出生早期の新生児における体温及び栄養管理が体重減少と黄疸発現に及ぼす影響

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  • 久保田 史郎
    久保田生命科学研究所 久保田産婦人科麻酔科医院
  • 財津 將嘉
    東京大学大学院医学系研究科公衆衛生学教室
  • 吉原 達也
    久保田産婦人科麻酔科医院 医療法人相生会福岡みらい病院臨床研究センター

書誌事項

タイトル別名
  • Neonatal Management of Body Temperature and Nutrition on Body Weight Loss and Neonatal Jaundice
  • シュッショウ ソウキ ノ シンセイジ ニ オケル タイオン オヨビ エイヨウ カンリ ガ タイジュウ ゲンショウ ト オウダン ハツゲン ニ オヨボス エイキョウ

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抄録

After birth, the environment of infants suddenly changes from inside to outside of the uterus. Therefore, infants should immediately adapt to the new environment. However, their cardiopulmonary abilities are yet immature and vulnerable to the sudden change. The room temperature of delivery rooms (around 25℃) is likely to be low for infants. Due to the immature abilities to produce and maintain heat, infants thus have a considerable risk of hypothermia, which can cause unstable circulatory status. Breast milk is an excellent nutritional source for infants, and breastfeeding is currently recommended worldwide. However, in some instances, breastfeeding may not sufficiently meet the basal metabolism of infants for the first several days after birth in Japan. In general, the maximum body-weight loss is more significant in breastfed infants compared with bottle-fed infants. Excessive body-weight loss is known to increase the risks of hypoglycemia, hypernatremia, and hyperbilirubinemia. These critical neonatal situations can lead to permanent central nervous damages. In our hospital, we applied a combination method of thermal control and nutritional regulation to meet the basal metabolism (50 kcal/kg/day). In this method, neonates were maintained in the neutral environment temperature (32-34℃) for more than 1-2 hours after birth. This thermal control stabilizes the autonomic nerve system, which has benefits on bowel movement, early initiation of oral intake, and rapid excretion of meconium. Neonates were also fed with 5％ glucose solution (10 mL/kg) at 1 hour after birth, breastfed every 3 hours, and the formula was added (if applicable) to meet basal metabolism. We have reported the results of this combination method, with very low incidence rates for excessive body-weight loss (1.9％) and neonatal jaundice required phototherapy (0.3％). Here, we review and discuss the influence of the neonatal management of body temperature and nutrition after birth on infantsʼ clinical outcomes.

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