Kamitsuka M D, Horton M K, Williams M A
Division of Neonatal Medicine, Swedish Medical Center, Seattle, Washington 98122, USA.
Pediatrics. 2000 Feb;105(2):379-84. doi: 10.1542/peds.105.2.379.
To evaluate the incidence of necrotizing enterocolitis (NEC) after implementing standardized feeding schedules.
This was a cohort study, which retrospectively reviewed the incidence of NEC for a 3-year period before implementing feeding schedules and prospectively evaluated the incidence of NEC for a 3-year period after implementing feeding schedules in infants with birth weights between 1250 and 2500 g and <35 weeks' gestation. The feeding schedules were comprised of 3 parts. First, no group was fed within the first 24 hours of life. Feeds were started between 24 to 72 hours of life based on birth weight. Second, the initial feed was full-strength breast milk or half-strength formula. Half-strength formula was changed to full-strength formula on the fourth day for all groups. Third, the daily feeding volume increase was no greater than 20 mL/kg for all groups.
In the 477 infants before the feeding schedules, there were 23 (4.8%) cases of definite NEC defined as pneumatosis on abdominal film or NEC confirmed at the time of surgery, and in the 466 infants after the feeding schedules, there were 5 (1.1%) cases of NEC. Before the feeding schedules, those who developed NEC started feeds sooner 1.5 +/- 1.5 (+/- standard deviation [SD]) days versus 3.0 +/-.7 (+/-SD) days, reached full feeds sooner 4.0 +/- 1.8 (+/- SD) days versus 9.8 +/-.5 (+/-SD) days and were more likely to have been started on formula than those who developed NEC after implementing the feeding schedules. The mean time for NEC to occur after the feeding schedules increased from 5.9 +/- 4.1 (+/-SD) days to 19.4 +/- 16.3 (+/- SD) days, although not statistically significant. The number of mothers who received prenatal steroids increased after the feeding schedules. The number of infants with NEC, however, significantly decreased whether their mothers were pretreated with steroids. The risk of NEC was reduced 84% after the introduction of feeding schedules as determined by multiple logistic regression analysis and adjusting for confounding by birth weight, white race, prenatal steroid exposure, day of life of first feed, day of life to reach full feeds, and breast milk.
The incidence of NEC was significantly decreased after the implementation of standardized feeding schedules, which was independent of birth weight, prenatal steroid exposure, breast milk, day of life of first feed, and the number of days to reach full feeds.
评估实施标准化喂养方案后坏死性小肠结肠炎（NEC）的发生率。
这是一项队列研究，回顾性分析出生体重在1250至2500克且孕周小于35周的婴儿在实施喂养方案前3年的NEC发生率，并前瞻性评估实施喂养方案后3年的NEC发生率。喂养方案包括3个部分。首先，出生后24小时内不进行喂养。根据出生体重在出生后24至72小时开始喂养。其次，初始喂养为全浓度母乳或半浓度配方奶。所有组在第4天将半浓度配方奶改为全浓度配方奶。第三，所有组每日喂养量增加不超过20毫升/千克。
在实施喂养方案前的477例婴儿中，有23例（4.8%）确诊为NEC，定义为腹部X线片显示有肠壁积气或手术时确诊为NEC；在实施喂养方案后的466例婴儿中，有5例（1.1%）发生NEC。在实施喂养方案前，发生NEC的婴儿开始喂养的时间更早（1.5±1.5[±标准差（SD）]天，而未发生NEC的为3.0±0.7[±SD]天），达到全量喂养的时间更早（4.0±1.8[±SD]天，而未发生NEC的为9.8±0.5[±SD]天），且比实施喂养方案后发生NEC的婴儿更有可能一开始就采用配方奶喂养。实施喂养方案后NEC发生的平均时间从5.9±4.1[±SD]天增加到19.4±16.3[±SD]天，尽管无统计学意义。实施喂养方案后接受产前类固醇治疗的母亲数量增加。然而，无论母亲是否接受过类固醇预处理，发生NEC的婴儿数量均显著减少。通过多因素逻辑回归分析并校正出生体重、白人种族、产前类固醇暴露、首次喂养日龄、达到全量喂养日龄和母乳等混杂因素后，实施喂养方案后NEC的风险降低了84%。
实施标准化喂养方案后NEC的发生率显著降低，且与出生体重、产前类固醇暴露、母乳、首次喂养日龄以及达到全量喂养所需天数无关。
