代谢性骨病高危新生儿营养补充现况调查

Nutrients Supplementation in Neonates with High Risk of Metabolic Bone Disease

目的:研究代谢性骨病高危新生儿临床骨代谢相关营养素补充及监测现状。方法:回顾性收集2014—2016年上海儿童医学中心重症新生儿监护室(NICU)收治的出生体重小于1 500g或者胎龄小于32w,并且肠外营养支持(parenteral nutrition,PN)使用大于4w的患儿共76例。记录患儿住院期间肠内外营养使用时间,总热卡,钙、磷、维生素D补给量,每周血清碱性磷酸酶、血清钙、磷检测频次等。结果:对于代谢性骨病高危新生儿的肠内外钙元素、磷元素的补给总量仅部分达到美国肠内肠外营养指南建议量,每日补钙量平均为19. 84mg/(kg·d)[7. 36～50. 31mg/(kg·d)],其中PN钙补充占钙补给总量的10%～25%;每日补磷量平均为14. 38mg/(kg·d)[4. 99～37. 22mg/(kg·d)]。生后2w均开始每日摄入维生素D 900IU。住院期间各种骨代谢监测指标的每周检测频率从第1～5w均呈下降趋势:血清碱性磷酸酶分别为94%、73%、57%、52%、26%;血清钙为18. 4%、21. 2%、19. 7%、21. 0%、13. 1%;血清磷为21. 0%、21. 0%、14. 4%、10. 5%、10. 5%。血清25-(OH)维生素D3、骨密度均未测定。结论:目前临床上对代谢性骨病高危新生儿钙和磷的补给量(包括肠内和肠外)未能达到国际指南建议量,临床监测不足。建议对代谢性骨病高危新生儿及时有效的补充骨代谢相关营养素,并定期进行血清碱性磷酸酶、血清磷、血清钙、血清25-(OH)维生素D3和骨密度检测,以预防代谢性骨病,促进其正常生长发育。

Objective To investigate the current situation of nutrients supplementation and monitoring for the neonates with high risk of metabolic bone disease during hospitalization.Method Retrospective screening was conducted in the NICU of Shanghai Children s Medical Center from January 2014 to December 2016.Totally 76 neonates whose birth weight was less than 1 500 g or gestational age was less than 32 weeks,along treated with parenteral nutrition for more than four weeks were enrolled.We recorded the duration of parenteral nutrition,total calorie intake,calcium and phosphorus intake,vitamin D supplement,as well as blood tests frequency including serum alkaline phosphatase,serum calcium and phosphate during hospitalization.Result The amount of clinical calcium and phosphorus supplementations(including enteral and parenteral)failed to meet the international guideline.The supplement of calcium for high risk neonates with metabolic bone disease was low,the average supplement of calcium was 19.84mg/(kg·d)[7.36~50.31mg/(kg·d)],where PN calcium accounted for 10%~25%of the total calcium supplement,the average supplement of phosphorus was 14.38mg/(kg·d)[4.99~37.22mg/(kg·d)].From the first week to the fifth week of hospitalization,the blood test frequency of serum alkaline phosphatase were 94%,73%,57%,52%and 26%,respectively.The serum calcium test frequency were 18.4%,21.2%,19.7%,21.0%and 13.1%,respectively.The serum phosphorus test frequency were 21.0%,21.0%,14.4%,10.5%and 10.5%,respectively.Neither vitamin D nor bone mineral density were measured.The daily vitamin D supplementation was 900IU from 2 weeks after birth.Conclusion Currently clinical monitoring and nutrition supplementations for neonates with high risk of metabolic bone disease failed to meet the international guideline.We recommend that regularly monitoring the blood alkaline phosphatase,serum phosphorus,calcium,25-(OH)vitamin D 3 levels and bone mineral density,as well as adequate nutrients supplementations should be beneficial for the neonates with high risk of metabolic bone disease.