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具有正常与异常产前多普勒特征的小于胎龄儿的早期喂养耐受性

Early feeding tolerance in small for gestational age infants with normal versus abnormal antenatal Doppler characteristics.

作者信息

Ahamed M F, Dar Pe'er, Vega M, Kim Mimi, Gao Q, Havranek T

机构信息

Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Southern Illinois University School of Medicine, IL, USA.

Department of Obstetrics and Gynecology and Women's Health, Division of Fetal Medicine and OBGYN Ultrasound, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA.

出版信息

J Neonatal Perinatal Med. 2017;10(1):43-48. doi: 10.3233/NPM-1682.

DOI:10.3233/NPM-1682

PMID:28304325

Abstract

OBJECTIVES

To determine differences in feeding tolerance amongst preterm small for gestational age (SGA) infants with normal versus abnormal umbilical artery Doppler flow defined as absent or reversed end diastolic flow (AREDF).

METHODS

This was a retrospective cohort study of infants <35 weeks gestational age (GA) and birth weight (BW) <10th percentile. Day of initiation of feeds, days to full feeds and CRIB II scores were the primary outcomes. Clinical characteristics were compared between the groups of SGA infants with normal and AREDF. Multivariable regression models were fit to the data to adjust for potential confounders of the association of AREDF and feeding intolerance.

RESULTS

120 infants with normal and 64 infants with AREDF were included. The infants with AREDF were smaller (971 g vs. 1183 g, p = 0.0002), less mature (29.9 wks vs. 31.2 wks, p = 0.0009), had higher CRIB II score (7.2 vs. 5.2, p = 0.0033), started feeding later (4.1 days vs. 3.3 days, p = 0.020) and advanced slower to full feeds (17.7 days vs. 13.7 days, p = 0.0017). Necrotizing enterocolitis was similar between the groups (p = 0.18). After adjusting for confounders, Doppler flow was no longer a significant predictor of the initiation (p = 0.37) and advancement of feeds (p = 0.44).

CONCLUSIONS

Infants with AREDF are sicker at birth and have more feeding difficulties; after adjusting for BW and GA, Doppler flow was no longer a significant predictor of feeding intolerance.

摘要

目的

确定胎龄小于35周、出生体重低于第10百分位数的早产小于胎龄（SGA）婴儿中，脐动脉多普勒血流正常与异常（定义为舒张末期血流缺失或反向，即AREDF）之间在喂养耐受性方面的差异。

方法

这是一项对胎龄（GA）<35周且出生体重（BW）<第10百分位数的婴儿进行的回顾性队列研究。开始喂养的日期、达到全量喂养的天数和CRIB II评分是主要结局指标。对脐动脉多普勒血流正常和存在AREDF的SGA婴儿组的临床特征进行比较。将多变量回归模型应用于数据，以调整AREDF与喂养不耐受之间关联的潜在混杂因素。

结果

纳入了120例脐动脉多普勒血流正常的婴儿和64例存在AREDF的婴儿。存在AREDF的婴儿体重更小（971g对1183g，p = 0.0002），成熟度更低（29.9周对31.2周，p = 0.0009），CRIB II评分更高（7.2对5.2，p = 0.0033），开始喂养的时间更晚（4.1天对3.3天，p = 0.020），达到全量喂养的进展更慢（17.7天对13.7天，p = 0.0017）。两组之间坏死性小肠结肠炎的发生率相似（p = 0.18）。在调整混杂因素后，多普勒血流不再是开始喂养（p = 0.37）和喂养进展（p = 0.44）的显著预测因素。