Pérez Luis Alfonso, Pradilla Germán Lauro, Díaz Gaby, Bayter Sandra María
Departamento de Pediatría, Facultad de Salud, Escuela de Medicina, Universidad Industrial de Santander, Bucaramanga, Colombia.
Biomedica. 2011 Oct-Dec;31(4):485-91. doi: 10.1590/S0120-41572011000400003.
The development of necrotizing enterocolitis is a common and serious risk to newborns. It is caused by splanchnic bed vasoconstriction that can produce intestinal necrosis. The role of onset time, type and, speed enhancements of The factors of enteral feeding related with necrotizing enterocolitis genesis such as feeding onset, type and frequency are not well understood.
The incidence of necrotizing enterocolitis and mortality among infants will be compared in infants whose enteral feeding was initiated 48 hours after birth to those whose feeding began on day 5 postpartum.
A controlled clinical trial was conducted among 239 newborns weighing between 750-1,500 g and a gestation age of 27-32 weeks of gestational age. The infants were randomly assigned to two groups--135 to an early feeding regime and 104 to delayed feeding. Breast milk or formula milk was used. Feeding was begun with one ml every six hours, progressing to three hour intervals and 20 ml/kg daily. This was increased to 150 ml/kg-d if the infant condition remained stable and it manifested no oral intolerance.
In the early feeding group, 14 (10;4 %) necrotizing enterocolitis cases occurred, and in the late feeding group, 9 (8.7 %) occurred (RR= 1.22, 95 % CI 0.49-3.20, p= 0.65). Five children died in early feeding group (3.7 %, 95% CI 1.4-8.9) and eight in late feeding group (7.7 %, 95 % CI 3.6-15.0, RR=0.46, 95 % CI 0.12-1,60, p= 0.18).
Early enteral feeding in preterm newborns does not increase the risk of necrotizing enterocolitis or mortality among them; however it represents nutritional advantages for these infants.
坏死性小肠结肠炎的发展是新生儿常见且严重的风险。它由内脏床血管收缩引起，可导致肠道坏死。与坏死性小肠结肠炎发生相关的肠内喂养因素，如喂养开始时间、类型和频率的起始时间、类型及速度增加的作用尚不清楚。
比较出生后48小时开始肠内喂养的婴儿与产后第5天开始喂养的婴儿中坏死性小肠结肠炎的发病率和死亡率。
对239名体重在750 - 1500克、胎龄为27 - 32周的新生儿进行了一项对照临床试验。婴儿被随机分为两组——135名采用早期喂养方案，104名采用延迟喂养。使用母乳或配方奶。开始时每6小时喂1毫升，逐渐进展到每3小时一次，每日20毫升/千克。如果婴儿状况保持稳定且无口服不耐受情况，则增加至150毫升/千克 - 天。
早期喂养组发生14例（10.4%）坏死性小肠结肠炎病例，延迟喂养组发生9例（8.7%）（相对危险度 = 1.22，95%可信区间0.49 - 3.20，p = 0.65）。早期喂养组5名儿童死亡（3.7%，95%可信区间1.4 - 8.9），延迟喂养组8名儿童死亡（7.7%，95%可信区间3.6 - 15.0，相对危险度 = 0.46，95%可信区间0.12 - 1.60，p = 0.18）。
早产新生儿早期肠内喂养不会增加坏死性小肠结肠炎的风险或死亡率；然而，这对这些婴儿具有营养优势。
