Li Zheng-hong, Dong Mei, Wang Dan-hua
Department of Pediatrics, Chinese Academy of Medical Sciences, Beijing, China.
Zhonghua Er Ke Za Zhi. 2012 Jul;50(7):543-8.
Along with the elevation of survival rate of very low birth weight infants (VLBWI), the enteral feeding of VLBWI has become one of the most important factors, which influence the length of stay, short and long-term prognosis. This study aimed to explore safe and effective clinical protocols of VLBWI enteral feeding.
According to different correlative degree of related factors to VLBWI enteral feeding, different scoring system was formulated for the enteral feeding and monitoring proposal of VLBWI. The safety and efficacy of the score system was evaluated.
Forty-eight VLBWIs in group A was not treated with any score system, gestational age (30.0 ± 2.1) weeks, birth weight (1173 ± 170) g; while 48 VLBWIs in group B were guided with the scoring system, gestational age (30.3 ± 1.7) weeks, birth weight (1133 ± 238) g, there was no significant difference between two groups. The incidence of newborn respiratory distress syndrome of group B was significantly higher than that of group A (P = 0.016). The time of umbilical catheterization of group B was longer than that of group A. There was no significant difference in the incidence of other complications between two groups. The beginning milk volume, milk volume on the third, seventh, fourteenth, twenty-first, twenty-eight day of group B were significantly higher than that of group A [5.6 vs. 3.5 ml/(kg·d), P = 0.008, 12.3 vs. 5.7 ml/(kg·d), P = 0.000, 29.1 vs 8.9 ml/(kg·d), P = 0.000, 62.5 vs. 44.6 ml/(kg·d), P = 0.020, 98.1 vs. 71.5 ml/(kg·d), P = 0.005, 128.0 vs. 102.4 ml/(kg·d), P = 0.011]. The time achieving full enteral feeding of group B was shorter than that of group A (26.7 vs 32.9d, P = 0.007). The incidence of necrotizing enterocolitis in group B was lower than that of group A(0/48 vs. 4/48, P = 0.041). There was no significant difference of the total amino acid dosage between two groups. The total dosage of fatty emulsion was less, and the duration of parenteral nutrition was shorter in group B than in group A (50.3 vs. 73.9 g/kg, P = 0.000, 31.5 vs. 37.8 d, P = 0.016). There was no significant difference in length of stay between two groups. VLBWI of group B began to gain weight earlier [5.0 (4.3, 6.0) vs. 5.0 (5.0, 7.0) d, P = 0.028], regained birth weight earlier (9.2 vs. 11.6 d, P = 0.001), and got more weight in the second week (178 vs. 138 g, P = 0.020).
VLBWI guided with the scoring system achieved full enteral feeding faster, and shortened the duration of parenteral nutrition without increasing the incidence of necrotizing enterocolitis.
随着极低出生体重儿（VLBWI）存活率的提高，VLBWI的肠内喂养已成为影响住院时间、短期和长期预后的最重要因素之一。本研究旨在探索VLBWI肠内喂养安全有效的临床方案。
根据与VLBWI肠内喂养相关因素的不同关联程度，制定不同的评分系统用于VLBWI的肠内喂养及监测方案。对该评分系统的安全性和有效性进行评估。
A组48例VLBWI未采用任何评分系统，胎龄（30.0±2.1）周，出生体重（1173±170）g；B组48例VLBWI采用评分系统指导，胎龄（30.3±1.7）周，出生体重（1133±238）g，两组间无显著差异。B组新生儿呼吸窘迫综合征的发生率显著高于A组（P=0.016）。B组脐导管留置时间长于A组。两组其他并发症的发生率无显著差异。B组开始喂奶量、第3、7、14、21、28天的奶量均显著高于A组[5.6比3.5ml/（kg·d），P=0.008；12.3比5.7ml/（kg·d），P=0.000；29.1比8.9ml/（kg·d），P=0.000；62.5比44.6ml/（kg·d），P=0.020；98.1比71.5ml/（kg·d），P=0.005；128.0比102.4ml/（kg·d），P=0.011]。B组达到完全肠内喂养的时间短于A组（26.7比32.9天，P=0.007）。B组坏死性小肠结肠炎的发生率低于A组（0/48比4/48，P=0.041）。两组总氨基酸用量无显著差异。B组脂肪乳剂总用量少，肠外营养持续时间短于A组（50.3比73.9g/kg，P=0.000；31.5比37.8天，P=0.016）。两组住院时间无显著差异。B组VLBWI开始体重增加更早[5.0（4.3，6.0）比5.0（5.0，7.0）天，P=0.028]，更早恢复出生体重（9.2比11.6天，P=0.001），且在第二周体重增加更多（178比138g，P=0.020）。
采用评分系统指导的VLBWI能更快实现完全肠内喂养，缩短肠外营养持续时间，且不增加坏死性小肠结肠炎的发生率。
