Khan Z, Morris N, Unterrainer H, Haiden N, Holasek S J, Urlesberger B
Division of Neonatology, Medical University of Graz, Austria.
Institute of Pathophysiology and Immunology, Medical University of Graz, Austria.
J Neonatal Perinatal Med. 2018;11(1):11-19. doi: 10.3233/NPM-18179.
Preterm birth is a medical emergency and it is becoming evident that adequate nutrition starting in the first hours of life is of major importance for short and even more so for long-term health outcomes of the premature newborn. The aim was to analyze postnatal nutrient supply and growth patterns of preterm infants in response to a standardized feeding protocol during stay at neonatal intensive care unit (NICU).
A prospective cohort study was conducted at NICU, Children Hospital Graz. Infants were divided in two groups:<28 weeks (Extremely preterm infants, EPI); ≥28 weeks (very preterm infants, VPI).
EPI compared to VPI stayed longer on parenteral nutrition and needed more time to reach full enteral nutrition, required more days on ventilation and had a higher corrected age at discharge. Moreover, fortification of enteral feeds was initiated later in EPI group (p < 0.001). As a consequence, cumulative supply of protein, fat and energy was significantly lower in EPI. However, both groups exceeded the European Society of Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommended glucose intake in week 5. At discharge, we found significant differences in all growth parameters (weight Z scores: EPI = - 1.19 vs VPI = - 0.71, length Z scores: EPI = - 1.62 vs VPI = - 0.84; HC Z scores: EPI = - 1.19 vs VPI = - 0.46).
Provision of aggressive parenteral nutrition during first 3 weeks of life and earlier fortification should be ensured. The use of mother milk fortifier resulted in glucose intake above the ESPGHAN recommendations in later weeks - this needs to be evaluated in future studies.
早产是一种医疗急症，越来越明显的是，从生命的最初几个小时开始提供充足的营养对于早产新生儿的短期乃至长期健康结局至关重要。目的是分析在新生儿重症监护病房（NICU）住院期间，早产儿按照标准化喂养方案的产后营养供应和生长模式。
在格拉茨儿童医院的NICU进行了一项前瞻性队列研究。婴儿分为两组：<28周（极早产儿，EPI）；≥28周（早产儿，VPI）。
与VPI相比EPI接受肠外营养的时间更长，达到完全肠内营养所需的时间更长，需要机械通气的天数更多，出院时矫正年龄更大。此外，EPI组开始强化肠内喂养的时间更晚（p<0.001）。因此，EPI组蛋白质、脂肪和能量的累积供应量显著较低。然而，两组在第5周时均超过了欧洲胃肠病学、肝病学和营养学会（ESPGHAN）推荐的葡萄糖摄入量。出院时，我们发现所有生长参数均存在显著差异（体重Z评分：EPI=-1.19 vs VPI=-0.71；身长Z评分：EPI=-1.62 vs VPI=-0.84；头围Z评分：EPI=-1.19 vs VPI=-0.46）。
应确保在生命的前3周提供积极的肠外营养并尽早强化。在随后几周使用母乳强化剂导致葡萄糖摄入量超过ESPGHAN的建议——这需要在未来的研究中进行评估。
