Cormack Barbara, Sinn John, Lui Kei, Tudehope David
Auckland City Hospital, Auckland, New Zealand.
J Paediatr Child Health. 2013 Apr;49(4):E340-7. doi: 10.1111/jpc.12016. Epub 2012 Dec 11.
This survey investigated standardised feeding guidelines and nutrition policy in Australasian neonatal intensive care units and compared these with previously published surveys and international consensus nutrition recommendations.
An electronic survey on enteral nutrition comprising a wide range of questions about clinical practice was e-mailed to all 25 Australasian neonatal intensive care unit directors of tertiary perinatal centres.
Twenty-five surveys were distributed; 24 (96%) were completed. All respondents preferred breast milk as the first feed. For infants <1000 g, 58% started feeds at 1 mL every 4 hours and 83% started enteral feeds on day 0-2 in the absence of contraindications. The identification of bile-stained gastric aspirates significant enough to withhold feeds varied. Multicomponent breast milk fortifiers were added by 58% when enteral feeds reached 150 mL/kg day, while 21% added these earlier at 120 mL/kg day or less. Iron supplementation was started at 4 weeks by 63% and at 6 weeks by 27%. Only 42% of units had a neonatal dietitian. Of the 24 units who responded, 58% had no written enteral feeding guidelines.
Enteral nutrition was initiated earlier than in the past. Great variation remains in clinical practices. Nutritional implications are discussed. Standardisation of feeding guidelines and enteral nutrition policy based on current evidence and international consensus nutrition recommendations may be beneficial and should be encouraged.
本调查研究了澳大利亚和新西兰新生儿重症监护病房的标准化喂养指南和营养政策，并将其与先前发表的调查结果及国际共识营养建议进行比较。
通过电子邮件向所有25家澳大利亚三级围产期中心新生儿重症监护病房主任发送了一份关于肠内营养的电子调查问卷，其中包含一系列关于临床实践的问题。
共发放25份调查问卷；24份（96%）完成。所有受访者均首选母乳作为首次喂养。对于体重<1000克的婴儿，58%每4小时以1毫升的量开始喂养，83%在无禁忌证的情况下于第0 - 2天开始肠内喂养。对足以暂停喂养的胆汁染色胃吸出物的判定存在差异。当肠内喂养量达到150毫升/千克·日时，58%的单位添加了多成分母乳强化剂，而21%在120毫升/千克·日及以下时就更早添加了这些强化剂。63%的单位在4周开始补充铁剂，27%在6周开始。只有42%的单位有新生儿营养师。在回复的24个单位中，58%没有书面的肠内喂养指南。
肠内营养开始时间比过去更早。临床实践中仍存在很大差异。对营养方面的影响进行了讨论。基于当前证据和国际共识营养建议对喂养指南和肠内营养政策进行标准化可能有益，应予以鼓励。
