Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, 750 Welch Road, Palo Alto, CA 94304, USA.
J Perinatol. 2011 Apr;31 Suppl 1:S61-7. doi: 10.1038/jp.2010.185.
The objective of this study was to evaluate the impact of a standardized enteral feeding protocol for very low birth weight (VLBW) infants on nutritional, clinical and growth outcomes.
Retrospective analysis of VLBW cohorts 9 months before and after initiation of a standardized feeding protocol consisting of 6-8 days of trophic feedings, followed by an increase of 20 ml/kg/day. The primary outcome was days to reach full enteral feeds defined as 160 ml/kg/day. Secondary outcomes included rates of necrotizing enterocolitis and culture-proven sepsis, days of parenteral nutrition and growth end points.
Data were analyzed on 147 VLBW infants who received enteral feedings, 83 before ('Before') and 64 subsequent to ('After') feeding protocol initiation. Extremely low birth weight (ELBW) infants in the After group attained enteral volumes of 120 ml/kg/day (43.9 days Before vs 32.8 days After, P=0.02) and 160 ml/kg/day (48.5 days Before vs 35.8 days After, P=0.02) significantly faster and received significantly fewer days of parenteral nutrition (46.2 days Before vs 31.3 days After, P=0.01). Necrotizing enterocolitis decreased in the After group among VLBW (15/83, 18% Before vs 2/64, 3% After, P=0.005) and ELBW infants (11/31, 35% Before vs 2/26, 8% After, P=0.01). Late-onset sepsis decreased significantly in the After group (26/83, 31% Before vs 6/64, 9% After, P=0.001). Excluding those with weight <3rd percentile at birth, the proportion with weight <3rd percentile at discharge decreased significantly after protocol initiation (35% Before vs 17% After, P=0.03).
These data suggest that implementation of a standardized feeding protocol for VLBW infants results in earlier successful enteral feeding without increased rates of major morbidities.
本研究旨在评估极低出生体重儿（VLBW）标准化肠内喂养方案对营养、临床和生长结局的影响。
回顾性分析 9 个月前和实施标准化喂养方案后的 VLBW 队列，该方案包括 6-8 天的营养喂养，随后每天增加 20ml/kg。主要结局是达到全肠内喂养的天数，定义为 160ml/kg/天。次要结局包括坏死性小肠结肠炎和培养阳性败血症的发生率、肠外营养天数和生长终点。
共分析了 147 例接受肠内喂养的 VLBW 婴儿的数据，其中 83 例在喂养方案实施前（“前”组），64 例在实施后（“后”组）。在后组中，极低出生体重儿（ELBW）婴儿达到 120ml/kg/天的肠内容量（43.9 天前 vs 32.8 天后，P=0.02）和 160ml/kg/天的肠内容量（48.5 天前 vs 35.8 天后，P=0.02）的速度明显更快，且接受肠外营养的天数明显更少（46.2 天前 vs 31.3 天后，P=0.01）。在后组中，VLBW（15/83，18%前 vs 2/64，3%后，P=0.005）和 ELBW 婴儿（11/31，35%前 vs 2/26，8%后，P=0.01）中坏死性小肠结肠炎的发生率降低。在后组中，晚发性败血症显著下降（26/83，31%前 vs 6/64，9%后，P=0.001）。排除出生体重<第 3 百分位的婴儿后，方案实施后出院时体重<第 3 百分位的婴儿比例显著下降（35%前 vs 17%后，P=0.03）。
这些数据表明，对极低出生体重儿实施标准化喂养方案可更早成功进行肠内喂养，且不会增加主要并发症的发生率。
Zotero 插件