优化生长受限的极早产儿的肠内营养——一项艰巨的任务。

Optimising enteral nutrition in growth restricted extremely preterm neonates--a difficult proposition.

作者信息

Shah P, Nathan E, Doherty D, Patole S

机构信息

a Department of Neonatal Paediatrics , KEM Hospital for Women , Perth , Australia .

b Women and Infants Research Foundation, KEM Hospital for Women , Perth , Australia .

出版信息

J Matern Fetal Neonatal Med. 2015 Nov;28(16):1981-4. doi: 10.3109/14767058.2014.974538. Epub 2014 Nov 4.

DOI:10.3109/14767058.2014.974538

PMID:25302862

Abstract

BACKGROUND

Optimising enteral nutrition of extremely preterm neonates (EP: Gestation <28 weeks) with intrauterine growth restriction (IUGR) has always been difficult considering their higher risk of necrotising enterocolitis (NEC), and frequency of feed intolerance.

AIM

To evaluate the nutritional outcomes in EP neonates with IUGR.

METHODS

Data on demographic characteristics, feeding details (e.g. type of milk, postnatal age at start), and outcomes to discharge or death were collected from the medical notes for all EP neonates, who survived first 72 h of life, between January 2009 and December 2010. A standardised feeding protocol was followed during the study period.

RESULTS

38/220 (17.3%) EP neonates admitted during the study period had IUGR. The mean (IQR) age at start of minimal enteral nutrition [7 (5-10) versus 5 (4-8) days, p = 0.005), and nutritional (1 ml/2 hourly) feeds [12 (8-15) versus 9 (7-13) days, p = 0.034] was significantly delayed in IUGR compared to non-IUGR neonates. IUGR neonates reached full enteral feeds (150 ml/kg/day) at a significantly late median (IQR) postnatal age [32 (21-40) versus 24 (17-31) days, p = 0.009), taking longer time to achieve this milestone [20 (15-34) versus 16 (12-4) days, p = 0.008). The incidence of postnatal growth restriction was significantly higher in IUGR versus non-IUGR (73% versus 45%, p = 0.003) neonates. The incidence of ≥ Stage II NEC was low [18/220 (8.1%)] to make valid statistical comparisons.

CONCLUSION

Optimising enteral nutrition in growth restricted extremely preterm neonates is difficult using the current strategies for enteral nutrition.

摘要

背景

考虑到极低出生体重早产儿（EP：孕周<28周）合并宫内生长受限（IUGR）发生坏死性小肠结肠炎（NEC）的风险较高以及喂养不耐受的发生率较高，优化其肠内营养一直很困难。

目的

评估合并IUGR的极低出生体重早产儿的营养结局。

方法

收集2009年1月至2010年12月期间所有度过生命最初72小时的极低出生体重早产儿的医疗记录中的人口统计学特征、喂养细节（如奶的类型、开始喂养时的出生后年龄）以及出院或死亡结局。研究期间遵循标准化喂养方案。

结果

研究期间收治的220例极低出生体重早产儿中有38例（17.3%）合并IUGR。与非IUGR早产儿相比，IUGR早产儿开始微量肠内营养的平均（IQR）年龄显著延迟[7（5 - 10）天对5（4 - 8）天，p = 0.005]，开始营养性（每2小时1毫升）喂养的平均（IQR）年龄也显著延迟[12（8 - 15）天对9（7 - 13）天，p = 0.034]。IUGR早产儿达到完全肠内喂养（150毫升/千克/天）时的出生后年龄中位数（IQR）显著延迟[32（21 - 40）天对24（17 - 31）天，p = 0.009]，达到这一里程碑所需时间更长[20（15 - 34）天对16（12 - 4）天，p = 0.008]。IUGR早产儿出生后生长受限的发生率显著高于非IUGR早产儿（73%对45%，p = 0.003）。≥II期NEC的发生率较低[18/220（8.1%）]，无法进行有效的统计学比较。