Early protein parenteral nutrition effects on kidney function

Abstract

We hypothesized that early high protein administration has no harmful effects on kidney functions & it has a beneficial effect on preterm growth. Our primary aim was to evaluate the effect of early high protein parenteral nutrition on kidney function in preterm infant. Our secondary aim was to evaluate its effect on weight gain, incidence of necrotizing enterocolitis, sepsis & glycemic control. Parenteral Nutrition can be defined as provision of nutrition for metabolic requirements and growth through the parenteral route. (Chaudhari, 2006). This work was carried out to study the effect of early high protein parenteral nutrition on kidney functions in preterm infants. All cases were subjected to clinicalevaluation included anthropometric measurements, vital signs evaluation & individual system examination. Laboratory work up was done to all patients & included urine samples for micro-albuminuria , creatinine & sodium and blood samples for serum creatinine , BUN, sodium , potassium, blood sugar & arterial blood gases. The three groups were comparable regarding sex distribution, gestational age & the risk factors. After seven days of admission with provision of TPN to group B & C, affection of kidney function was similar in the three groups, some cases showed mild microalbuminuria which was attributed to kidney immaturity. Patients with kidney affection had risk factors rather than high protein TPN (e.g. sepsis) & their percentage was comparable among the three groups. Enhanced growth was recorded among infants who received early high protein TPN, while the group who did not receive TPN recorded growth failure even weight loss. There was no significant difference in blood pressure among the three groups. Despite there was significant difference in hemoglobin concentration & hematocrit values among the three groups, blood picture parameters were within the normal ranges. Rate of infection was comparable in the three groups, with the highest among group A infants (who received no TPN). Serum electrolytes levels were within normal ranges in the three groups after seven days of admission. Blood sugar was significantly better controlled in group C infants who received early high protein TPN as intravenous amino acids stimulate insulin secretion. Comparing the three groups regarding incidence of metabolic disturbance (metabolic acidosis) revealed no significant difference. Keywords : FeNa :Fractionated sodium excretion; TPN :Total parenteral nutrition; PN: parenteral nutrition