Division of Neonatology, Akron Children's Hospital, Akron, OH, USA.
J Perinatol. 2013 Nov;33(11):851-7. doi: 10.1038/jp.2013.66. Epub 2013 Jun 13.
To assess how a standard practice for nutrition support in very low birth weight (VLBW) neonates would impact on their hospital course.
This was a prospective, single center, before vs after comparison of a non-standardized approach to nutrition in VLBW neonates to a standardized approach. Standardization of feeding initiation, feeding volume and caloric advancement, management of feeding aspirates (residuals), use of starter parenteral nutrition (PN), use of breast milk and donor breast milk, initiation and discontinuation of intravenous (IV) intralipids, documentation of protein use, and utilization of percutaneously inserted central venous catheters were performed. Multiple outcome measures were evaluated. Fisher's exact, Mann-Whitney U-tests and χ(2) tests were used for statistical analysis.
Sixty-nine infants in the pre-standardization (non-standardized) group were compared with 154 infants in the standardized approach group. Analysis was performed for each group as a whole. Statistically significant improvements were seen in multiple areas for the standardized group including the day of life birth weight was regained (P<0.0005), use of breast milk as the initial feeding (P<0.0001), use of starter PN on admission (P<0.0001), earlier time for initiation of PN (P<0.0001), decreased use of PN overall (P<0.0001), enteral protein use (P<0.0001), earlier time for initiation of IV intralipids (P<0.002), day of life for full enteral feeds (P<0.0005) and first day for initiation of enteral feeds (P<0.0001). Fewer infants born microcephalic at birth remained so at discharge in the standardized group as compared with the pre-standardized group (P<0.02). Similarly, less infants born small for gestational age at birth remained so at discharge in the standardized group as compared with the pre-standardized group (P<0.05). Two cases of necrotizing enterocolitis (NEC) occurred in the pre-standardization group and one in the standardized group. No coagulase-negative Staphlococcal infections or line infections occurred during the entire study period. Two cases of sepsis occurred in the pre-standardization group, both in infants <750 g. No cases of sepsis occurred in the standardized group. Cost savings were remarkable from decreased PN usage in the standard group.
Implementation of a standardized approach to nutrition in VLBW infants reduces the use of PN thereby reducing cost, causes a more rapid regain of birth weight, decreases the number of babies that are small for gestational age and microcephalic at discharge, and decreases the time to full enteral feeds. No adverse increases in mortality, sepsis, NEC, coagulase-negative Staphlococcal infections or line infections occurred.
评估极低出生体重（VLBW）新生儿营养支持的标准实践如何影响其住院过程。
这是一项前瞻性、单中心、前后对照研究，比较了 VLBW 新生儿非标准化营养方法与标准化营养方法。通过标准化喂养起始、喂养量和热量推进、喂养吸出物（残留量）管理、起始使用肠外营养（PN）、使用母乳和捐赠母乳、开始和停止静脉（IV）脂肪乳、记录蛋白质使用情况以及使用经皮插入中心静脉导管，对喂养方法进行了评估。评估了多项结果指标。使用 Fisher 确切检验、Mann-Whitney U 检验和 χ(2)检验进行统计分析。
69 例在标准前（非标准化）组与 154 例在标准组进行比较。对每个组进行了整体分析。标准化组在多个方面均显示出统计学上的显著改善，包括恢复出生体重的日龄（P<0.0005）、使用母乳作为初始喂养（P<0.0001）、入院时起始使用 PN（P<0.0001）、更早开始 PN（P<0.0001）、整体上减少 PN 使用（P<0.0001）、肠内蛋白质使用（P<0.0001）、更早开始 IV 脂肪乳（P<0.002）、开始全肠内喂养的日龄（P<0.0005）和开始肠内喂养的第 1 天（P<0.0001）。与标准前组相比，标准化组出生时小头畸形的婴儿在出院时仍保持小头畸形的比例较低（P<0.02）。同样，与标准前组相比，出生时小于胎龄的婴儿在标准化组中仍保持小于胎龄的比例较低（P<0.05）。标准前组有 2 例坏死性小肠结肠炎（NEC），标准组有 1 例。在整个研究期间，均未发生凝固酶阴性葡萄球菌感染或导管感染。标准前组有 2 例败血症，均发生在<750 g 的婴儿中。标准组未发生败血症。标准组 PN 使用减少，显著降低了成本。
在 VLBW 婴儿中实施标准化营养方法可减少 PN 的使用，从而降低成本，更快地恢复出生体重，减少出院时小于胎龄和小头畸形的婴儿数量，并缩短达到全肠内喂养的时间。未增加死亡率、败血症、NEC、凝固酶阴性葡萄球菌感染或导管感染。
