标准化的缓慢肠内喂养方案可降低极低出生体重儿坏死性小肠结肠炎的发生率。
Standardized slow enteral feeding protocol reduces necrotizing enterocolitis in micropremies.
作者信息
Viswanathan S, Merheb R, Wen Xintong, Collin M, Groh-Wargo S
机构信息
Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA.
Division of Neonatology, Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
出版信息
J Neonatal Perinatal Med. 2017;10(2):171-180. doi: 10.3233/NPM-171680.
BACKGROUND
Compared to early enteral feeds, delayed introduction and slow enteral feeding advancement to reduce necrotizing enterocolitis (NEC) is not well studied in micropremies (<750g birth weight).
METHODS
Pre-post case control study. Micropremies who followed a standardized slow enteral feeding (SSEF) protocol (September 2009 to March 2015) were compared with a similar group of historical controls (PreSSEF, January 2003 to July 2009). Enteral feeding withheld for first 10-14 days and advanced at <10 ml/kg/day in the SSEF group.
RESULTS
Ninety-two infants in the SSEF group were compared with 129 PreSSEF group. Birth weight and gestational age in SSEF and PreSSEF were similar. Breast milk initiation rate was higher in SSEF (87.0 vs. 72.0%, p = 0.01) compared to PreSSEF, but were similar at full enteral feeds. Compared with PreSSEF, feeding initiation day, full enteral feeding day, parenteral nutrition days, and total central line days were longer in SSEF. There was significant reduction in NEC (1.1 vs. 16.2%, p < 0.01), surgical NEC (0.0 vs. 7.8%, p < 0.01) and NEC/death (7.6 vs. 29.5%, p < 0.01), in SSEF compared to PreSSEF. SSEF, compared to PreSSEF, had more cholestasis (41.8 vs 28.8%, p = 0.04), higher peak serum alkaline phosphatase (638 vs. 534 IU/dL, p < 0.01), but similar rates of late-onset sepsis (39.1 vs 43.4%, p = 0.53). In infants who survived to discharge, SSEF had higher discharge weight, lower extra-uterine growth restriction, and similar length of stay, compared to PreSSEF.
CONCLUSIONS
A SSEF protocol significantly reduces the incidence of NEC and combined NEC/death in micropremies.
背景
与早期肠内喂养相比，为降低坏死性小肠结肠炎（NEC）而延迟开始及缓慢推进肠内喂养在超低体重儿（出生体重<750g）中的研究尚不充分。
方法
前后对照病例研究。将遵循标准化缓慢肠内喂养（SSEF）方案的超低体重儿（2009年9月至2015年3月）与一组类似的历史对照（PreSSEF，2003年1月至2009年7月）进行比较。SSEF组在出生后的前10 - 14天不进行肠内喂养，并以<10ml/kg/天的速度推进肠内喂养。
结果
SSEF组的92例婴儿与PreSSEF组的129例婴儿进行了比较。SSEF组和PreSSEF组的出生体重和胎龄相似。与PreSSEF组相比，SSEF组开始母乳喂养的比例更高（87.0%对72.0%，p = 0.01），但在完全肠内喂养时相似。与PreSSEF组相比，SSEF组开始喂养的天数、完全肠内喂养的天数、肠外营养的天数和中心静脉置管的总天数更长。与PreSSEF组相比，SSEF组的NEC发生率显著降低（1.1%对16.2%，p < 0.01）、外科手术相关的NEC发生率显著降低（0.0%对7.8%，p < 0.01）以及NEC/死亡发生率显著降低（7.6%对29.5%，p < 0.01）。与PreSSEF组相比，SSEF组胆汁淤积更多（41.8%对28.8%，p = 0.04），血清碱性磷酸酶峰值更高（638对534IU/dL，p < 0.01），但晚发性败血症的发生率相似（39.1%对43.4%，p = 0.53）。在存活至出院的婴儿中，与PreSSEF组相比，SSEF组出院时体重更高，宫外生长受限更低，住院时间相似。
结论
SSEF方案显著降低了超低体重儿NEC及NEC/死亡的发生率。
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