早期産・低出生体重児の栄養管理
低出生体重児は、体内栄養蓄積量が少なく容易に栄養学的クライシスに陥る可能性があるのみならず、栄養不良がその後の成長発育や神経学的予後にも影響するため早期からの栄養介入が不可欠である。このような観点から、早期から積極的な栄養投与（early aggressive nutrition）が行われるようになっているが、臓器の未熟性から高血糖や高窒素血症あるいはリフィーディング症候群（refeeding syndrome；以下、RSと略）などの代謝障害を起こす可能性があり厳重なモニタリングが必要となる。また、胎児期～幼小児期の発達環境で胎児に細胞レベルのエピジェネティクス変化が生じ、成人期の肥満、虚血性...
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| Published in | 日本静脈経腸栄養学会雑誌 Vol. 34; no. 1; pp. 7 - 10 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本静脈経腸栄養学会
2019
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 2189-0161 2189-017X |
| DOI | 10.11244/jspen.34.7 |
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| Abstract | 低出生体重児は、体内栄養蓄積量が少なく容易に栄養学的クライシスに陥る可能性があるのみならず、栄養不良がその後の成長発育や神経学的予後にも影響するため早期からの栄養介入が不可欠である。このような観点から、早期から積極的な栄養投与（early aggressive nutrition）が行われるようになっているが、臓器の未熟性から高血糖や高窒素血症あるいはリフィーディング症候群（refeeding syndrome；以下、RSと略）などの代謝障害を起こす可能性があり厳重なモニタリングが必要となる。また、胎児期～幼小児期の発達環境で胎児に細胞レベルのエピジェネティクス変化が生じ、成人期の肥満、虚血性心疾患、高血圧、糖尿病、骨粗鬆症などの慢性疾患リスクにも影響を与えること（developmental origins of health and disease）が知られており、長期にわたりさまざまな注意を要する。 |
|---|---|
| AbstractList | 低出生体重児は、体内栄養蓄積量が少なく容易に栄養学的クライシスに陥る可能性があるのみならず、栄養不良がその後の成長発育や神経学的予後にも影響するため早期からの栄養介入が不可欠である。このような観点から、早期から積極的な栄養投与（early aggressive nutrition）が行われるようになっているが、臓器の未熟性から高血糖や高窒素血症あるいはリフィーディング症候群（refeeding syndrome；以下、RSと略）などの代謝障害を起こす可能性があり厳重なモニタリングが必要となる。また、胎児期～幼小児期の発達環境で胎児に細胞レベルのエピジェネティクス変化が生じ、成人期の肥満、虚血性心疾患、高血圧、糖尿病、骨粗鬆症などの慢性疾患リスクにも影響を与えること（developmental origins of health and disease）が知られており、長期にわたりさまざまな注意を要する。 |
| Author | 千葉, 正博 |
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| References | 20) Riskin A, Hartman C, Shamir R. Parenteral Nutrition in Very Low Birth Weight Preterm Infants. Isr Med Assoc J 17: 310-315, 2015. 15) Chien HC, Chen CH, Wang TM, et al. Neurodevelopmental outcomes of infants with very low birth weights are associated with the severity of their extra-uterine growth retardation. Pediatr Neonatol 59: 168-175, 2018. 8) Chawla D, Agarwal R, Deorari AK, et al. Fluid and electrolyte management in term and preterm neonates. Indian J Pediatr 75: 255-259, 2008. 24) Kinsell JE, Jokesh B, Broughton S, et al. Dietary polyunsaturated fatty acids and eicosanoids: potential effects on the modulation of inflammatory and immune cells: an overview. Nutrition 6: 24-44, 1990. 6) Genoni G, Binotti M, Monzani A, et al. Nonrandomised interventional study showed that early aggressive nutrition was effective in reducing postnatal growth restriction in preterm infants. Acta Paediatr 106: 1589-1595, 2017. 30) Pająk A, Królak-Olejnik B, Szafrańska A. Early hypophosphatemia in very low birth weight preterm infants. Adv Clin Exp Med 27: 841-847, 2018. 33) Casey PH, Bradley RH, Whiteside-Mansell L, et al. Evolution of obesity in a low birth weight cohort. J Perinatol 32: 91-96, 2012. 18) Fajans SS, Floyd JC Jr, Knopf RF, et al. Effect of amino acids and proteins on insulin secretion in man. Rec Prog Horm Res 23: 617-662, 1967. 32) Euser AM, Finken MJ, Keijzer-Veen MG, et al. Associations between prenatal and infancy weight gain and BMI, fat mass, and fat distribution in young adulthood: a prospective cohort study in males and females born very preterm. Am J Clin Nutr 81: 480-487, 2005. 19) Kadrofske MM, Parimi PS, Gruca LL, et al. Effect of intravenous amino acids on glutamine and protein kinetics in low-birth-weight preterm infants during the immediate neonatal period. Am J Physiol Endocrinol Metab 290: 622-630, 2006. 7) Hartnoll G, Bétrémieux P, Modi N. Body water content of extremely preterm infants at birth. Arch Dis Child Fetal Neonatal Ed 83: 56-59, 2000. 