通过实施基于证据的早产儿喂养套餐预防产后生长受限。
Prevention of postnatal growth restriction by the implementation of an evidence-based premature infant feeding bundle.
机构信息
Nursing (Neonatology), Albany Medical Center, Albany, NY, USA.
Pediatrics (Neonatology), Children's Hospital at Albany Medical Center, Albany, NY, USA.
出版信息
J Perinatol. 2015 Aug;35(8):642-9. doi: 10.1038/jp.2015.35. Epub 2015 Apr 16.
OBJECTIVE
To develop an evidence-based feeding bundle to safely decrease the rate of PNGR in VLBW infants.
STUDY DESIGN
The bundle was developed and implemented in January 2010, followed by 3 years of monitoring bundle compliance and infant outcomes (days to first feed (FD), days to reach full feeds (FF), and birth-discharge growth trajectories (delta z-score)).
RESULTS
Data were collected on 482 infants (119 pre-bundle). PNGR decreased from 35% to 19% (P<0.01) and weight delta z-score improved from -0.82 to -0.45 (P<0.001). Percentage of infants with head circumference (HC) below 10th percentile at discharge decreased from 21% to 9% (P<0.01) and HC delta z-score improved from -0.65 to -0.17 (P<0.001). FD and FF also decreased significantly. Rates of necrotizing enterocolitis, peak alkaline phosphatase and peak direct bilirubin levels all trended downward.
CONCLUSIONS
An evidence-based, standardized feeding bundle was safe and effective in reducing the rate of PNGR and in improving head growth in VLBW infants.
目的
制定循证喂养方案，以安全降低极低出生体重儿（VLBW）的 PNGR 发生率。
研究设计
该方案于 2010 年 1 月制定并实施，随后对方案依从性和婴儿结局（首次喂养日（FD）、达到全喂养日（FF）天数以及出生-出院生长轨迹（delta z 评分））进行了 3 年监测。
结果
共收集了 482 名婴儿（119 名在方案前）的数据。PNGR 从 35%降至 19%（P<0.01），体重 delta z 评分从-0.82 改善至-0.45（P<0.001）。出院时头围（HC）低于第 10 百分位数的婴儿比例从 21%降至 9%（P<0.01），HC delta z 评分从-0.65 改善至-0.17（P<0.001）。FD 和 FF 也显著降低。坏死性小肠结肠炎、碱性磷酸酶峰值和直接胆红素峰值的发生率均呈下降趋势。
结论
循证、标准化喂养方案安全且有效，可降低 VLBW 婴儿的 PNGR 发生率，并改善头围生长。
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