Kimak Karine S, de Castro Antunes Margarida M, Braga Taciana D, Brandt Katia G, de Carvalho Lima Marilia
*Post-Graduate Program in Child and Adolescent Health †Department of Maternal and Child Health, Federal University of Pernambuco ‡Neonatal Intensive Care Unit, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.
J Pediatr Gastroenterol Nutr. 2015 Oct;61(4):445-50. doi: 10.1097/MPG.0000000000000835.
The aim of the present study was to investigate the influence of enteral feeding management on occurrences of necrotizing enterocolitis (NEC) in very-low-birth-weight (VLBW) infants.
This was a case-control study conducted in a sample of 1028 VLBW infants (750 to 1499 g) admitted to a neonatal intensive care unit between January 2003 and May 2008. "Cases" were infants born with VLBW and diagnosed with NEC within the first 30 days of life, and "controls" were VLBW infants who did not develop NEC during this period. Occurrences of NEC were defined using the modified Bell criteria (stage ≥2).
Among the 1028 VLBW infants, 55 (5.4%) developed NEC within the first month of life. Logistic regression analysis showed that breast milk given exclusively for <7 days (odds ratio [OR] = 4.02), never achieving full enteral feeding during the first month (OR = 3.50), and parenteral nutrition (OR = 2.70) were factors that increased the chances of NEC occurrence. The use of vasoactive drugs was associated with a lower risk of NEC (OR = 0.15).
Breast milk should be recommended as a priority for the enteral nutrition of VLBW infants for no <7 days. Enteral nutrition should start early and progress quickly to achieve full enteral feeding; these procedures may help reduce the occurrence of NEC.
本研究旨在探讨肠内喂养管理对极低出生体重（VLBW）婴儿坏死性小肠结肠炎（NEC）发生率的影响。
这是一项病例对照研究，研究对象为2003年1月至2008年5月期间入住新生儿重症监护病房的1028例VLBW婴儿（750至1499克）。“病例”为出生时体重极低且在出生后30天内被诊断为NEC的婴儿，“对照”为在此期间未发生NEC的VLBW婴儿。NEC的发生采用改良贝尔标准（≥2期）进行定义。
在1028例VLBW婴儿中，55例（5.4%）在出生后第一个月内发生了NEC。逻辑回归分析显示，仅母乳喂养<7天（优势比[OR]=4.02）、在第一个月内从未实现完全肠内喂养（OR=3.50）以及肠外营养（OR=2.70）是增加NEC发生几率的因素。使用血管活性药物与较低的NEC风险相关（OR=0.15）。
应优先推荐VLBW婴儿进行至少7天的母乳喂养以进行肠内营养。肠内营养应尽早开始并迅速推进以实现完全肠内喂养；这些措施可能有助于降低NEC的发生率。
