Использование специализированного лечебного продукта у недоношенного ребенка с постнатальной недостаточностью питания: клинический случай

Обоснование. Белково-энергетическая недостаточность — это распространенное многофакторное патологическое состояние у детей раннего возраста. Диетологическая коррекция белково-энергетической недостаточности у незрелых младенцев с применением специализированных продуктов не всегда достаточно эффективна, что связано с остаточными проявлениями сочетанной перинатальной патологии.

Описание клинического случая. Глубоконедоношенному ребенку с выраженной белково-энергетической недостаточностью в позднем периоде сочетанной перинатальной патологии (перинатальное поражение центральной нервной системы и бронхолегочная дисплазия) назначена лечебная высокопитательная (высокобелковая/высокоэнергетическая) молочная смесь по индивидуальной схеме. На фоне диетологической коррекции отмечена положительная динамика клинических проявлений основного и сопутствующих заболеваний.

Заключение. Высококалорийная и обогащенная белком лечебная смесь может эффективно корригировать белково-энергетическую недостаточность у недоношенных младенцев с сочетанной перинатальной патологией в восстановительном периоде (периоде компенсации нарушенных функций).

1. Schwatzenberg SJ, Georgieff MK. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics. 2018;141(2):e20173716. doi: 10.1542/peds.2017-3716

2. WHO. Global Nutrition Targets 2025: Policy Brief Series (WHO/NMH/NHD/14.2). Geneva, Switzerland: World Health Organization; 2014.

3. Zhang Z, Li F, Hannon BA, et al. Effect of Oral Nutritional Supplementation on Growth in Children with Undernutrition: A Systematic Review and Meta-Analysis. Nutrients. 2021;13(9):3036. doi: 10.3390/nu13093036

4. Perkins JM, Kim R, Krishna A, et al. Understanding the association between stunting and child development in low- and middle-income countries: Next steps for research and intervention. Soc Sci Med. 2017;193:101–109. doi: 10.1016/j.socscimed.2017.09.039

5. Ong KK, Kennedy K, Castaneda-Gutierrez E, et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr. 2015;104(10):974–986. doi: 10.1111/apa.13128

6. Figueras-Aloy J, Palet-Trujols C, Matas-Barceló I, et al. Extrauterine growth restriction in very preterm infant: etiology, diagnosis, and 2-year follow-up. Eur J Pediatr. 2020;179(9):1469–1479. doi: 10.1007/s00431-020-03628-1

7. Makker K, Ji Y, Hong X, Wang X. Antenatal and neonatal factors contributing to extra uterine growth failure (EUGR) among preterm infants in Boston Birth Cohort (BBC). J Perinatol. 2021;41(5): 1025–1032. doi: 10.1038/s41372-021-00948-4

8. Martinez-Jimenez MD, Gomez-Garcia FJ, Gil-Campos M, et al. Comorbidities in childhood associated with extrauterine growth restriction in preterm infants: a scoping review. Eur J Pediatr. 2020; 179(8):1255–1265. doi: 10.1007/s00431-020-03613-8

9. Hiltunen H, Loyttyniemi E, Isolauri E, Rautava S. Early nutrition and growth until the corrected age of 2 years in extremely preterm infants. Neonatology. 2018;113(2):100–107. doi: 10.1159/000480633

10. Raaijmakers A, Jacobs L, Rayyan M, et al. Catch-up growth in the first two years of life in Extremely Low Birth Weight (ELBW) infants is associated with lower body fat in young adolescence. PLoS One. 2017;12(3):e0173349. doi: 10.1371/journal.pone.0173349

11. Embleton N, Korada M, Wood CL, et al. Catch-up growth and metabolic outcomes in adolescents born preterm. Arch Dis Child. 2016;101(11):1026–1031. doi: 10.1136/archdischild-2015-310190

12. Teller IC, Embleton ND, Griffin IJ, et al. Post-discharge formula feeding in preterm infants: A systematic review mapping evidence about the role of macronutrient enrichment. Clin Nutr. 2016;35(4):791–801. doi: 10.1016/j.clnu.2015.08.006

13. Peila C, Spada E, Giuliani F, et al. Extrauterine Growth Restriction: Definitions and Predictability of Outcomes in a Cohort of Very Low Birth Weight Infants or Preterm Neonates. Nutrients. 2020 Apr 26; 12(5):1224. doi: 10.3390/nu12051224.

