Response to “Review of Trace Mineral Requirements for Preterm Infants: What Are the Current Recommendations for Clinical Practice?”

Finch, Carolyn

doi:10.1177/0884533615598966

Cited by 31 publications

(49 citation statements)

References 4 publications

(1 reference statement)

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“…However, we found no association between IPC and hepatotoxicity as indexed by direct hyperbilirubinemia and elevated hepatic transaminases. Our finding that IPC in premature infants with PNAC may not be associated with worsening of hepatic dysfunction is in agreement with recent studies, albeit in older infants …”

Section: Discussionsupporting

confidence: 93%

“…Copper is an essential trace element and acts as a cofactor in several key physiological metabolic pathways . Although the evidence for optimal parenteral copper supplementation in premature infants is lacking, the American Society of Clinical Nutrition (ASCN) recommends a standard daily dosage of 20 μg/kg/d, whereas the American Society for Parenteral and Enteral Nutrition (ASPEN) recommends 29 μg/kg/d of parenteral copper supplementation with parenteral nutrition (PN) for premature infants without cholestasis, irrespective of gestational age (GA) …”

mentioning

confidence: 99%

“…In addition, premature infants have low ceruloplasmin concentration at birth, which is further aggravated by a maturational lag in the hepatic synthesis of ceruloplasmin that limits their ability to mobilize hepatic stores of copper and increase circulating concentration of copper . Therefore, very premature infants have markedly reduced serum copper concentrations (range 30–40 μg/dL) during the first few postnatal weeks, which gradually increase with the postmenstrual age (PMA) and reach the adult reference range of 65–120 μg/dL (multiply by 6.47 to convert to μmol/L) during early infancy . Therefore, premature infants may be at increased risk for copper deficiency with prolonged copper‐free PN.…”

mentioning

confidence: 99%

“…The evidence‐based approach for parenteral copper supplementation with monitoring of serum copper concentration and hepatic function to prevent copper deficiency and toxicity in premature infants with PNAC is lacking. Both ASCN and ASPEN guidelines caution for the risk of copper toxicity in the presence of cholestasis and recommend reducing or stopping the daily dose of copper in the presence of cholestasis . To balance the potential risk for copper deficiency associated with copper‐free PN against the potential risk for hepatotoxicity that may be associated with daily parenteral copper supplementation in premature infants with PNAC, our neonatal nutrition team implemented a practice of intermittent parenteral copper supplementation (IPC) for PN‐dependent premature infants with PNAC with monitoring of copper status once every 2–4 weeks.…”

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confidence: 99%

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Copper Supplementation in Premature Infants With Parenteral Nutrition–Associated Cholestasis

2018

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The aim of this study was to evaluate the effect of intermittent parenteral copper supplementation (IPC) on serum copper status and biochemical and hematological measures of copper toxicity and deficiency in premature infants with parenteral nutrition (PN)-associated cholestasis (PNAC). We performed a prospective nested observational study in premature infants with PNAC who received IPC after the development of PNAC. Infants with chromosomal disorders, TORCH (toxoplasmosis, parvovirus, syphilis, rubella, cytomegalovirus, herpes, human immunodeficiency virus) infection, metabolic disorder, and/or surgical abnormality of the hepatobiliary system were excluded. Serum copper concentrations were measured once every 2-4 weeks while receiving PN; 24 premature infants were studied. The mean gestational age (GA) of infants was 28.6 ± 4.7 weeks. On regression analysis, there was no significant association between IPC and serum copper concentration (coefficient 2.72, 95% CI: -27 to 32; P = .84) after controlling for GA, gender, and baseline copper intake before PNAC. There was no significant association of IPC with alanine and aspartate transaminases levels (hepatotoxicity) and platelet count, hematocrit, white blood cell count, and neutrophil count (measures of copper deficiency) after controlling for confounders. GA and postmenstrual age were independently and positively associated with serum copper concentration after controlling for confounders on regression analyses. Thus, IPC in premature infants with PNAC does not influence copper status and is not associated with biochemical and hematological measures of copper deficiency and/or toxicity. Serum copper concentration in premature infants with PNAC receiving IPC is determined by the degree of prematurity and postmenstrual age.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Copper Supplementation in Premature Infants With Parenteral Nutrition–Associated Cholestasis

