section: Influences O F Metabolic Acidosismentioning

confidence: 99%

Renal Aspects of Calcium and Phosphorus Metabolism in Preterm Infants

Senterre

¹

,

Sallé

²

1988

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The aim of this study is to emphasize renal aspects of calcium and phosphorus metabolism from our data of more than 200 metabolic balance studies carried out in preterm infants. Renal production of 125-dihydroxyvitamin D increased rapidly after birth provided the concentration of the substrate, 25-hydroxyvitamin D, is adequate. The gut of preterm infants is able to respond to the active metabolite of vitamin D. Mean plasma phosphate threshold for tubular reabsorption of phosphate is high, about 2.1 mmol/l or 6.5 mg/dl. The low fractional excretion of phosphate cannot be explained by immature parathyroid function nor by renal unresponsiveness to parathormone, at least after the first days of life. It is probably due to regulating factors related to the high rate of growth. Because of reduced glomerular filtration rate, a too high phosphorus intake may result in hyperphosphatemia. Conversely, a too low phosphorus intake will lead to a phosphate depletion syndrome characterized by marked increase in urinary calcium excretion, no urinary phosphate, and hypophosphatemia. Preterm infants with chronic metabolic acidosis are able to acidify urine so that titratable acid is directly related to urinary excretion of phosphate. Clinical implications are that calcium:phosphorus ratio in milk must be adapted according to net bone and soft tissue retention.

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“…This confirms the urge of newborns to retain nitrogen, even receiving a protein-energy intake lower than recommended, as occurred in the present study, which is consistent with the available literature. 26 In our study, in one week, 97.7% of the patients were in an anabolic state, even with a protein-energy intake below that which is recommended and, probably because of that, there were no significant changes in prealbumin, RBP and weight.…”

Section: Weight Outcomementioning

confidence: 41%

Avaliação da suplementação de albumina humana exógena na nutrição parenteral total de recém-nascidos gravemente doentes

Porto¹,

Jorge²,

Assis³

2005

J. Pediatr. (Rio J.)

0

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Objective: In view of the controversies found in the literature, the present study was conducted to determine the effect of the use of exogenous human albumin on the nutritional status of newborn infants submitted to total parenteral nutrition.Methods: Thirty critically ill newborn infants weighing less than 2,500 g were divided into two groups: 15 infants receiving total parenteral nutrition without human albumin (C control group) and 15 with human albumin (group A). Total protein, albumin, prealbumin, and retinol-binding protein were determined at the beginning (3-4 days of postnatal age) and at the end of the study (10-11 days of postnatal age). On the seventh day of the study, nitrogen balance (retention) was measured. The following clinical parameters were evaluated: weight, age at the beginning of enteral nutrition, time to reach a full enteral volume, length of stay in the intensive care unit, total hospitalization time, and mortality. Results:The results showed a significant difference (p < 0.05) in serum albumin and total protein levels (p < 0.05) between groups at the end of the study. Median albumin levels were 2.95 g/dl in group C (2.71-3.16 g/dl), whereas group A showed median albumin levels of 4.10 g/dl, (3.76-4.66 g/dl). Total protein levels were 4.9 g/dl (4.4-5.2 g/dl) and 5.6 g/dl (5.5-6.3 g/dl), respectively, with no repercussions on any of the remaining parameters evaluated. Conclusions:On the basis of the results obtained in the present study, no benefits were derived from the use of human albumin in total parenteral nutrition in severely ill newborns; therefore its use cannot be recommended, unless the objective is exclusively to elevate albumin levels. J Pediatr (Rio J)

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Nitrogen, Fat and Minerals’ Balances in Premature Infants Fed Acidified or Nonacidified Half-skimmed Cow Milk

Cited by 17 publications

References 12 publications

Exogenous human albumin supplementation in total parenteral nutrition of critically ill newborns

Exogenous human albumin supplementation in total parenteral nutrition of critically ill newborns

Renal Aspects of Calcium and Phosphorus Metabolism in Preterm Infants

Avaliação da suplementação de albumina humana exógena na nutrição parenteral total de recém-nascidos gravemente doentes

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