Li Zai-ling, Ye Hong-mao, Wang Ji-shan, Han Tong-yan, Wang Xin-li
Department of Pediatrics, Third Hospital of Beijing University, Beijing 100083, China.
Zhonghua Er Ke Za Zhi. 2008 Apr;46(4):243-6.
To study serum gastrin levels in response to early minimal feeding in premature infants and evaluate the clinical effect of early minimal feeding.
Premature infants with critical score < or = 90 were randomly assigned into two groups: early minimal feeding group (n = 48), non-early minimal feeding group (n = 47). Other premature infants (n = 30) without any complications (critical score > 90) were assigned as normal control group. The premature infants in normal control group were fed with water at 6 h after birth, 1 - 2 ml/kg every time, after once or twice, they were fed with formula, increasing in the amount of formula gradually, until adequate. The premature infants in early minimal feeding group were fed with formula within 72 h after birth, 0.5 - 1 ml/kg, once every 3 h, the amount of formula was increased gradually, until adequate. The premature infants without early minimal feeding were not fed with formula until the illness was stable, the amount of formula was increased gradually until adequate. Situation of gastrointestinal feeding tolerance, growth and development, and clinical symptoms were observed and recorded for the three groups. Serum gastrin levels were monitored at 1, 3, 7 day after birth by radioimmunoassay.
Serum gastrin concentrations in the three groups elevated from 1 to 7 days. In early minimal feeding group [(82.4 +/- 24.5) ng/L] and non-early minimal feeding group [(87.0 +/- 40.2) ng/L], the concentrations were significantly higher than those in normal control group [(66.4 +/- 19.7) ng/L] at day 1 (F = 3.36, P < 0.05). At day 3 and 7, the concentrations in early minimal feeding group [(96.3 +/- 14.6) ng/L, (113.0 +/- 16.5) ng/L] were significantly higher than those in non-early minimal feeding group [(73.9 +/- 13.5) ng/L, (92.4 +/- 12.2) ng/L] (P < 0.05). There were significant differences among the three groups in infants with feeding intolerance (2/30, 5/48, 14/47), the period reached full enteral feeding [(20.6 +/- 5.7) d, (27.8 +/- 6.1) d, (39.5 +/- 4.7) d], and in number of hospital day [(29.0 +/- 4.6) d, (39.0 +/- 4.8) d, (48.0 +/- 5.6) d] (P < 0.05). There were significant differences between early minimal feeding group and non-early minimal feeding group in the weight gain three and four weeks after birth [(19.1 +/- 2.4) g/d, (11.9 +/- 3.3) g/d], the period reached birthweight [(19.8 +/- 4.2) d, (25.2 +/- 5.1) d] (P < 0.05). There were no significant difference among the three groups in the weight gain in one and two weeks after birth [(5.9 +/- 2.9) g/d vs. (5.0 +/- 2.1) g/d], the numbers of premature infants with infection, anemia, apnea, or hypoglycemia.
Early minimal feeding in premature infants leads to secretion of gastrin, promotes the development of gastrointestine and may not be associated with occurrence of complications.
研究早产儿早期微量喂养时血清胃泌素水平的变化，并评价早期微量喂养的临床效果。
将危重评分≤90分的早产儿随机分为两组：早期微量喂养组（n = 48）、非早期微量喂养组（n = 47）。将无任何并发症（危重评分>90分）的其他早产儿（n = 30）作为正常对照组。正常对照组早产儿出生后6 h喂水，每次1～2 ml/kg，喂1～2次后喂配方奶，奶量逐渐增加至足量。早期微量喂养组早产儿出生后72 h内开始喂配方奶，0.5～1 ml/kg，每3 h喂1次，奶量逐渐增加至足量。未进行早期微量喂养的早产儿在病情稳定后才开始喂配方奶，奶量逐渐增加至足量。观察并记录三组患儿胃肠道喂养耐受性、生长发育及临床症状情况。出生后1、3、7 d采用放射免疫法监测血清胃泌素水平。
三组血清胃泌素浓度在出生后1～7 d均升高。出生后1 d，早期微量喂养组[（82.4±24.5）ng/L]和非早期微量喂养组[（87.0±40.2）ng/L]血清胃泌素浓度均显著高于正常对照组[（66.4±19.7）ng/L]（F = 3.36，P < 0.05）。出生后3、7 d，早期微量喂养组[（96.3±14.6）ng/L，（113.0±16.5）ng/L]血清胃泌素浓度显著高于非早期微量喂养组[（73.9±13.5）ng/L，（92.4±12.2）ng/L]（P < 0.05）。三组患儿喂养不耐受情况（2/30，5/48，14/47）、达到完全肠内喂养的时间[（20.6±5.7）d，（27.8±6.1）d，（39.5±4.7）d]及住院天数[（29.0±4.6）d，（39.0±4.8）d，（48.0±5.6）d]比较，差异有统计学意义（P < 0.05）。早期微量喂养组与非早期微量喂养组出生后3、4周体重增长[（19.1±2.4）g/d，（11.9±3.3）g/d]、恢复出生体重的时间[（19.8±4.2）d，（25.2±5.1）d]比较，差异有统计学意义（P < 0.05）。三组患儿出生后1、2周体重增长[（5.9±2.9）g/d对（5.0±2.1）g/d]、感染、贫血、呼吸暂停或低血糖早产儿例数比较，差异无统计学意义。
早产儿早期微量喂养可促使胃泌素分泌，促进胃肠道发育，且可能与并发症的发生无关。
