Journal of pediatric surgery · 1999
Anabolic recovery relative to degree of prematurity after acute injury in neonates.
СтатьяПоддержка исследования: вне правительства СШАПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
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Tueting J L, Byerley L O, Chwals W J
Аннотация
PURPOSE: In contrast to full-term infants, premature neonates generate accelerated growth rates after birth in an attempt to "catch up" to normal weight-for-age levels. Because this catch-up ability is related to gestational age, the authors postulated that there would be significant differences in anabolic recovery based on the degree of prematurity. To evaluate this hypothesis in surgical and septic neonates, we used serial postoperative prealbumin (PA) serum concentrations as an index of the return to anabolic metabolism after surgical stress.
METHODS: Serum PA concentrations were measured on the day of surgery (DOS) and daily for a 10-postoperative day (POD) period in 73 acutely ill neonates after surgery. These infants were divided into two groups: mature infants with gestational ages > or =35 weeks (average, 38.2+/-1.84; n = 55), and premature infants with gestational ages < or =34 weeks (average, 29.7+/-2.93; n = 18). Infants were subgrouped based on insult type into either surgery (n = 56), or sepsis (n = 17). Statistical significance between groups at the given postoperative times was established using independent unpaired t tests assuming unequal variances.
RESULTS: There was no significant difference in the daily nitrogen and caloric intake between the groups. Although recovery of hepatic prealbumin synthesis after the resolution of injury insult increased progressively in both gestational age groups, premature infants increased prealbumin production significantly earlier and to a greater degree than their nearer-term counterparts.
CONCLUSIONS: These results suggest an earlier return of anabolic protein metabolism after acute injury in premature neonates versus infants that are born nearer term in both the surgery and the sepsis subgroups. These findings may be useful in modifying strategies for protein and nutritional repletion in acutely stressed preterm infants.
METHODS: Serum PA concentrations were measured on the day of surgery (DOS) and daily for a 10-postoperative day (POD) period in 73 acutely ill neonates after surgery. These infants were divided into two groups: mature infants with gestational ages > or =35 weeks (average, 38.2+/-1.84; n = 55), and premature infants with gestational ages < or =34 weeks (average, 29.7+/-2.93; n = 18). Infants were subgrouped based on insult type into either surgery (n = 56), or sepsis (n = 17). Statistical significance between groups at the given postoperative times was established using independent unpaired t tests assuming unequal variances.
RESULTS: There was no significant difference in the daily nitrogen and caloric intake between the groups. Although recovery of hepatic prealbumin synthesis after the resolution of injury insult increased progressively in both gestational age groups, premature infants increased prealbumin production significantly earlier and to a greater degree than their nearer-term counterparts.
CONCLUSIONS: These results suggest an earlier return of anabolic protein metabolism after acute injury in premature neonates versus infants that are born nearer term in both the surgery and the sepsis subgroups. These findings may be useful in modifying strategies for protein and nutritional repletion in acutely stressed preterm infants.