12) Mansour F, Petersen D, De Coppi P, et al. Effect of sodium deficiency on growth of surgical infants: a retrospective observational study. Pediatr Surg Int 30: 1279-1284, 2014. 3) Makrides M, Anderson A, Gibson RA, et al. Improving the neurodevelopmental outcomes of low-birthweight infants. Nestle Nutr Inst Workshop Ser 74: 211-221, 2013. 31) Brener Dik PH, Galletti MF, Fernández Jonusas SA, et al. Early hypophosphatemia in preterm infants receiving aggressive parenteral nutrition. J Perinatol 35: 712-715, 2015. 23) Koletzko B, Goulet O, Hunt J, et al. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 41: S1–S87, 2005. 1) Barker DJ, Osmond C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet 10: 1077-1081, 1986. 4) Wilson DC, Cairns P, Halliday HL, et al. Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 77: 4-11, 1997. 21) Spear ML, Amr S, Hamosh M, et al. Lecithin: cholesterol acyltransferase (LCAT) activity during lipid infusion in premature infants. J Pediatr Gastroenterol Nutr 13: 72-76, 1991. 5) Thureen PJ, Hay WW Jr. Early aggressive nutrition in preterm infants. Semin Neonatol 6: 403-415, 2001. 14) Stephens BE, Walden RV, Gargus RA, et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics 123: 1337-1343, 2009. 17) Ogilvy-Stuart AL, Beardsall K. Management of hyperglycaemia in the preterm infant. Arch Dis Child Fetal Neonatal Ed 95: 126-131, 2010. 34) Singhal A, Fewtrell M, Cole TJ, et al. Low nutrient intake and early growth for later insulin resistance in adolescents born preterm. Lancet 361: 1089-1097, 2003. 22) Goel R, Hamosh M, Stahl GE, et al. Plasma lecithin: cholesterol acyltransferase and plasma lipolytic activity in preterm infants given total parenteral nutrition with 10% or 20% Intralipid. Acta Paediatr 84: 1060-1064, 1995. 13) Embleton ND. Optimal protein and energy intakes in preterm infants. Early Hum Dev 83: 831-837, 2007. 35) Pfister KM, Zhang L, Miller NC, et al. Early body composition changes are associated with neurodevelopmental and metabolic outcomes at 4 years of age in very preterm infants. Pediatr Res. 21: [Epub ahead of print], 2018. 10) Hopfer U. Digestion and absorption of basic nutritional constituents. Edited by Devline TM, Textbook of Biochemistry with Clinical Correlations. 6th Edition. Wiley-Liss, NJ, 2006, 1046-1051. 29) Bonsante F, Iacobelli S, Latorre G, et al. Initial amino acid intake influences phosphorus and calcium homeostasis in preterm infants-it is time to change the composition of the early parenteral nutrition. PLoS One. 8:e72880, 2013. 26) Gura KM, Lee S, Valim C, et al. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics 121: 678-686, 2008. 9) Al-Dahhan J, Haycock GB, Nichol B, et al. Sodium homeostasis in term and preterm neonates. Arch Dis Child 59: 945-950, 1984. 16) Xu YM, Zhu XP, Xiao Z, et al. Influence of aggressive nutritional support on growth and development of very low birth weight infants. Clin Exp Obstet Gynecol 41: 717-722, 2014. 27) Yamamoto N, Saitoh M, Moriuchi A, et al. Effect of dietary αlinolenate / linoleate balance on brain lipid compositions and learning ability of rats. J Lipid Res 28: 144-151, 1987. 2) Gluckman PD, Hanson MA, Beedle AS. Early life events and their consequences for later disease: a life history and evolutionary perspective. Am J Hum Biol 19: 1-19, 2007. 36) Stawerska R, Szałapska M, Hilczer M, et al. Ghrelin, insulin-like growth factor I and adipocytokines concentrations in born small for gestational age prepubertal children after the catch-up growth. J Pediatr Endocrinol Metab 29: 939-945, 2016. 11) Gallini F, Maggio L, Romagnoli C, et al. Progression of renal function in preterm neonates with gestational age < or = 32 weeks. Pediatr Nephrol 15: 119-124, 2000. 28) Beken S, Dilli D, Fettah ND, et al. The influence of fish-oil lipid emulsions on retinopathy of prematurity in very low birth weight infants: a randomized controlled trial. Early Hum Dev 90: 27-31, 2014. 25) Gura KM, Duggan CP, Collier SB, et al. Reversal of parenteral nutrition-associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management. Pediatrics 118: 197-201, 2006. |
