dos Santos Mezzacappa Maria Aparecida Marques, Collares Edgard Ferro
Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, São Paulo, Brazil.
J Pediatr Gastroenterol Nutr. 2005 Mar;40(3):339-44. doi: 10.1097/01.mpg.0000150421.00161.f0.
The authors hypothesized that acute respiratory distress (ARD) delays gastric emptying. The objective was to test this hypothesis by assessing gastric emptying on the second and seventh days of life in premature infants with ARD resulting from pulmonary disease.
Thirty-nine newborns with ARD starting on the first day of life were selected and paired with 39 healthy control newborns matched by weight (within 250 g). Gestational age was <or =35 weeks and birth weight was < or =1750 g for all subjects. Gastric emptying was assessed at 48.0 +/- 24.0 hours and at 168.0 +/- 24.0 hours of life. A test meal consisting of 3 mL/kg of 5% glucose in water labeled with phenol red was administered by gastric tube over 1 minute and gastric retention was determined as percent test meal remaining in the stomach 30 minutes after administration.
Gastric retention at 30 minutes varied considerably in both groups and was significantly higher (P < 0.01) in newborns with ARD (61.4%) than controls (51.8%) at 48.0 +/- 24.0 hours, decreasing significantly after partial or full remission of ARD at 168 +/- 24 hours of life. Gastric retention was 60.2% in newborns with feeding intolerance and 36.8% in tolerant newborns (P < 0.001) at 168 hours. ARD and periventricular or intraventricular hemorrhage were predictors of gastric retention at 48 +/- 24 hours of life, whereas feeding intolerance and gestational age were predictors of gastric retention at 168 +/- 24 hours. Gastric retention was inversely correlated with gestational age.
Gastric emptying is delayed in premature infants with ARD during the first 72 hours of life and may impair the initiation of enteral feeding.
作者推测急性呼吸窘迫（ARD）会延迟胃排空。目的是通过评估因肺部疾病导致ARD的早产儿出生后第二天和第七天的胃排空情况来验证这一假设。
选取39例出生第一天就出现ARD的新生儿，并与39例体重匹配（相差250克以内）的健康对照新生儿配对。所有受试者的胎龄≤35周，出生体重≤1750克。在出生后48.0±24.0小时和168.0±24.0小时评估胃排空情况。通过胃管在1分钟内给予由3毫升/千克溶于水中的5%葡萄糖并标记有酚红的试验餐，给药30分钟后测定胃内残留试验餐的百分比来确定胃潴留情况。
两组在30分钟时的胃潴留情况差异很大，出生后48.0±24.0小时时，患有ARD的新生儿（61.4%）的胃潴留明显高于对照组（51.8%）（P<0.01），在出生后168±24小时ARD部分或完全缓解后显著下降。出生后168小时，有喂养不耐受的新生儿胃潴留为60.2%，耐受的新生儿为36.8%（P<0.001）。ARD和脑室周围或脑室内出血是出生后48±24小时胃潴留的预测因素，而喂养不耐受和胎龄是出生后168±24小时胃潴留的预测因素。胃潴留与胎龄呈负相关。
患有ARD的早产儿在出生后的头72小时内胃排空延迟，可能会影响肠内喂养的开始。
