Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, , London, UK.
Arch Dis Child Fetal Neonatal Ed. 2014 Jan;99(1):F6-F11. doi: 10.1136/archdischild-2013-304393. Epub 2013 Aug 23.
To describe feeding and gastrointestinal outcomes in growth-restricted infants <29 weeks' gestation and to determine the rate of feed advancement which they tolerate.
Analysis of prospectively collected data from a randomised feeding trial, the Abnormal Doppler Enteral Prescription Trial (ADEPT).
54 neonatal units in the UK and Ireland.
404 preterm, growth-restricted infants with abnormal antenatal Doppler studies from ADEPT. 83 infants <29 weeks and 312 infants ≥ 29 weeks' gestation were included in this analysis.
In ADEPT, infants were randomised to start milk 'early' on day 2 after birth, or 'late' on day 6. Subsequent feed advancement followed a regimen, which should have achieved full feeds by day 16 in the early and day 20 in the late group.
Full feeds were achieved later in infants <29 weeks; median age 28 days {IQR 22-40} compared with 19 days {IQR 17-23} in infants ≥ 29 weeks (HR 0.35, 95% CI 0.3 to 0.5). The incidence of necrotising enterocolitis was also higher in this group; 32/83 (39%) compared to 32/312 (10%) in those ≥ 29 weeks (RR 3.7, 95% CI 2.4 to 5.7). Infants <29 weeks tolerated very little milk for the first 10 days of life and reached full feeds 9 days later than predicted from the trial regimen.
Growth-restricted infants born <29 weeks' gestation with abnormal antenatal Doppler failed to tolerate even the careful feeding regimen of ADEPT. A slower advancement of feeds may be required for these infants.
ISRCTN87351483.
描述胎龄<29 周的生长受限婴儿的喂养和胃肠道结局，并确定他们能够耐受的喂养进展速度。
对来自随机喂养试验（ADEPT）的前瞻性收集数据进行分析。
英国和爱尔兰的 54 个新生儿单位。
ADEPT 中 404 名胎龄<29 周的生长受限、产前多普勒异常的早产儿。本分析纳入了 83 名胎龄<29 周和 312 名胎龄≥29 周的婴儿。
在 ADEPT 中，婴儿在出生后第 2 天“早期”开始接受牛奶，或在第 6 天“晚期”开始接受牛奶。随后的喂养进展遵循一种方案，该方案应该在早期组的第 16 天和晚期组的第 20 天达到全奶喂养。
胎龄<29 周的婴儿达到全奶喂养的时间较晚；中位数年龄 28 天 {IQR 22-40}，而胎龄≥29 周的婴儿为 19 天 {IQR 17-23}（HR 0.35，95%CI 0.3 至 0.5）。这组的坏死性小肠结肠炎发生率也较高；83 名婴儿中有 32 名（39%），而 312 名婴儿中有 32 名（10%）（RR 3.7，95%CI 2.4 至 5.7）。胎龄<29 周的婴儿在前 10 天的生命中几乎不能耐受任何牛奶，并且达到全奶喂养的时间比试验方案预测的晚 9 天。
胎龄<29 周、产前多普勒异常的生长受限婴儿甚至不能耐受 ADEPT 精心制定的喂养方案。这些婴儿可能需要更缓慢的喂养进展。
ISRCTN87351483。