| References_xml | – reference: 31) Brener Dik PH, Galletti MF, Fernández Jonusas SA, et al. Early hypophosphatemia in preterm infants receiving aggressive parenteral nutrition. J Perinatol 35: 712-715, 2015. – reference: 20) Riskin A, Hartman C, Shamir R. Parenteral Nutrition in Very Low Birth Weight Preterm Infants. Isr Med Assoc J 17: 310-315, 2015. – reference: 32) Euser AM, Finken MJ, Keijzer-Veen MG, et al. Associations between prenatal and infancy weight gain and BMI, fat mass, and fat distribution in young adulthood: a prospective cohort study in males and females born very preterm. Am J Clin Nutr 81: 480-487, 2005. – reference: 9) Al-Dahhan J, Haycock GB, Nichol B, et al. Sodium homeostasis in term and preterm neonates. Arch Dis Child 59: 945-950, 1984. – reference: 2) Gluckman PD, Hanson MA, Beedle AS. Early life events and their consequences for later disease: a life history and evolutionary perspective. Am J Hum Biol 19: 1-19, 2007. – reference: 12) Mansour F, Petersen D, De Coppi P, et al. Effect of sodium deficiency on growth of surgical infants: a retrospective observational study. Pediatr Surg Int 30: 1279-1284, 2014. – reference: 6) Genoni G, Binotti M, Monzani A, et al. Nonrandomised interventional study showed that early aggressive nutrition was effective in reducing postnatal growth restriction in preterm infants. Acta Paediatr 106: 1589-1595, 2017. – reference: 33) Casey PH, Bradley RH, Whiteside-Mansell L, et al. Evolution of obesity in a low birth weight cohort. J Perinatol 32: 91-96, 2012. – reference: 11) Gallini F, Maggio L, Romagnoli C, et al. Progression of renal function in preterm neonates with gestational age < or = 32 weeks. Pediatr Nephrol 15: 119-124, 2000. – reference: 13) Embleton ND. Optimal protein and energy intakes in preterm infants. Early Hum Dev 83: 831-837, 2007. – reference: 25) Gura KM, Duggan CP, Collier SB, et al. Reversal of parenteral nutrition-associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management. Pediatrics 118: 197-201, 2006. – reference: 15) Chien HC, Chen CH, Wang TM, et al. Neurodevelopmental outcomes of infants with very low birth weights are associated with the severity of their extra-uterine growth retardation. Pediatr Neonatol 59: 168-175, 2018. – reference: 23) Koletzko B, Goulet O, Hunt J, et al. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 41: S1–S87, 2005. – reference: 7) Hartnoll G, Bétrémieux P, Modi N. Body water content of extremely preterm infants at birth. Arch Dis Child Fetal Neonatal Ed 83: 56-59, 2000. – reference: 22) Goel R, Hamosh M, Stahl GE, et al. Plasma lecithin: cholesterol acyltransferase and plasma lipolytic activity in preterm infants given total parenteral nutrition with 10% or 20% Intralipid. Acta Paediatr 84: 1060-1064, 1995. – reference: 34) Singhal A, Fewtrell M, Cole TJ, et al. Low nutrient intake and early growth for later insulin resistance in adolescents born preterm. Lancet 361: 1089-1097, 2003. – reference: 4) Wilson DC, Cairns P, Halliday HL, et al. Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 77: 4-11, 1997. – reference: 16) Xu YM, Zhu XP, Xiao Z, et al. Influence of aggressive nutritional support on growth and development of very low birth weight infants. Clin Exp Obstet Gynecol 41: 717-722, 2014. – reference: 19) Kadrofske MM, Parimi PS, Gruca LL, et al. Effect of intravenous amino acids on glutamine and protein kinetics in low-birth-weight preterm infants during the immediate neonatal period. Am J Physiol Endocrinol Metab 290: 622-630, 2006. – reference: 5) Thureen PJ, Hay WW Jr. Early aggressive nutrition in preterm infants. Semin Neonatol 6: 403-415, 2001. – reference: 8) Chawla D, Agarwal R, Deorari AK, et al. Fluid and electrolyte management in term and preterm neonates. Indian J Pediatr 75: 255-259, 2008. – reference: 30) Pająk A, Królak-Olejnik B, Szafrańska A. Early hypophosphatemia in very low birth weight preterm infants. Adv Clin Exp Med 27: 841-847, 2018. – reference: 35) Pfister KM, Zhang L, Miller NC, et al. Early body composition changes are associated with neurodevelopmental and metabolic outcomes at 4 years of age in very preterm infants. Pediatr Res. 21: [Epub ahead of print], 2018. – reference: 1) Barker DJ, Osmond C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet 10: 1077-1081, 1986. – reference: 28) Beken S, Dilli D, Fettah ND, et al. The influence of fish-oil lipid emulsions on retinopathy of prematurity in very low birth weight infants: a randomized controlled trial. Early Hum Dev 90: 27-31, 2014. – reference: 36) Stawerska R, Szałapska M, Hilczer M, et al. Ghrelin, insulin-like growth factor I and adipocytokines concentrations in born small for gestational age prepubertal children after the catch-up growth. J Pediatr Endocrinol Metab 29: 939-945, 2016. – reference: 18) Fajans SS, Floyd JC Jr, Knopf RF, et al. Effect of amino acids and proteins on insulin secretion in man. Rec Prog Horm Res 23: 617-662, 1967. – reference: 17) Ogilvy-Stuart AL, Beardsall K. Management of hyperglycaemia in the preterm infant. Arch Dis Child Fetal Neonatal Ed 95: 126-131, 2010. – reference: 3) Makrides M, Anderson A, Gibson RA, et al. Improving the neurodevelopmental outcomes of low-birthweight infants. Nestle Nutr Inst Workshop Ser 74: 211-221, 2013. – reference: 26) Gura KM, Lee S, Valim C, et al. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics 121: 678-686, 2008. – reference: 24) Kinsell JE, Jokesh B, Broughton S, et al. Dietary polyunsaturated fatty acids and eicosanoids: potential effects on the modulation of inflammatory and immune cells: an overview. Nutrition 6: 24-44, 1990. – reference: 10) Hopfer U. Digestion and absorption of basic nutritional constituents. Edited by Devline TM, Textbook of Biochemistry with Clinical Correlations. 6th Edition. Wiley-Liss, NJ, 2006, 1046-1051. – reference: 21) Spear ML, Amr S, Hamosh M, et al. Lecithin: cholesterol acyltransferase (LCAT) activity during lipid infusion in premature infants. J Pediatr Gastroenterol Nutr 13: 72-76, 1991. – reference: 29) Bonsante F, Iacobelli S, Latorre G, et al. Initial amino acid intake influences phosphorus and calcium homeostasis in preterm infants-it is time to change the composition of the early parenteral nutrition. PLoS One. 8:e72880, 2013. – reference: 14) Stephens BE, Walden RV, Gargus RA, et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics 123: 1337-1343, 2009. – reference: 27) Yamamoto N, Saitoh M, Moriuchi A, et al. Effect of dietary αlinolenate / linoleate balance on brain lipid compositions and learning ability of rats. J Lipid Res 28: 144-151, 1987. |
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| Snippet | 低出生体重児は、体内栄養蓄積量が少なく容易に栄養学的クライシスに陥る可能性があるのみならず、栄養不良がその後の成長発育や神経学的予後にも影響するため早期からの栄養介入が不可欠である。このような観点から、早期から積極的な栄養投与（early aggressive... |
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| SubjectTerms | リフィーディング症候群 低出生体重児 生活習慣病胎児期発症起源説 |
| Title | 早期産・低出生体重児の栄養管理 |
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