2018

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“…Las necesidades de zinc en el RN prematuro son elevadas debido a la escasez de depósitos y demandas para el crecimiento (450-500 mcg/kg/día) (23,24), por lo que en caso de no ser cubiertas con las soluciones de oligoelementos pediátricas, se recomienda suplemento específico de zinc. Esto es especialmente importante cuando existen pérdidas gastrointestinales aumentadas (diarrea u ostomías) (23) (ver capítulo de "Requerimientos en nutrición parenteral pediátrica", tabla X).…”

Section: Requerimientos De Minerales Y Oligoelementosunclassified

Nutrición parenteral en situaciones clínicas especiales

Martínez¹,

Giner

2017

Nutr Hosp

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RECIÉN NACIDO PREMATUROLa nutrición parenteral (NP) constituye un pilar fundamental en la nutrición del recién nacido (RN) prematuro, especialmente en el RN muy prematuro (< 32 semanas de gestación) y RN prematuro extremo (< 28 semanas de gestación) (1). En estos pacientes, la administración de una NP balanceada y precoz se considera de elección (2). Dos metaanálisis han demostrado que la NP precoz en el RN prematuro < 1.500 g es segura, sin aumentar el riesgo de efectos adversos (3,4), y ha mostrado beneficios en relación con un balance nitrogenado positivo (ver aporte proteico) y mayor ganancia ponderal respecto a controles, aunque no se ha observado mayor longitud o perímetro craneal al alta en el grupo de intervención (3). Cabe destacar que los ensayos clínicos analizados cuentan con pequeño tamaño muestral y son heterogéneos (3,4). NECESIDADES ENERGÉTICASLa evidencia sobre las necesidades energéticas del RN prematuro es muy escasa, pues desde una aproximación empírica es muy difícil desligar el efecto de la energía administrada del obtenido por el aporte proteico y resto de nutrientes. Por tanto, las recomendaciones energéticas del RN prematuro se basan en el método factorial, asumiendo que su composición corporal es similar a la del feto y que el crecimiento debería ser similar al que ocurre intraútero (5). Actualmente, se recomienda un aporte inicial de 60 kcal/kg/día, con aumento rápido y progresivo hasta las 90-100 kcal/kg/día en la primera semana (1). Posteriormente se irá incrementado en función del peso de RN (2,6), con el objetivo de conseguir un crecimiento lo más próximo al crecimiento fetal (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" en las tablas II y III). MODIFICACIONES EN EL DISEÑO DEL PREPARADO DE NP Requerimientos proteicosEl aporte proteico mínimo para conseguir un balance nitrogenado positivo en el RN prematuro es 1,5 g/kg/día (6). No obstante, en los últimos años se ha demostrado seguro el aporte inicial de 2,4 g/kg/ día el primer día de vida (4,7,8). Los resultados dependen no solo de la dosis de aminoácidos (AA) sino del aporte concomitante de calorías no proteicas. Así, en el RN prematuro < 1.500 g el aporte proteico inicial de 2,4 g/kg/día junto a lípidos (2 g/kg/día el primer día, incrementando a 3 g/kg/día el segundo) mejoró el balance nitrogenado respecto al mismo aporte proteico sin lípidos (7). Aportes iniciales superiores (3,6 g/kg/día junto a lípidos) no han demostrado mejorar el balance nitrogenado y se asocian a aumento de urea plasmática que refleja una mayor oxidación de AA (7,9). En un reciente ensayo clínico con RN prematuros < 1.500 g se demostró mayor síntesis de albúmina en 12 pacientes con aporte precoz proteico de 3,6 g/ kg/día junto a lípidos comparados con 9 pacientes que recibieron 2,4 g/kg/día junto a lípidos (8), datos que deben ser refrendados en estudios de mayor tamaño muestral (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" para incrementos posteriores).La fórmula de AA a administrar debe contener cisteína, tiro...

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Enteral zinc supplementation for prevention of morbidity and mortality in preterm neonates

Staub

Evers

Askie

2021

Cochrane Database of Systematic Reviews

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Response to “Review of Trace Mineral Requirements for Preterm Infants: What Are the Current Recommendations for Clinical Practice?”

Cited by 31 publications

References 4 publications

Copper Supplementation in Premature Infants With Parenteral Nutrition–Associated Cholestasis

Copper Supplementation in Premature Infants With Parenteral Nutrition–Associated Cholestasis

Nutrición parenteral en situaciones clínicas especiales

Enteral zinc supplementation for prevention of morbidity and mortality in preterm neonates

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