van Elburg R M, van den Berg A, Bunkers C M, van Lingen R A, Smink E W A, van Eyck J, Fetter W P F
Division of Neonatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2004 Jul;89(4):F293-6. doi: 10.1136/adc.2003.027367.
To study the effect of minimal enteral feeding (MEF) on intestinal permeability and feeding tolerance in preterm infants with intrauterine growth retardation (gestational age < 37 weeks, birth weight for gestational age p < 10). Furthermore, to determine whether fetal blood flow pulsatility or intestinal permeability predict feeding tolerance in these infants.
Randomised controlled trial.
Within 48 hours of birth, infants were randomised to MEF or no enteral feeding (NEF) for five days in addition to parenteral feeding. Intestinal permeability was measured by the sugar absorption test before (SAT1) and after (SAT2) the study. The sugar absorption test measured the urinary lactulose/mannitol (LM) ratio after oral ingestion of a solution (375 mosm) containing mannitol and lactulose. Charts of all infants were assessed for measures of feeding tolerance. Fetal blood flow pulsatility index (U/C ratio) was measured within the seven days before birth.
Of the 56 infants enrolled, 42 completed the study: 20 received MEF and 22 NEF. The decrease in LM ratio (LM ratio 1 - LM ratio 2) was not significantly different between the two groups (0.25 v 0.11; p = 0.14). Feeding tolerance, growth, and incidence of necrotising enterocolitis were not significantly different between the two groups. Neither the U/C nor the LM ratio 1 predicted feeding tolerance.
The results suggest that MEF of preterm infants with intrauterine growth retardation has no effect on the decrease in intestinal permeability after birth. Neither fetal blood flow pulsatility nor intestinal permeability predicts feeding tolerance.
研究微量肠内喂养（MEF）对宫内生长受限（胎龄<37周，出生体重低于同胎龄儿第10百分位数）早产儿肠道通透性及喂养耐受性的影响。此外，确定胎儿血流搏动性或肠道通透性是否可预测这些婴儿的喂养耐受性。
随机对照试验。
出生后48小时内，除肠外营养外，将婴儿随机分为接受MEF或不进行肠内喂养（NEF）组，为期5天。在研究前（SAT1）和研究后（SAT2）通过糖吸收试验测量肠道通透性。糖吸收试验通过口服含有甘露醇和乳果糖的溶液（375毫渗量）后测量尿乳果糖/甘露醇（LM）比值。评估所有婴儿的图表以获取喂养耐受性指标。在出生前7天内测量胎儿血流搏动指数（U/C比值）。
在纳入的56例婴儿中，42例完成了研究：20例接受MEF，22例接受NEF。两组之间LM比值的下降（LM比值1-LM比值2）无显著差异（0.25对0.11；p=0.14）。两组之间的喂养耐受性、生长情况及坏死性小肠结肠炎的发生率无显著差异。U/C比值和LM比值1均不能预测喂养耐受性。
结果表明，宫内生长受限早产儿的MEF对出生后肠道通透性的降低无影响。胎儿血流搏动性和肠道通透性均不能预测喂养耐受性。
