{"id":2106,"date":"2025-09-17T13:29:05","date_gmt":"2025-09-17T16:29:05","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=2106"},"modified":"2025-09-17T13:29:05","modified_gmt":"2025-09-17T16:29:05","slug":"nutrientes-nutricao-parenteral-prematuros","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/nutrientes-nutricao-parenteral-prematuros\/","title":{"rendered":"Quais s\u00e3o os Nutrientes Essenciais para Beb\u00eas Prematuros que Recebem Nutri\u00e7\u00e3o Parenteral?"},"content":{"rendered":"

A nutri\u00e7\u00e3o parenteral em rec\u00e9m\u2011nascidos prematuros \u00e9 vital quando a via oral ou enteral n\u00e3o atende \u00e0s demandas nutricionais.<\/p>\n

Anteriormente, abordamos como deve ser feita a nutri\u00e7\u00e3o parenteral do prematuro. A seguir, confira quais os macronutrientes e micronutrientes fundamentais para apoiar o crescimento e o desenvolvimento desses pequenos pacientes.<\/p>\n

Quais s\u00e3o os nutrientes indispens\u00e1veis na nutri\u00e7\u00e3o parenteral do prematuro?<\/h2>\n

Prote\u00ednas<\/strong><\/h5>\n

As prote\u00ednas s\u00e3o os principais componentes de todas as c\u00e9lulas do organismo humano. Ou seja, \u00e9 preciso garantir o suprimento adequado para alcan\u00e7ar o desenvolvimento apropriado e evitar a desnutri\u00e7\u00e3o do rec\u00e9m-nascido (1).<\/p>\n

Sendo assim, diretrizes internacionais de nutri\u00e7\u00e3o parenteral pedi\u00e1trica (ESPGHAN\/ESPEN\/ESPR\/CSPEN) recomendam a ingest\u00e3o m\u00ednima de 1,5 g\/kg\/dia<\/strong>, principalmente para beb\u00eas com peso muito baixo, sendo que as doses podem ser progressivas (2).<\/p>\n

Recentemente, a ASPEN recomendou n\u00e3o usar uma dose inicial de >3 g\/kg\/dia. Ao considerar a dose-alvo m\u00e1xima, recomenda-se o fornecimento de doses em um m\u00ednimo de 3 g\/kg\/dia, sem aumento al\u00e9m de 3,5 g\/kg\/dia<\/strong> (3).<\/p>\n

Carboidratos<\/strong><\/h5>\n

Entre os carboidratos, a glicose \u00e9 a principal fonte n\u00e3o proteica de energia, principalmente pela sua f\u00e1cil metaboliza\u00e7\u00e3o. Ela \u00e9 essencial para o desenvolvimento cerebral do rec\u00e9m-nascido prematuro (4).<\/p>\n

Seu suprimento na nutri\u00e7\u00e3o parenteral varia de acordo com a idade gestacional e as necessidades de cada indiv\u00edduo.<\/p>\n

Segundo as diretrizes, a o suprimento parenteral de glicose recomendado para rec\u00e9m-nascidos \u00e9 de (2):<\/p>\n

    \n
  • Dia 1: 4 a 8 mg\/kg\/min;<\/strong><\/li>\n
  • Dia 2 em diante: meta de 8 a 10 mg\/kg\/min<\/strong>, com o m\u00e1ximo de 12 mg\/kg\/min.<\/li>\n<\/ul>\n

     <\/p>\n

    Lip\u00eddios<\/strong><\/h5>\n

    Os lip\u00eddios s\u00e3o fontes importantes de energia e calorias para o crescimento. Al\u00e9m disso, eles prov\u00eam \u00e1cidos graxos essenciais para o desenvolvimento cerebral (1).<\/p>\n

    Portanto, a emuls\u00e3o lip\u00eddica<\/strong> pode ser iniciada em pr\u00e9-termos logo ap\u00f3s o nascimento e n\u00e3o deve ser postergada para al\u00e9m do segundo dia de vida (6).<\/p>\n

    Segundo os especialistas da ASPEN, para melhorar o crescimento, recomenda-se o fornecimento de emuls\u00f5es lip\u00eddicas em uma dose de 3 g\/kg\/dia,<\/strong> para ELs \u00e0 base de \u00f3leo de soja ou multicomponentes (3).<\/p>\n

