극소 저출생 체중아의 정맥영양에서 칼슘과 인의 농도에 따른 효과 비교

Abstract

Hypothesis

If calcium and phosphorus were administered to very low birth weight infants in amounts more than those currently used in the standard parenteral nutrition solution, the apparent retention of calcium and phosphorus will be increased and the bone mineralization will be improved in these very low birth weight infants.

Patients

Fifteen very low birth weight infants (<1,500gm) who were admitted to NICU at Asan Medical Center from February 1994 to August 1994 were recruited for the study. All of these infants required more than 2 weeks of parenteral nutrition therapy.

Methods

Those infants who received parenteral nutrition were divided into 2 groups : The standard supplement group (n=7, mean gestational age 28.6±2.1 weeks, mean birth weight 1,195±258gm), and high supplement group (n=8, mean gestational age 30.3±1.3 weeks, mean birth weight 1,129±197gm). The amount of elemental calcium supplied in the standard supplement group and high supplement group were 45mg/kg/day and 90mg/kg/day, respectively and the radio of calcium to phosphorus in parenteral nutrition solution was 1.7: 1 in both groups. The level of serum calcium, phosphorus, and alkiline phophatase was measured on 3rd and 14th day of the parenteral nutrition along with the urinary excretion of 24 hour calcium and phosphorus to estimate the retention of calcium and phosphorus in the body.

The x-ray of the wrist was taken on 4th week of parenteral nutrition to see the mineralization of the bone and the changes for rickets. The sacral bone density was measured in both groups prior to discharge by using DPA(double-photon absorptiometry) when infants reached 1,800-2,000gm.

Results

1) There were no differences in the serum concentration of calcium, phosphorus and alkaline phosphatase on 3rd and 14th day of parenteral nutrition between the standard and high supplement group. Both groups had similar values of the urinary excretion of calcium, phosphorus and the tubular reabsorption of phosphorus on 3rd and 14th day of parenteral nutrition.

2) The retentions of calcium and phosphorus which were checked on 3rd and 14th day of parenteral nutrition were significantly higher in the high supplement group than the standard group and this finding was statistically significant at p<0.05.

3) The radiographic findings of the rickets and osteopenia were more frequently observed in the standard supplement group than the high supplement group. Both bone mineral content (BMC) and bone mineral density(BMD) as measured by DPA were significantly higher in the high supplement group than the standard group(p<0.05).

Conclusion

The parenteral nutrition supply of high concentration of calcium and phosphorus in very low birth weight infant increased the retention of these minerals in the body, hence increasing the bone mineral contents. However, this study has its limitation due to small number of patients enrolled, therefore, further study is required to observe the effect of parenteral supply of calcium and phosphorus therapy on mineral retention and bone mineral content in very low birth weight infants.

Hypothesis

If calcium and phosphorus were administered to very low birth weight infants in amounts more than those currently used in the standard parenteral nutrition solution, the apparent retention of calcium and phosphorus will be increased and the bone mineralization will be improved in these very low birth weight infants.

Patients

Fifteen very low birth weight infants (<1,500gm) who were admitted to NICU at Asan Medical Center from February 1994 to August 1994 were recruited for the study. All of these infants required more than 2 weeks of parenteral nutrition therapy.

Methods

Those infants who received parenteral nutrition were divided into 2 groups : The standard supplement group (n=7, mean gestational age 28.6±2.1 weeks, mean birth weight 1,195±258gm), and high supplement group (n=8, mean gestational age 30.3±1.3 weeks, mean birth weight 1,129±197gm). The amount of elemental calcium supplied in the standard supplement group and high supplement group were 45mg/kg/day and 90mg/kg/day, respectively and the radio of calcium to phosphorus in parenteral nutrition solution was 1.7: 1 in both groups. The level of serum calcium, phosphorus, and alkiline phophatase was measured on 3rd and 14th day of the parenteral nutrition along with the urinary excretion of 24 hour calcium and phosphorus to estimate the retention of calcium and phosphorus in the body.

The x-ray of the wrist was taken on 4th week of parenteral nutrition to see the mineralization of the bone and the changes for rickets. The sacral bone density was measured in both groups prior to discharge by using DPA(double-photon absorptiometry) when infants reached 1,800-2,000gm.

Results

1) There were no differences in the serum concentration of calcium, phosphorus and alkaline phosphatase on 3rd and 14th day of parenteral nutrition between the standard and high supplement group. Both groups had similar values of the urinary excretion of calcium, phosphorus and the tubular reabsorption of phosphorus on 3rd and 14th day of parenteral nutrition.

2) The retentions of calcium and phosphorus which were checked on 3rd and 14th day of parenteral nutrition were significantly higher in the high supplement group than the standard group and this finding was statistically significant at p<0.05.

3) The radiographic findings of the rickets and osteopenia were more frequently observed in the standard supplement group than the high supplement group. Both bone mineral content (BMC) and bone mineral density(BMD) as measured by DPA were significantly higher in the high supplement group than the standard group(p<0.05).

Conclusion

The parenteral nutrition supply of high concentration of calcium and phosphorus in very low birth weight infant increased the retention of these minerals in the body, hence increasing the bone mineral contents. However, this study has its limitation due to small number of patients enrolled, therefore, further study is required to observe the effect of parenteral supply of calcium and phosphorus therapy on mineral retention and bone mineral content in very low birth weight infants.