中度早产婴儿的营养实践、指南依从性及产后生长：法国NUTRIQUAL调查
Nutrition practice, compliance to guidelines and postnatal growth in moderately premature babies: the NUTRIQUAL French survey.
作者信息
Iacobelli Silvia, Viaud Marianne, Lapillonne Alexandre, Robillard Pierre-Yves, Gouyon Jean-Bernard, Bonsante Francesco
机构信息
Centre d'Etudes Périnatales de l'Océan Indien, CHU La Réunion - Saint Pierre, BP 350 97448, Saint Pierre Cedex, France.
Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion - Saint Pierre, Saint Pierre Cedex, BP 350 97448, France.
出版信息
BMC Pediatr. 2015 Sep 3;15:110. doi: 10.1186/s12887-015-0426-4.
BACKGROUND
The nutritional care provided to moderately premature babies is poorly studied. For a large cohort of such babies, we aimed to describe: nutrition practice intentions, comparison of the intended with the actual practice, compliance of actual practice to current nutrition guidelines, and postnatal growth.
METHODS
A questionnaire was sent out to 29 neonatal intensive care units in France, in order to address practice intentions. In the same units, retrospective patient's data were collected to assess actual practice, compliance to nutrition guidelines and infant postnatal growth. The cumulative nutritional deficit during the two first weeks of life was calculated and variables associated with ΔZ-score for weight at 36 weeks postconceptional age/discharge (ΔZ-score(w) 36PCA/DC) were analysed by multivariate linear regression.
RESULTS
276 infants born 30 to 33 weeks of gestation were studied. Among them, 76% received parenteral nutrition on central venous line after birth. On day of life 1 (DOL1), 93% of infants had parenteral amino acids (AA), at an intake ≥ 1.5 g/kg in 27% of cases. Lipids were started at ≤ DOL2 in 47% of infants. There was a divergence between the intended and the actual practice for both AA and lipids intake. The AA and energy cumulative deficit (DOL1 to DOL14) were respectively 10.9 ± 8.3 g/kg and 483 ± 181 kcal/kg. Weight Z-score (mean ± SD) significantly decreased from birth (-0.17 ± 0.88) to 36 weeks PCA/DC (-1.00 ± 0.82) (p < 0.0001), and the extra-uterine growth retardation (EUGR) rate at 36 weeks PCA/DC was 24.2%. Independent variables associated with ΔZ-score(w) 36PCA/DC were AA cumulative intake and DOL of full enteral feeding.
CONCLUSIONS
Nutrition intake was not in compliance with recommendations, and the rate of EUGR was considerable in this cohort. Efforts are needed to improve adherence to nutrition guidelines and growth outcome of moderately preterm infants.
背景
针对中度早产婴儿的营养护理研究较少。对于一大群此类婴儿，我们旨在描述：营养实践意图、预期实践与实际实践的比较、实际实践对当前营养指南的依从性以及出生后的生长情况。
方法
向法国的29个新生儿重症监护病房发放问卷，以了解实践意图。在相同的病房中，收集患者的回顾性数据，以评估实际实践、对营养指南的依从性以及婴儿出生后的生长情况。计算出生后头两周的累积营养缺乏量，并通过多元线性回归分析与孕龄36周/出院时体重的ΔZ评分（ΔZ-score(w) 36PCA/DC）相关的变量。
结果
研究了276例妊娠30至33周出生的婴儿。其中，76%的婴儿出生后接受了中心静脉肠外营养。出生后第1天（DOL1），93%的婴儿接受了肠外氨基酸（AA），27%的病例摄入量≥1.5 g/kg。47%的婴儿在≤DOL2时开始使用脂质。AA和脂质摄入量的预期实践与实际实践之间存在差异。AA和能量累积缺乏量（DOL1至DOL14）分别为10.9±8.3 g/kg和483±181 kcal/kg。体重Z评分（平均值±标准差）从出生时的（-0.17±0.88）显著下降至孕龄36周/出院时的（-1.00±0.82）（p<0.0001），孕龄36周时宫外生长迟缓（EUGR）率为24.2%。与ΔZ-score(w) 36PCA/DC相关的独立变量为AA累积摄入量和完全肠内喂养的DOL。
结论
营养摄入量不符合推荐标准，该队列中的EUGR率相当高。需要努力提高对营养指南的依从性以及中度早产儿的生长结局。
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