    J\u00e1 de acordo com os profissionais do grupo ESPGHAN\/ESPEN\/ESPR\/CSPEN, a ingest\u00e3o parenteral de lip\u00eddios n\u00e3o deve exceder 4 g\/kg\/dia<\/strong> em rec\u00e9m nascidos prematuros. Al\u00e9m disso, para NP com dura\u00e7\u00e3o superior a alguns dias, as ELs a base de \u00f3leo de soja n\u00e3o s\u00e3o recomendadas, mas sim as ELs compostas, com ou sem \u00f3leo de peixe (6).<\/p>\n

    Enfatiza-se a necessidade de garantir o fornecimento de \u00e1cidos graxos essenciais suficientes, a fim de evitar o preju\u00edzo do crescimento e outros desfechos adversos (3).<\/p>\n

    Nesse sentido, recomenda-se a ingest\u00e3o m\u00ednima de 0,25 g\/kg\/dia de \u00e1cido linoleico para o rec\u00e9m-nascido pr\u00e9-termo e de 0,1 g\/kg\/dia para o rec\u00e9m-nascido a termo (6).<\/p>\n\n\n\n\n\n\n
    Macronutriente<\/strong><\/td>\nRecomenda\u00e7\u00e3o para NP do beb\u00ea prematuro<\/strong><\/td>\n<\/tr>\n
    Prote\u00ednas<\/td>\nEntre 1,5 a 3,5 g\/kg\/dia<\/td>\n<\/tr>\n
    Carboidratos<\/td>\n4 a 8 mg\/kg\/min no 1\u00ba dia, e 8 a 10 mg\/kg\/min no 2\u00ba dia em diante<\/td>\n<\/tr>\n
    Lip\u00eddios<\/td>\n3 a 4 g\/kg\/dia<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    Micronutrientes<\/strong><\/h5>\n

    Para al\u00e9m dos macronutrientes, a oferta adequada de micronutrientes \u2014 como eletr\u00f3litos, oligoelementos e vitaminas \u2014 \u00e9 indispens\u00e1vel para garantir o crescimento e desenvolvimento adequado do rec\u00e9m-nascido prematuro.<\/p>\n

    Abaixo, veja recomenda\u00e7\u00f5es de fornecimento dos principais micronutrientes para a nutri\u00e7\u00e3o parenteral do prematuro (5).<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    Micronutriente<\/strong><\/td>\nRecomenda\u00e7\u00f5es<\/strong><\/td>\n<\/tr>\n
    S\u00f3dio<\/td>\n3\u20135 mEq\/kg\/dia durante a fase de estabiliza\u00e7\u00e3o, crescimento e cuidado p\u00f3s-natal<\/td>\n<\/tr>\n
    Pot\u00e1ssio<\/td>\n1 a 2 mEq\/kg\/dia, mas a suplementa\u00e7\u00e3o de pot\u00e1ssio n\u00e3o deve ser iniciada at\u00e9 que a produ\u00e7\u00e3o urin\u00e1ria adequada seja estabelecida<\/td>\n<\/tr>\n
    C\u00e1lcio<\/td>\n60\u201380 mg\/kg\/dia suplementado desde o primeiro dia<\/td>\n<\/tr>\n
    Fosfato<\/td>\n45\u201360 mg\/kg\/dia suplementado desde o primeiro dia<\/p>\n

     <\/td>\n<\/tr>\n

    Zinco<\/td>\n400\u2013500 \u03bcg\/kg\/dia<\/td>\n<\/tr>\n
    Cobre<\/td>\n20 a 40 \u03bcg\/kg\/dia<\/td>\n<\/tr>\n
    Sel\u00eanio<\/td>\nEntre 2\u20133 \u03bcg\/kg\/dia com um m\u00e1ximo de 60 a 100 \u03bcg\/dia<\/td>\n<\/tr>\n
    Iodo<\/td>\n\u00a01 \u03bcg\/kg\/dia<\/td>\n<\/tr>\n
    Vitamina A<\/td>\n700 a 1500 UI\/kg\/dia<\/td>\n<\/tr>\n
    Vitamina D<\/td>\n200 a 1000 UI\/dia<\/td>\n<\/tr>\n
    Vitamina E<\/td>\n2,8 a 3,5 mg\/kg\/dia<\/td>\n<\/tr>\n
    Vitamina K<\/td>\n10 ug\/kg\/dia<\/td>\n<\/tr>\n
    Vitamina C<\/td>\n15 a 25 mg\/kg\/dia<\/td>\n<\/tr>\n
    Tiamina<\/td>\n0,35 a 0,50 mg\/kg\/dia<\/td>\n<\/tr>\n
    Riboflavina<\/td>\n0,15 a 0,2 mg\/kg\/dia<\/td>\n<\/tr>\n
    Piridoxina<\/td>\n0,15 a 0,2 mg\/kg\/dia<\/td>\n<\/tr>\n
    Niacina<\/td>\n4 a 6,8 mg\/kg\/dia<\/td>\n<\/tr>\n
    Vitamina B12<\/td>\n0,3 ug\/kg\/dia<\/td>\n<\/tr>\n
    \u00c1cido f\u00f3lico<\/td>\n56 mg\/kg\/dia<\/td>\n<\/tr>\n
    \u00c1cido pantot\u00eanico<\/td>\n2,5 mg\/kg\/dia<\/td>\n<\/tr>\n
    Biotina<\/td>\n5 a 8 ug\/kg\/dia<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    Conclus\u00e3o<\/h2>\n

