Department of Neonatology, Ratna Memorial Hospital, Pune, India.
Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia.
Eur J Clin Nutr. 2018 Feb;72(2):281-287. doi: 10.1038/s41430-017-0040-7. Epub 2017 Dec 19.
BACKGROUND/OBJECTIVES: Necrotizing enterocolitis (NEC ≥ Stage II) is associated with high mortality and morbidity in preterm infants. To assess if introduction of standardized feeding regimen (SFR) and routine probiotic supplementation (RPS) was associated with reduced incidence of NEC in preterm infants in our nursery in a resource limited set up.
SUBJECTS/METHODS: This was a retrospective cohort study assessing the incidence of NEC ≥ Stage II before (Epoch 1: N = 144) vs. after (Epoch 2, N = 144) implementation of SFR and RPS in preterm infants < 35 weeks.
The median (IQR) gestation and birth weight in epoch 1 and epoch 2 was [32 (30, 33.5) vs. 31.5 (30, 34) weeks, p = 0.829], and [1350 (1100, 1700) vs. 1370 (1110, 1550) g, p = 0.363] respectively. Both groups had predominantly outborn infants (Epoch 1: 79.2% vs. Epoch 2: 78.2%; p = 1.00). Multivariate analysis after adjusting for potential confounders found a significantly lower incidence of NEC ≥ Stage II after implementing SFR and RPS (Epoch 1: 17.4% vs. Epoch 2:9.0%, adjusted odds ratio aOR: 0.19; 95% CI: 0.05, 0.71, p = 0.013). The incidence of the composite outcome of 'NEC or Mortality' was also significantly lower after the intervention (Epoch 1: 21.5% vs. Epoch 2: 14.6%; aOR 0.24, 95% CI: 0.07, 0.85, p = 0.027).
Introduction of SFR and RPS was associated with significant reduction in NEC ≥ Stage II and the composite outcome of NEC ≥ Stage II /mortality in preterm infants.
背景/目的：坏死性小肠结肠炎（NEC≥Ⅱ期）与早产儿的高死亡率和发病率相关。为了评估在资源有限的环境下，我们的新生儿病房引入标准化喂养方案（SFR）和常规益生菌补充（RPS）是否与早产儿中 NEC 的发生率降低有关。
研究对象/方法：这是一项回顾性队列研究，评估了在实施 SFR 和 RPS 之前（第 1 个时期：N=144）和之后（第 2 个时期：N=144）早产儿中＜35 周龄的 NEC≥Ⅱ期的发生率。
第 1 个时期和第 2 个时期的中位（IQR）胎龄和出生体重分别为[32（30，33.5）vs.31.5（30，34）周，p=0.829]和[1350（1100，1700）vs.1370（1110，1550）g，p=0.363]。两组均以早产儿为主（第 1 个时期：79.2% vs.第 2 个时期：78.2%；p=1.00）。在调整了潜在混杂因素后进行多变量分析发现，实施 SFR 和 RPS 后，NEC≥Ⅱ期的发生率显著降低（第 1 个时期：17.4% vs.第 2 个时期：9.0%，调整后的优势比 aOR：0.19；95%可信区间：0.05，0.71，p=0.013）。干预后“NEC 或死亡率”的复合结局发生率也显著降低（第 1 个时期：21.5% vs.第 2 个时期：14.6%；aOR 0.24，95%可信区间：0.07，0.85，p=0.027）。
引入 SFR 和 RPS 与早产儿中 NEC≥Ⅱ期和 NEC≥Ⅱ期/死亡率复合结局的显著降低有关。
