极早产儿的早期渐进性喂养：一项随机试验。
Early progressive feeding in extremely preterm infants: a randomized trial.
机构信息
Department of Pediatrics, School of Medicine; and Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
出版信息
Am J Clin Nutr. 2018 Mar 1;107(3):365-370. doi: 10.1093/ajcn/nqy012.
BACKGROUND
Due to insufficient evidence, extremely preterm infants (≤28 wk of gestation) rarely receive early progressive feeding (small increments of feeding volumes between 1 and 4 d after birth). We hypothesized that early progressive feeding increases the number of full enteral feeding days in the first month after birth.
OBJECTIVE
The aim of this study was to determine the feasibility and efficacy of early progressive feeding in extremely preterm infants.
DESIGN
In this single-center randomized trial, extremely preterm infants born between September 2016 and June 2017 were randomly assigned to receive either early progressive feeding without trophic feeding (early feeding group) or delayed progressive feeding after a 4-d course of trophic feeding (delayed feeding group). Treatment allocation occurred before or on feeding day 1. The primary outcome was the number of full enteral feeding days in the first month after birth. Secondary outcomes were death, necrotizing enterocolitis (NEC), culture-proven sepsis, growth percentiles at 36 wk postmenstrual age, use of parenteral nutrition, and need for central venous access.
RESULTS
Sixty infants were included (median gestational age: 26 wk; mean ± SD birth weight: 832 ± 253 g). The primary outcome differed between groups (median difference favoring the early feeding group: +2 d; 95% CI: 0, 3 d; P = 0.02). Early progressive feeding reduced the use of parenteral nutrition (4 compared with 8 d; P ≤ 0.01) and the need for central venous access (9 compared with 13 d; P ≤ 0.01). The outcome of culture-proven sepsis (10% compared with 27%; P = 0.18), restricted growth (weight, length, and head circumference <10th percentile) at 36 wk postmenstrual age (25% compared with 50%; P = 0.07), and the composite outcome of NEC or death (27% compared with 20%; P = 0.74) did not differ between groups.
CONCLUSION
Early progressive feeding increases the number of full enteral feeding days in extremely preterm infants. This trial was registered at www.clinicaltrials.gov as NCT02915549.
背景
由于证据不足，极早产儿（≤28 孕周）很少接受早期渐进式喂养（出生后 1 至 4 天内逐渐增加喂养量）。我们假设早期渐进式喂养可增加出生后第一个月的完全肠内喂养天数。
目的
本研究旨在确定极早产儿早期渐进式喂养的可行性和有效性。
设计
这是一项单中心随机试验，将 2016 年 9 月至 2017 年 6 月间出生的极早产儿随机分配至接受早期无营养性喂养（早期喂养组）或经 4 天营养性喂养后再开始渐进式喂养（延迟喂养组）。治疗分配在喂养第 1 天之前或当天进行。主要结局为出生后第一个月的完全肠内喂养天数。次要结局为死亡、坏死性小肠结肠炎（NEC）、培养阳性败血症、生后 36 周校正胎龄时的生长百分位数、肠外营养的使用和中心静脉通路的需求。
结果
共纳入 60 例患儿（中位胎龄：26 周；平均±标准差出生体重：832±253 g）。两组主要结局存在差异（早期喂养组更优，优势差为+2 天；95%CI：0 至 3 天；P=0.02）。早期渐进式喂养减少了肠外营养的使用（4 天对比 8 天；P≤0.01）和中心静脉通路的需求（9 天对比 13 天；P≤0.01）。培养阳性败血症（10%对比 27%；P=0.18）、生后 36 周校正胎龄时生长受限（体重、身长和头围＜第 10 百分位数）（25%对比 50%；P=0.07）和 NEC 或死亡复合结局（27%对比 20%；P=0.74）在两组间无差异。
结论
早期渐进式喂养可增加极早产儿的完全肠内喂养天数。本试验在 clinicaltrials.gov 注册，编号为 NCT02915549。
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