Fanaro Silvia
Neonatal Intensive Care Unit, Paediatric Section, University of Ferrara, Italy.
J Matern Fetal Neonatal Med. 2012 Oct;25 Suppl 4:54-6. doi: 10.3109/14767058.2012.715021.
Postnatal growth restriction and failure to thrive is a major issue in preterm, especially extremely low-birth-weight infants. Optimization of enteral nutrition, without increasing the risk of necrotizing enterocolitis (NEC), has thus become a priority for the neonatologist, who often has to face the challenge of interpreting the clinical and prognostic significance of common and aspecific signs of feeding intolerance (FI). The neonatologist often prescribes enteral nutrition as if walking on a tightrope between the purposed attainment of full enteral feeding and the fear of NEC. Despite advances in neonatal intensive care, NEC still remains one of the leading causes of mortality (15-30%) and morbidity in very-low-birth-weight infants. However, the relationship between FI and NEC remains unknown. Feeding intolerance often leads to discontinuation of enteral feeds, delayed attainment of full enteral feeding and prolongation of hospitalization. Strategies aimed at preventing and/or treating episodes of feeding intolerance are diverse and not always supported by scientific evidence.
出生后生长受限和发育不良是早产儿尤其是极低出生体重儿的一个主要问题。因此，在不增加坏死性小肠结肠炎（NEC）风险的情况下优化肠内营养，已成为新生儿科医生的首要任务，他们常常面临解读喂养不耐受（FI）常见且非特异性体征的临床和预后意义这一挑战。新生儿科医生在开具肠内营养处方时，常常像是在达到完全肠内喂养的目标与担心发生NEC之间走钢丝。尽管新生儿重症监护取得了进展，但NEC仍然是极低出生体重儿死亡（15%-30%）和发病的主要原因之一。然而，FI与NEC之间的关系仍然不明。喂养不耐受常常导致肠内喂养中断、完全肠内喂养延迟及住院时间延长。旨在预防和/或治疗喂养不耐受发作的策略多种多样，且并非总是有科学依据支持。
