Dunn L, Hulman S, Weiner J, Kliegman R
Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106.
J Pediatr. 1988 Apr;112(4):622-9. doi: 10.1016/s0022-3476(88)80185-9.
In a prospective randomized trial, we studied the effects of early hypocaloric enteral feedings (PO) begun at 48 hours of age in 19 infants compared with 20 infants who received no enteral feedings (NPO) for at least the first 9 days of life. Both groups initially received the majority of their calories by parenteral alimentation. The groups were similar with respect to birth weight, gestational age, sex, Apgar score, and major neonatal diagnoses. The early enteral feeds proved to be significantly beneficial without an increased incidence of complications. The PO group reached full enteral feedings faster than the NPO group (31.2 vs 47.3 days). The PO group had a greater decline in serum bilirubin concentration over the first 2 weeks of life and spent less time under phototherapy (6.8 vs 9.5 days). Less cholestasis was observed among the PO infants (6.7% vs 33%), and peak direct bilirubin levels were also lower (0.7 vs 2.5 mg/dL). Osteopenia of prematurity, manifested by significantly lower alkaline phosphatase activity, was also decreased in the PO group, perhaps because of greater calcium intake during the first month among PO infants (1.3 vs 0.8 g). Compared with complete bowel rest, early onset of hypocaloric enteral feedings has beneficial effects on indirect hyperbilirubinemia, cholestatic jaundice, and metabolic bone disease of very low birth weight infants.
在一项前瞻性随机试验中，我们研究了19例出生48小时开始早期低热量肠内喂养（经口喂养）的婴儿与20例出生后至少前9天未进行肠内喂养（非经口喂养）的婴儿的情况。两组最初大部分热量均通过肠外营养获得。两组在出生体重、胎龄、性别、阿氏评分及主要新生儿诊断方面相似。结果显示早期肠内喂养具有显著益处且并发症发生率未增加。经口喂养组比非经口喂养组更快达到完全肠内喂养（31.2天对47.3天）。经口喂养组在出生后前2周血清胆红素浓度下降幅度更大，接受光疗的时间更短（6.8天对9.5天）。经口喂养的婴儿胆汁淤积较少（6.7%对33%），直接胆红素峰值水平也更低（0.7mg/dL对2.5mg/dL）。经口喂养组早产儿骨矿物质减少情况也有所减轻，表现为碱性磷酸酶活性显著降低，这可能是因为经口喂养婴儿在出生后第一个月钙摄入量更多（1.3g对0.8g）。与完全肠道休息相比，早期开始低热量肠内喂养对极低出生体重儿的间接高胆红素血症、胆汁淤积性黄疸和代谢性骨病具有有益影响。
