Cakmak Celik F, Aygun C, Cetinoglu E
Department of Pediatrics, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
Eur J Clin Nutr. 2009 Apr;63(4):580-4. doi: 10.1038/sj.ejcn.1602957. Epub 2007 Nov 28.
BACKGROUND/OBJECTIVE: In this retrospective study, we intended to test whether early enteral feeding (EEF) of very low birth weight (VLBW) preterm babies increases the risk of necrotizing enterocolitis (NEC) or not.
Overall, 297 VLBW preterm babies admitted to the neonatal intensive care unit (NICU) between April 2003 and April 2006 were included. The study consisted of two periods: the first period was between April 2003 and October 2004, when babies were not fed enterally until they were extubated (167 preterm VLBWs). The second period was between November 2004 and April 2006, when babies were fed even when they were intubated, starting preferably on the first day of life (130 preterm VLBWs). Criteria for withholding enteral feeding in both periods were hypotension necessitating vasopressor agent use, abdominal distention, abdominal tenderness and suspected or proven NEC. Possible risk factors for NEC were also recorded.
The overall incidence of NEC in VLBW preterm babies was 6.7% and did not differ between the two study periods: 7.2% in the late and 6.2% in the EEF regimens. On logistic regression analysis, the most important risk factors associated with NEC were sepsis (P<0.001) and blood culture positivity (P<0.001). The average daily weight gain was significantly higher in the early fed babies (P=0.011).
The EEF of VLBW preterm babies does not increase the risk of NEC. Increased daily weight gain is an important reason to feed these babies earlier.
背景/目的：在这项回顾性研究中，我们旨在测试极低出生体重（VLBW）早产儿的早期肠内喂养（EEF）是否会增加坏死性小肠结肠炎（NEC）的风险。
总共纳入了2003年4月至2006年4月期间入住新生儿重症监护病房（NICU）的297例VLBW早产儿。该研究包括两个阶段：第一阶段为2003年4月至2004年10月，在此期间婴儿在拔管前不进行肠内喂养（167例VLBW早产儿）。第二阶段为2004年11月至2006年4月，在此期间婴儿即使在插管时也进行喂养，最好从出生第一天开始（130例VLBW早产儿）。两个阶段中停止肠内喂养的标准为需要使用血管升压药的低血压、腹胀、腹部压痛以及疑似或确诊的NEC。还记录了NEC可能的危险因素。
VLBW早产儿NEC的总体发生率为6.7%，两个研究阶段之间无差异：晚期喂养方案中为7.2%，EEF方案中为6.2%。逻辑回归分析显示，与NEC相关的最重要危险因素是败血症（P<0.001）和血培养阳性（P<0.001）。早期喂养的婴儿平均每日体重增加显著更高（P=0.011）。
VLBW早产儿的EEF不会增加NEC的风险。每日体重增加增加是更早喂养这些婴儿的一个重要原因。
