营养在促进支气管肺发育不良早产儿生长中的作用：一项前瞻性非随机干预队列研究。
The role of nutrition in promoting growth in pre-term infants with bronchopulmonary dysplasia: a prospective non-randomised interventional cohort study.
作者信息
Giannì Maria Lorella, Roggero Paola, Colnaghi Maria Rosa, Piemontese Pasqua, Amato Orsola, Orsi Anna, Morlacchi Laura, Mosca Fabio
机构信息
NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122 Milan, Italy.
出版信息
BMC Pediatr. 2014 Sep 22;14:235. doi: 10.1186/1471-2431-14-235.
BACKGROUND
Pre-term infants who develop bronchopulmonary dysplasia (BPD) are at risk of postnatal growth failure. It has been reported that energy expenditure is higher in infants with BPD than in those without BPD. The aim of the study was to evaluate whether increasing the enteral energy intake of pre-term infants with BPD can improve post-natal growth.
METHODS
This prospective, non-randomised interventional cohort study was designed to assess growth in 57 preterm infants with BPD (gestational age <32 weeks, birth weight <1500 g, and persistent oxygen dependency for up to 28 days of life) fed individually tailored fortified breast milk and/or preterm formula, and a historical control group of 73 pre-term infants with BPD fed breast milk fortified in accordance with the instructions of the manufacturer and/or pre-term formula. Between-group differences in the continuous variables were analysed using Student's t test or the Mann-Whitney test; the discrete variables were compared using the chi-squared test. Linear regression analysis was used to investigate the independent contribution of enteral energy intake to weight gain velocity.
RESULTS
The duration of parenteral nutrition was similar in the historical and intervention groups (43.7 ± 30.9 vs 39.6 ± 17.4 days). After the withdrawal of parenteral nutrition, enteral energy intake was higher in the infants in the intervention group with mild or moderate BPD (131 ± 6.3 vs 111 ± 4.6 kcal/kg/day; p < 0.0001) and in those with severe BPD (126 ± 5.3 vs 105 ± 5.1 kcal/kg/day; p < 0.0001), whereas enteral protein intake was similar (3.2 ± 0.27 vs 3.1 ± 0.23 g/kg/day).Weight gain velocity was greater in the infants in the intervention group with mild or moderate BPD (14.7 ± 1.38 vs 11.5 ± 2 g/kg/day, p < 0.0001) and in those with severe BPD (11.9 ± 2.9 vs 8.9 ± 2.3 g/kg/day; p < 0.007). The percentage of infants with post-natal growth retardation at 36 weeks of gestational age was higher in the historical group (75.3 vs 47.4; p = 0.02).
CONCLUSIONS
On the basis of the above findings, it seems that improved nutritional management promotes post-natal ponderal growth in pre-term infants with BPD.
背景
发生支气管肺发育不良（BPD）的早产儿有出生后生长发育迟缓的风险。据报道，患有BPD的婴儿能量消耗高于未患BPD的婴儿。本研究的目的是评估增加患有BPD的早产儿的肠内能量摄入量是否能改善出生后的生长情况。
方法
本前瞻性、非随机干预队列研究旨在评估57例患有BPD的早产儿（胎龄<32周，出生体重<1500 g，出生后持续吸氧依赖长达28天）的生长情况，这些婴儿喂养个体化定制的强化母乳和/或早产儿配方奶粉，以及一个历史对照组，该组73例患有BPD的早产儿按照制造商的说明喂养强化母乳和/或早产儿配方奶粉。连续变量的组间差异采用学生t检验或曼-惠特尼检验进行分析；离散变量采用卡方检验进行比较。采用线性回归分析来研究肠内能量摄入对体重增加速度的独立贡献。
结果
历史对照组和干预组的肠外营养持续时间相似（43.7±30.9天 vs 39.6±17.4天）。停止肠外营养后，干预组中轻度或中度BPD的婴儿肠内能量摄入量更高（131±6.3 vs 111±4.6 kcal/kg/天；p<0.0001），重度BPD的婴儿也是如此（126±5.3 vs 105±5.1 kcal/kg/天；p<0.0001），而肠内蛋白质摄入量相似（3.2±0.27 vs 3.1±0.23 g/kg/天）。干预组中轻度或中度BPD的婴儿体重增加速度更快（14.7±1.38 vs 11.5±2 g/kg/天，p<0.0001），重度BPD的婴儿也是如此（11.9±2.9 vs 8.9±2.3 g/kg/天；p<0.007）。历史对照组中孕36周时出生后生长迟缓的婴儿百分比更高（75.3 vs 47.4；p=0.02）。
结论
基于上述发现，似乎改善营养管理可促进患有BPD的早产儿出生后的体重增长。
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