14. Wiechers C; Bernhard W, Goelz R, et al. Optimizing Early Neonatal Nutrition and Dietary Pattern in Premature Infants. Int J Environ Res Public Health. 2021;18(14):7544. doi: 10.3390/ijerph18147544

15. Stocker JT, Dehner LP, Husain AN. Means and standard deviations of weights and measurements of lifeborn infants by body weight (Appendix 28–29). In: Stocker & Dehner’s Pediatric Pathology. Stocker JT, Dehner LP, eds. 2nd ed. Philadelphia, PA, USA: Lippinkott Williams &Wilkins; 2002.

16. Fabrizio V, Trzaski JM, Brownell EA, et al. Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk. Cochrane Database Syst Rev. 2020; 11(11):CD013465. doi: 10.1002/14651858.CD013465.pub2

17. Ruys CA, van de Lagemaat M, Rotteveel J, et al. Improving long-term health outcomes of preterm infants: how to implement the findings of nutritional intervention studies into daily clinical practice. Eur J Pediatr. 2021;180(6):1665–1673. doi: 10.1007/s00431-021-03950-2

18. Ahnfeldt AM, Stanchev H, Jørgensen HL, et al. Age and weight at final discharge from an early discharge programme for stable but tube-fed preterm infants. Acta Paediatr. 2015;104(4):377–383. doi: 10.1111/apa.12917

19. Wilson E, Bonamy A-KE, Bonet M, et al. The EPICE Research Group. Room for improvement in breast milk feeding after very preterm birth in Europe: Results from the EPICE cohort. Matern Child Nutr. 2017;14(1):e12485. doi: 10.1111/mcn.12485

20. Agostoni C, Buonocore G, Carnielli VP, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010;50(1):85–91. doi: 10.1097/MPG.0b013e3181adaee0

21. Young L, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula for preterm infants following hospital discharge. Cochrane Database Syst Rev. 2016;12(12):CD004696. doi: 10.1002/14651858.CD004696

22. Guimarães H, Rocha G, Vasconcellos G, et al. Risk factors for bronchopulmonary dysplasia in five Portuguese neonatal intensive care units. Rev Port Pneumol. 2010;16(3):419–430. doi: 10.1016/s0873-2159(15)30039-8

23. Bancalari E, Jain D. Bronchopulmonary Dysplasia: 50 Years after the Original Description. Neonatology. 2019;115(4):384–391. doi: 10.1159/000497422

24. Milanesi BG, Lima PA, Villela LD, et al. Assessment of early nutritional intake in preterm infants with bronchopulmonary dysplasia: A cohort study. Eur J Pediatr. 2021;180(5):1423–1430. doi: 10.1007/s00431-020-03912-0

25. Uberos J, Lardón-Fernández M, Machado-Casas I, et al. Nutrition in extremely low birth weight infants: Impact on bronchopulmonary dysplasia. Minerva Paediatr. 2016;68(6):419–426.

