危重新生儿营养支持基础研究与临床应用

Progression of basic research and clinical practice for nutrition support in the critically ill neonates

危重新生儿常见疾病包括早产儿、低出生体质量儿以及需要早期手术干预的先天畸形等。目前,我国每年有100多万名患儿生后早期即需住院治疗,其中绝大多数无法正常喂养,需要接受营养支持。因此,建立危重新生儿营养支持规范一直是临床亟待解决的问题。课题组自1985年起,围绕新生儿临床营养支持,进行了一系列基础和临床研究,主要包括:①分析我国新生儿血清氨基酸代谢特点,成功研制国内首个小儿专用型静脉氨基酸制剂并广泛应用于临床;②通过静息能量代谢测定发现正常新生儿能量消耗值低于公式预计值,据此在国内外首次提出60～80 kcal/(kg.d)这一新生儿肠外营养能量推荐量(较传统值降低30%),并在临床应用中得到有效验证;③临床推广并培训经外周中心静脉置管,并率先开展经空肠穿刺造口术和经皮内镜胃造口术,完善肠内与肠外营养输注的新途径;④发现氧化应激线粒体凋亡途径是肠外营养相关肝损害的重要作用机制,并从动物实验和临床研究两个层面证实谷氨酰胺对肠外营养相关肝损伤具有一定的防治作用。此外,课题组还成功实施了新生儿短肠综合征的肠康复治疗,目前已成功救治来自全国各地共46例患儿,其中1例患儿剩余小肠仅25 cm。2005年和2010年,课题组依据循证医学原理,分别制定了《中国新生儿营养支持临床应用指南》和《中国儿科肠外肠内营养支持临床应用指南》,为国内儿科患者的合理营养支持提供依据,提高了临床营养的实践水平。课题组相关研究成果获国家科技进步二等奖。

At present, over lmillion critically ill newborn infants （including premature neonates, low birth weight babies and those with congenital malformation） each year need medical therapy shortly after birth, and most of them need nutrition support which is not only an essential part of the whole treatment but also important for their later health. Our research group carried out a series of basic and clinical research focusing on nutrition support in critically ill neonate ever since 1985. We found that the energy expenditure in neonates was lower than formula predicted value, and changed the energy recommendation to the value of 60 - 80 kcal/（ kg- d） for parenteral nutrition. We also successfully developed the first domestic pediatric amino acid preparation based on the analysis of serum amino acid characteristics in Chinese neonates. We help to introduce new techniques for nutrition support in neonates, including jejunal puncture ostomy and percutaneous endoscopic gastrostomy for enteral nutrition, as well as the use of peripherally inserted central venous catheters for parenteral nutrition. Liver injury is a severe complication of parenteral nutrition, and our studies revealed that oxidative stress related mitochondrial apoptotic pathway might be an important mechanism, while glutamine showed protective effect not only in animal study but also in our clinical trial. In addition, we successful implemented intestinal rehabilitation therapy in 46 neonates with short bowel syndrome from all around the country, including one case with residual small intestine of only 25 cm. In the year 2005 and 2010, we formulated evidence-based Chinese guidelines of clinical nutrition support in neonates and pediatric patients, which help to improve the application of adequate nutrition support in the field of neonatology and pediatrics. The research achievement won the second prize of National Science and Technology Progress Award.