Rayyis S F, Ambalavanan N, Wright L, Carlo W A
Department of Pediatrics, University of Alabama at Birmingham, Alabama 35233-7335, USA.
J Pediatr. 1999 Mar;134(3):293-7. doi: 10.1016/s0022-3476(99)70452-x.
To determine whether the rate of feed advancement affects the incidence of necrotizing enterocolitis (NEC).
Prospective randomized controlled trial involving 185 formula-fed infants with birth weight 501 to 1500 g and gestational age </=34 weeks. Infants were randomized into 2 groups: "slow" (n = 98), who received 15 cc/kg/d increments (a 10-day schedule to full feeds) and "fast" (n = 87), who received 35 cc/kg/d increments (a 5-day schedule to full feeds) of Similac Special Care 20 cal/oz. Feeds were increased only if well tolerated as defined by a protocol.
The incidence of NEC (Bell stage >/=II) was similar in both groups (slow 13% and fast 9%, P =.5). The incidence of perforation (Bell stage III) was also similar in both groups (slow 4% and fast 2%, P =.8). Feeds were started at a comparable postnatal age in both groups (median age: slow 5 days and fast 4 days, P =.9). Although the neonates in the fast group attained full enteral intake earlier (median days [25th and 75th percentiles]: slow 15 [12, 21] and fast 11 [8, 15], P <.001) and regained their birth weight earlier (slow 15 [11, 20] and fast 12 [8, 15], P <.05), their ages at discharge were not statistically different (slow 47 [31, 67] and fast 43 [29, 62], P =.3)
A greater than twofold difference in the rate of feed advancement from 15 cc/kg/d to 35 cc/kg/d did not affect the incidence of NEC >/= stage II. Factors other than feed advancement appear to be more important in the pathogenesis or progression of NEC.
确定喂养推进速度是否会影响坏死性小肠结肠炎（NEC）的发病率。
一项前瞻性随机对照试验，纳入185名出生体重501至1500克、胎龄≤34周的配方奶喂养婴儿。婴儿被随机分为两组：“慢速”组（n = 98），以每天15毫升/千克的增量（10天达到全量喂养）；“快速”组（n = 87），以每天35毫升/千克的增量（5天达到全量喂养）接受Similac Special Care 20卡/盎司配方奶。只有在符合方案定义的耐受良好情况下才增加喂养量。
两组NEC（Bell分期≥II期）的发病率相似（慢速组13%，快速组9%，P = 0.5）。两组穿孔（Bell分期III期）的发病率也相似（慢速组4%，快速组2%，P = 0.8）。两组开始喂养的出生后年龄相当（中位年龄：慢速组5天，快速组4天，P = 0.9）。尽管快速组的新生儿更早达到全肠道摄入量（中位天数[第25和第75百分位数]：慢速组15[12, 21]，快速组11[8, 15]，P < 0.001）且更早恢复出生体重（慢速组15[11, 20]，快速组12[8, 15]，P < 0.05），但他们的出院年龄无统计学差异（慢速组47[31, 67]，快速组43[2