26. Bott L, Béghin L, Devos P, et al. Nutritional Status at 2 Years in Former Infants with Bronchopulmonary Dysplasia Influences Nutrition and Pulmonary Outcomes During Childhood. Pediatr Res. 2006;60(3):340–344. doi: 10.1203/01.pdr.0000232793.90186.ca

27. Gianni ML, Roggero P, Colnaghi MR, et al. The role of nutrition in promoting growth in pre-term infants with bronchopulmonary dysplasia: A prospective non-randomised interventional cohort study. BMC Pediatr. 2014;14:235. doi: 10.1186/1471-2431-14-235

28. Barrington KJ, Fortin-Pellerin E, Pennaforte T. Fluid restriction for treatment of preterm infants with chronic lung disease. Cochrane Database Syst Rev. 2017;2(2):CD005389. doi: 10.1002/14651858.CD005389.pub2

29. Mangili G, Garzoli E, Sadou Y. Feeding dysfunctions and failure to thrive in neonates with congenital heart diseases. Pediatr Med Chir. 2018;40(1). doi: 10.4081/pmc.2018.196

30. Jadcherla S. Dysphagia in the high-risk infant: potential factors and mechanisms. Am J Clin Nutr. 2016;103(2):622S–628S. doi: 10.3945/ajcn.115.110106

31. Baillat M, Pauly V, Dagau G, et al. Association of First-Week Nutrient Intake and Extrauterine Growth Restriction in Moderately Preterm Infants: A Regional Population-Based Study. Nutrients. 2021;13(1):227. doi: 10.3390/nu13010227

32. Roggero P, Liotto N, Menis C, Mosca F. New Insights in Preterm Nutrition. Nutrients. 2020;12(6):1857. doi: 10.3390/nu12061857

33. EFSA Panel on Dietetic Products, N.a.A.N. Scientific Opinion on the essential composition of infant and follow-on formulae. EFSA J. 2014;12(7):3760. doi: 10.2903/j.efsa.2014.3760

34. Roggero P, Gianni ML, Amato O, et al. Growth and fat-free mass gain in preterm infants after discharge: a randomized controlled trial. Pediatrics. 2012;130(5):e1215–e1221. doi: 10.1542/peds.2012-1193

35. Roggero P, Gianni ML, Liotto N, et al. Small for gestational age preterm infants: nutritional strategies and quality of growth after discharge. J Matern Fetal Neonatal Med. 2011;24(Suppl. 1):144e6. doi: 10.3109/14767058.2011.607657

36. Lin L, Amissah E, Gamble GD, et al. Impact of macronutrient supplements on later growth of children born preterm or small for gestational age: A systematic review and meta-analysis of randomized and quasirandomised controlled trials. PLoS Med. 2020;17(5):e1003122. doi: 10.1371/journal.pmed.1003122

37. Moon K, Rao SC, Schulzke SM, et al. Long-chain polyunsaturated fatty acid supplementation in preterm infants. Cochrane Database Syst Rev. 2016;12:CD000375. doi: 10.1002/14651858.CD000375.pub5

38. Ilardi L, Proto A, Ceroni F, et al. Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus. Life (Basel). 2021;11(4):331. doi: 10.3390/life11040331

39. Fernández R, Urbano J, Carrillo A, et al. Comparison of the effect of three different protein content enteral diets on serum levels of proteins, nitrogen balance, and energy expenditure in critically ill infants: study protocol for a randomized controlled trial. Trials. 2019;20(1):585. doi: 10.1186/s13063-019-3686-8

40. Cui Y, Li L, Hu C, et al. Effects and Tolerance of Protein and Energy-Enriched Formula in Infants Following Congenital Heart Surgery: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr. 2018;42(1):196–204. doi: 10.1002/jpen.1031

41. Yu M-X, Zhuang S-Q, Gao X-Y, et al. Effects of a nutrient-dense formula compared with a post-discharge formula on post-discharge growth of preterm very low birth weight infants with extrauterine growth retardation: a multicentre randomised study in China. J Hum Nutr Diet. 2020;33(4):557–565. doi: 10.1111/jhn.12733

42. Намазова-Баранова Л.С., Турти Т.В., Лукоянова О.Л. и др. Лечебное питание с применением специализированного детского молочного продукта для энтерального питания с повышенным содержанием белка и энергии у детей первого года жизни с белково-энергетической недостаточностью // Педиатрическая фармакология. — 2016. — Т. 13. — № 1. — С. 27–32. doi: 10.15690/pf.v13i1.1511