Berseth Carol Lynn, Bisquera Jennifer A, Paje Virna U
Newborn Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Pediatrics. 2003 Mar;111(3):529-34. doi: 10.1542/peds.111.3.529.
Approximately 90% of infants who develop necrotizing enterocolitis (NEC) do so after being fed. Previous prospective studies have shown that infants given small enteral feedings for the first 7 to 10 days of feeding do not have an increased risk for NEC compared with those given no feedings. Although neonatologists now commonly increase feeding volumes, no study has compared the risk for NEC between infants fed these small volumes and those fed volumes that are increased slowly. The purpose of this study was to compare the risks and benefits of small and increasing feeding volume.
In a randomized, controlled trial, we randomly assigned 141 preterm infants in the newborn intensive care unit to be fed 10 days using 1 of 2 schedules. One group was fed 20 mL/kg/d for the first 10 study days (minimal). The other group (advancing) was fed 20 mL/kg/d on study day 1; feeding volume was increased by 20 mL/kg/d up to 140 mL/kg/d, which was maintained until study day 10. The main outcome measure was incidence of NEC; secondary outcomes were maturation of intestinal motor patterns, time to reach full enteral feedings, and incidence of late sepsis.
The study was closed early because 7 infants who were assigned to advancing feeding volumes developed NEC, whereas only 1 infant fed minimal feeding volumes did, or 10% versus 1.4%. Although infants who were fed minimal volumes established full enteral feeding volumes later than infants who were fed advancing volumes, maturation of intestinal motor patterns and the incidence of late sepsis and feeding intolerance was similar in the 2 groups.
Given that advancing feeding volumes increase the risk of NEC without providing benefits for motor function or feeding tolerance, neonatologists should consider using minimal feeding volumes until future trials assess the safety of advancing feeding volumes.
发生坏死性小肠结肠炎（NEC）的婴儿中约90%是在开始喂养后发病。既往前瞻性研究表明，在喂养的前7至10天给予少量肠内喂养的婴儿与未喂养的婴儿相比，发生NEC的风险并未增加。尽管新生儿科医生现在通常会增加喂养量，但尚无研究比较给予少量喂养的婴儿与缓慢增加喂养量的婴儿发生NEC的风险。本研究的目的是比较少量喂养和增加喂养量的风险与益处。
在一项随机对照试验中，我们将新生儿重症监护病房的141名早产儿随机分为两组，采用两种喂养方案之一进行10天的喂养。一组在研究的前10天给予20 mL/kg/d的喂养量（少量组）。另一组（增加组）在研究第1天给予20 mL/kg/d的喂养量；喂养量每天增加20 mL/kg/d，直至达到140 mL/kg/d，并维持至研究第10天。主要结局指标是NEC的发生率；次要结局指标是肠道运动模式的成熟度、达到完全肠内喂养的时间以及晚发性败血症的发生率。
该研究提前结束，因为分配到增加喂养量组的7名婴儿发生了NEC，而少量喂养组只有1名婴儿发生了NEC，即发生率分别为10%和1.4%。尽管少量喂养组婴儿建立完全肠内喂养量的时间晚于增加喂养量组婴儿，但两组肠道运动模式的成熟度、晚发性败血症的发生率和喂养不耐受情况相似。
鉴于增加喂养量会增加NEC的风险，且对运动功能或喂养耐受性无益处，新生儿科医生应考虑使用少量喂养，直至未来试验评估增加喂养量的安全性。
