Hamilton Emily, Massey Cynthia, Ross Julie, Taylor Sarah
Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States.
Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States.
Early Hum Dev. 2014 May;90(5):227-30. doi: 10.1016/j.earlhumdev.2014.02.005. Epub 2014 Mar 4.
BACKGROUND/AIM: Debate exists about when to initiate enteral feeding (EF) in very low birth weight (VLBW) preterm infants. This retrospective study compared the effectiveness of an education-based quality improvement project and the relationship of time of the first EF to necrotizing enterocolitis (NEC) or death incidence and parenteral nutrition (PN) days in VLBW infants.
STUDY DESIGN/SUBJECTS: VLBW infants born in 2 epochs were compared for hour of the first feed, PN days, NEC or death incidence, and feeding type. The 2 epochs were temporally divided by a quality improvement initiative to standardize initiation of EF in postnatal hours 6-24.
603 VLBW infants were included. Median time of feed initiation decreased from 33 (Epoch 1) to 14h (Epoch 2) (p<0.0001). Median PN days were 14 vs. 12, respectively (p=0.07). The incidence of NEC or death was 13.4% vs. 9.5%, respectively (p=0.14). When controlling for birth weight, gestational age, race, gender, and time period, earlier feed initiation was associated with decreased NEC or death (p=0.003). Evaluation of the relationship of early EF (defined as within the first 24h) in Epoch 2 alone showed that early EF was significantly associated with decreased NEC or death (6.3 vs 15.1%) (RR, 95% CI=0.28, 0.13-0.58) and less PN days (p<0.0001).
In a VLBW infant cohort, an education-based process improvement initiative decreased time of EF initiation to a median of 14h with no associated increase in NEC or death. In fact, results suggest that earlier feeding is associated with decreased NEC or death.
背景/目的：对于极低出生体重（VLBW）早产儿何时开始肠内喂养（EF）存在争议。这项回顾性研究比较了一项基于教育的质量改进项目的效果，以及首次肠内喂养时间与坏死性小肠结肠炎（NEC）或死亡率和VLBW婴儿肠外营养（PN）天数之间的关系。
研究设计/对象：比较了两个时期出生的VLBW婴儿的首次喂养时间、PN天数、NEC或死亡率以及喂养类型。这两个时期在时间上以一项质量改进措施为界，该措施旨在规范出生后6至24小时内开始肠内喂养的操作。
纳入了603例VLBW婴儿。首次喂养的中位时间从第1期的33小时降至第2期的14小时（p<0.0001）。PN天数的中位数分别为14天和12天（p=0.07）。NEC或死亡率分别为13.4%和9.5%（p=0.14）。在控制出生体重、胎龄、种族、性别和时间段后，更早开始喂养与NEC或死亡率降低相关（p=0.003）。仅对第2期早期肠内喂养（定义为出生后24小时内）的关系进行评估发现，早期肠内喂养与NEC或死亡率显著降低相关（6.3%对15.1%）（相对风险，95%置信区间=0.28，0.13 - 0.58）且PN天数减少（p<0.0001）。
在一个VLBW婴儿队列中，一项基于教育的流程改进措施将肠内喂养开始时间降至中位数14小时，且未伴随NEC或死亡率增加。事实上，结果表明更早喂养与NEC或死亡率降低相关。