    A combina\u00e7\u00e3o adequada de macronutrientes e micronutrientes na nutri\u00e7\u00e3o parenteral \u00e9 determinante para a sa\u00fade e o progn\u00f3stico de beb\u00eas prematuros. Um protocolo bem planejado pode transformar a sobrevida e favorecer um desenvolvimento mais pr\u00f3ximo ao intrauterino.<\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n

    Refer\u00eancias<\/p>\n

    1 – Baraton L, Ancel PY, Flamant C, Orsonneau JL, Darmaun D, Roz\u00e9 JC. Impact of changes in serum sodium levels on 2-year neurologic outcomes for very preterm neonates. Pediatrics. 2009 Oct;124(4):e655-61.<\/p>\n

    2 – van Goudoever JB, Carnielli V, Darmaun D, Sainz de Pipaon M; ESPGHAN\/ESPEN\/ESPR\/CSPEN working group on pediatric parenteral nutrition. ESPGHAN\/ESPEN\/ESPR\/CSPEN guidelines on pediatric parenteral nutrition: Amino acids. Clin Nutr. 2018 Dec;37(6 Pt B):2315-2323.<\/p>\n

    3 – Robinson DT, Calkins KL, Chen Y, Cober MP, Falciglia GH, Church DD, Mey J, McKeever L, Sentongo T. Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2023 Sep;47(7):830-858.<\/p>\n

    4 – Johnson PJ. Review of macronutrients in parenteral nutrition for neonatal intensive care population. Neonatal Netw. 2014 Jan-Feb;33(1):29-34.<\/p>\n

    5 – Rizzo V, Capozza M, Panza R, Laforgia N, Baldassarre ME. Macronutrients and Micronutrients in Parenteral Nutrition for Preterm Newborns: A Narrative Review. Nutrients. 2022 Apr 6;14(7):1530.<\/p>\n

    6 – Lapillonne A, Fidler Mis N, Goulet O, van den Akker CHP, Wu J, Koletzko B; ESPGHAN\/ESPEN\/ESPR\/CSPEN working group on pediatric parenteral nutrition. ESPGHAN\/ESPEN\/ESPR\/CSPEN guidelines on pediatric parenteral nutrition: Lipids. Clin Nutr. 2018 Dec;37(6 Pt B):2324-2336.<\/p>\n","protected":false},"excerpt":{"rendered":"

    A nutri\u00e7\u00e3o parenteral em rec\u00e9m\u2011nascidos prematuros \u00e9 vital quando a via oral ou enteral n\u00e3o atende \u00e0s demandas nutricionais. Anteriormente, abordamos como deve ser feita a nutri\u00e7\u00e3o parenteral do prematuro. A seguir, confira quais os macronutrientes e micronutrientes fundamentais para apoiar o crescimento e o desenvolvimento desses pequenos pacientes. Quais s\u00e3o os nutrientes indispens\u00e1veis na […]<\/p>\n","protected":false},"author":5902,"featured_media":2107,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49],"tags":[183,321,319,93,97,89,82,67,190,203,243,317,84],"class_list":["post-2106","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","tag-aspen","tag-eletrolitos","tag-espghan","tag-glicose","tag-lipidios","tag-macronutrientes","tag-micronutrientes","tag-nutricao-parenteral","tag-prematuros","tag-proteinas","tag-suporte-nutricional","tag-uti-neonatal","tag-vitaminas"],"acf":[],"yoast_head":"\nNutrientes na Nutri\u00e7\u00e3o Parenteral de Prematuros: Guia<\/title>\n<meta name=\"description\" content=\"Descubra os principais macronutrientes e micronutrientes na nutri\u00e7\u00e3o parenteral de prematuros e como garantir crescimento e desenvolvimento adequados.\" 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