Tyson J E, Kennedy K A
Pediatrics, University of Texas at Houston Medical School, 6431 Fannin, Suite 3.228, Houston, TX 77030, USA.
Cochrane Database Syst Rev. 2000(2):CD000504. doi: 10.1002/14651858.CD000504.
Because of concern that feedings may increase the risk of necrotizing enterocolitis, some high-risk infants have received prolonged periods of parenteral nutrition without enteral feedings. Providing minimal enteral feedings during this period of parenteral nutrition was developed as a strategy to enhance feeding tolerance and decrease time to reach full feedings.
For high-risk neonates receiving parenteral feedings, to assess the effect of minimal enteral nutrition (MEN) compared to no enteral nutrient intake on measures of feeding tolerance and neonatal outcome.
Searches were performed of the Oxford Database of Perinatal Trials, MEDLINE, abstracts and conference proceedings, references from relevant publications in the English language, and studies identified by personal communication.
Only randomized or quasi-randomized clinical trials were considered. Trials were included if they enrolled high-risk infants randomly assigned to receive minimal enteral feedings (defined as dilute or full strength feedings providing <= 25 kcal/kg/d for >= 5d) or no enteral nutrient intake (no feedings or water only).
The two reviewers reached consensus for inclusion of trials. Data regarding clinical outcomes were extracted and evaluated by the two reviewers independently of each other. Authors were contacted as needed and feasible to clarify or provide missing data. The specific data that were needed were requested in writing.
Among infants given minimal enteral nutrition (MEN), there was an overall reduction in days to full enteral feeding, total days that feedings were held, and total hospital stay. There was no discernible effect on necrotizing enterocolitis.
REVIEWER'S CONCLUSIONS: The evidence of benefit from MEN in these analyses is not convincing for a variety of reasons--the inherent difficulty of assessing enteral feedings in high-risk infants, the small size and methodologic limitations of the studies to date, unexplained heterogeneity with respect to some of the apparent benefits, the potential for bias to affect the findings in unblinded studies, and the unexcluded possibility that MEN might increase necrotizing enterocolitis. For these reasons, it is unclear whether MEN should be used in lieu of an equal period of time without enteral feedings.
由于担心喂养可能增加坏死性小肠结肠炎的风险，一些高危婴儿接受了长时间的肠外营养而未进行肠内喂养。在此肠外营养期间提供少量肠内喂养被开发为一种提高喂养耐受性并减少达到完全喂养所需时间的策略。
对于接受肠外喂养的高危新生儿，评估与不摄入肠内营养相比，少量肠内营养（MEN）对喂养耐受性指标和新生儿结局的影响。
检索了牛津围产期试验数据库、MEDLINE、摘要和会议记录、英文相关出版物的参考文献以及通过个人交流确定的研究。
仅考虑随机或准随机临床试验。如果试验纳入了随机分配接受少量肠内喂养（定义为稀释或全强度喂养，提供 <= 25 kcal/kg/d 且 >= 5 天）或不摄入肠内营养（不喂养或仅喂水）的高危婴儿，则该试验被纳入。
两位评审员就试验纳入达成共识。关于临床结局的数据由两位评审员相互独立提取和评估。必要时并在可行的情况下联系作者以澄清或提供缺失数据。所需的具体数据以书面形式索取。
在接受少量肠内营养（MEN）的婴儿中，达到完全肠内喂养的天数、停止喂养的总天数和住院总天数总体减少。对坏死性小肠结肠炎没有明显影响。
由于多种原因，这些分析中显示少量肠内营养（MEN）有益的证据并不令人信服——评估高危婴儿肠内喂养的内在困难、迄今为止研究的规模小和方法学局限性、一些明显益处方面无法解释的异质性、未设盲研究中存在影响研究结果的偏倚可能性，以及少量肠内营养（MEN）可能增加坏死性小肠结肠炎的未排除可能性。由于这些原因，尚不清楚是否应使用少量肠内营养（MEN）来替代相同时间段的无肠内喂养。
