Lin Grace C, Robinson Daniel T, Olsen Steven, Reber Kristina M, Moallem Mohannad, DiGeronimo Robert, Mulroy Cecilia, Datta Ankur, Murthy Karna
*Department of Pediatrics, Feinberg School of Medicine, Northwestern University and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL†Department of Pediatrics, University of Missouri School of Medicine and Children's Mercy Hospitals and Clinics, Kansas City, MO‡Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH§Department of Pediatrics, University of Utah (RD) and Primary Children's Medical Center, Salt Lake City, MO||Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI.
J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):111-116. doi: 10.1097/MPG.0000000000001504.
The aim of the study was to describe the nutritional provisions received by infants with surgical necrotizing enterocolitis (NEC) and the associated effects on short-term growth.
Through the Children's Hospitals Neonatal Database, we identified infants born ≤32 weeks' gestation with surgical NEC from 5 regional neonatal intensive care units for 4 years. Excluded infants had isolated intestinal perforation and died <14 days postoperatively. Infants were stratified by their median parenteral protein dose (low [LP] or high [HP] protein) for the first postoperative week. The primary outcome was postoperative weight growth velocity. Growth (weight, length, and head circumference [HC]) was measured and the effects related to protein dose were estimated using multivariable analyses.
There were 103 infants included; the median parenteral protein dose received was 3.27 g · kg · day (LP: 2.80 g · kg · day; HP: 3.87 g · kg · day). Postoperative weight (11.5 ± 6.5 g · kg · day) and linear growth (0.9 ± 0.2 cm/wk) were similar regardless of dose (P > 0.3 between groups for weight and length). Unadjusted and independent associations were identified with HC changes and HP dose (β = 0.1 cm/wk, P = 0.03) after adjusting for gestational age, the presence of severe bronchopulmonary dysplasia, short bowel syndrome, blood stream infection, severe intraventricular hemorrhage, small for gestational age, and calorie intake. Eventual nonsurvivors received 18% less protein and 14% fewer calories over the first postoperative month.
Postoperative protein doses in infants with surgical NEC appear related to increases in HC. The influence of postoperative nutritional support on risk of adverse outcomes deserves further attention.
本研究旨在描述接受外科手术治疗的坏死性小肠结肠炎（NEC）婴儿所获得的营养供给情况以及对短期生长的相关影响。
通过儿童医院新生儿数据库，我们确定了来自5个地区新生儿重症监护病房、孕周≤32周且接受外科手术治疗NEC的婴儿，研究时间为4年。排除的婴儿为单纯肠穿孔且术后<14天死亡者。根据术后第一周肠外蛋白质剂量中位数（低[LP]或高[HP]蛋白）对婴儿进行分层。主要结局为术后体重增长速度。测量生长指标（体重、身长和头围[HC]），并使用多变量分析评估与蛋白质剂量相关的影响。
共纳入103例婴儿；接受的肠外蛋白质剂量中位数为3.27 g·kg·天（LP：2.80 g·kg·天；HP：3.87 g·kg·天）。无论剂量如何，术后体重（11.5±6.5 g·kg·天）和线性生长（0.9±0.2 cm/周）相似（体重和身长组间P>0.3）。在校正孕周、严重支气管肺发育不良、短肠综合征、血流感染、重度脑室内出血、小于胎龄儿和热量摄入后，发现未校正和独立的关联与HC变化及HP剂量有关（β=0.1 cm/周，P=0.03）。最终未存活者在术后第一个月接受的蛋白质少18%，热量少14%。
接受外科手术治疗的NEC婴儿术后蛋白质剂量似乎与HC增加有关。术后营养支持对不良结局风险的影响值得进一步关注。
