Walter-Nicolet Elizabeth, Rousseau Véronique, Kieffer François, Fusaro Fabio, Bourdaud Nathalie, Oucherif Salima, Benachi Alexandra, Sarnacki Sabine, Mitanchez Delphine
Department of Pediatrics, Université Paris-Descartes, Hôpital Necker-Enfants Malades, Paris, France.
J Pediatr Gastroenterol Nutr. 2009 May;48(5):612-7. doi: 10.1097/MPG.0b013e31818c5281.
The aim of the study was to evaluate early minimal enteral feeding (MEF) and gradual enteral nutrition increment on neonatal outcome of gastroschisis.
An intervention group was prospectively assessed and compared with an observational historical control group. The prospective study relied on a new protocol of enteral nutrition. According to the new protocol, MEF was initiated 5 days after bowel reintegration and milk amounts were increased 12 mL/kg/day. In the control group, enteral nutrition was delayed until resolution of postoperative ileus, and increment of feeding was not systematized.
Twenty-two patients were included in the MEF group and compared with 51 control patients. Infants in the control group had lower gestational age (36 vs 35 gestational weeks [GW], P=0.03) and birth weight (2465 vs 2200 g, P=0.05). Time to first enteral nutrition (5 vs 11.5 days, P=0.0005) was significantly shorter in the MEF group. All patients in this group were fully enteral fed at day 60, though 30.4% of patients in the control group still needed parenteral nutrition at day 60 (P=0.004). Incidence of nosocomial infection was reduced (9% of patients vs 40%, P=0.016) and hospital stay tended to be shorter in the MEF group (40 vs 54.5 days, P=0.08). In the univariate analysis, factors influencing the length of parenteral nutrition during the 2 periods were the severity of perivisceritis and new nutritional protocol. In the multivariate analysis, only nutritional protocol was significantly associated with the length of parenteral nutrition (P=0.038).
Early MEF and controlled increase of nutritional elements after bowel reintegration significantly improved outcome of gastroschisis in newborns.
本研究旨在评估早期微量肠内喂养（MEF）及逐步增加肠内营养对腹裂新生儿预后的影响。
前瞻性评估一个干预组，并与一个观察性历史对照组进行比较。该前瞻性研究依据一种新的肠内营养方案。根据新方案，在肠道复位术后5天开始进行MEF，奶量以每天12 mL/kg的速度增加。在对照组中，肠内营养延迟至术后肠梗阻缓解，且喂养增加未系统化。
MEF组纳入22例患者，并与51例对照患者进行比较。对照组婴儿的孕周较低（36孕周对35孕周[GW]，P = 0.03），出生体重较低（2465 g对2200 g，P = 0.05）。MEF组首次进行肠内营养的时间显著更短（5天对11.5天，P = 0.0005）。该组所有患者在60天时完全通过肠内喂养，而对照组30.4%的患者在60天时仍需要肠外营养（P = 0.004）。MEF组医院感染发生率降低（患者比例9%对40%，P = 0.016），住院时间有缩短趋势（40天对54.5天，P = 0.08）。在单因素分析中，两个时期影响肠外营养时长的因素是内脏周围炎的严重程度和新的营养方案。在多因素分析中，只有营养方案与肠外营养时长显著相关（P =
