危重症婴儿的肽类营养能量密集型肠内喂养：一项观察性研究。
Peptide nutrient-energy dense enteral feeding in critically ill infants: an observational study.
机构信息
Department of Dietetics and Speech & Language Therapy, University of Southampton, Southampton, UK.
NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK.
出版信息
J Hum Nutr Diet. 2019 Jun;32(3):400-408. doi: 10.1111/jhn.12645. Epub 2019 Mar 8.
BACKGROUND
Enteral feeding is challenging in critically ill infants. Target intakes are often not achieved as a result of fluid restriction, procedural interruptions and perceived enteral feeding intolerance. In those infants perceived to have poor feeding tolerance, the use of a peptide nutrient-energy dense enteral feed (PEF) may improve nutritional intake and minimise feeding interruptions as a result of gastrointestinal symptoms. The aim of this observational study was to characterise the use of a PEF amongst critically ill infants in two paediatric intensive care units (PICUs).
METHODS
Records from critically ill infants aged <12 months admitted to two PICUs were retrospectively reviewed with a PICU length of stay (LOS) ≥ 7 days. Achievement of nutritional targets for the duration of PEF was reviewed. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters.
RESULTS
In total, 53 infants were included, with a median age on admission of 2.6 months. Median admission weight was 3.9 kg in PICU-1 and 4.7 kg in PICU-2. Median (interquatile range) energy intake in PICU-1 and PICU-2 was 68 (47-92) and 90 (63-124) kcal kg , respectively, and median (interquatile range) protein intake 1.7 (1.1-2.4) g kg and 2.5 (1.6-3.2) g kg , respectively. Feeding was withheld because of feeding intolerance in one infant (4%) on two occasions in PICU-1 for 2.5 h and in two infants (7%) on two occasions in PICU-2 for 19.5 h. Gastric residual mean (SD) volumes were 3.5 (5.4) mL kg in PICU-1 and 16.9 (15.6) mL kg in PICU-2.
CONCLUSIONS
Peptide nutrient-energy dense feeding in infants admitted to the PICU is feasible, well tolerated and nutritional targets are met. However, with this study design, it is not possible to draw any conclusions regarding the benefit of PEF over standard PE feed in critically ill children and future work is required to clarify this further.
背景
在危重症婴儿中，肠内喂养具有挑战性。由于液体限制、程序中断和感知的肠内喂养不耐受，目标摄入量通常无法达到。对于那些被认为喂养耐受性差的婴儿，使用肽营养能量密集型肠内喂养（PEF）可以改善营养摄入，并减少由于胃肠道症状而导致的喂养中断。本观察性研究的目的是描述在两个儿科重症监护病房（PICU）中危重症婴儿使用 PEF 的情况。
方法
回顾性分析了在两个 PICU 住院时间≥7 天的<12 个月的危重症婴儿的记录。审查了 PEF 期间营养目标的实现情况。将胃肠道症状（包括胃残留量、便秘和呕吐）作为耐受参数进行评估。
结果
共纳入 53 例婴儿，入院时的中位年龄为 2.6 个月。PICU-1 的中位入院体重为 3.9kg，PICU-2 的中位入院体重为 4.7kg。PICU-1 和 PICU-2 的中位（四分位间距）能量摄入量分别为 68（47-92）和 90（63-124）kcal·kg，中位（四分位间距）蛋白质摄入量分别为 1.7（1.1-2.4）和 2.5（1.6-3.2）g·kg。由于喂养不耐受，PICU-1 中有 1 例（4%）婴儿两次中断喂养，每次 2.5 小时，PICU-2 中有 2 例（7%）婴儿两次中断喂养，每次 19.5 小时。PICU-1 的胃残留平均（SD）体积为 3.5（5.4）mL·kg，PICU-2 的胃残留平均（SD）体积为 16.9（15.6）mL·kg。
结论
在 PICU 住院的婴儿中使用肽营养能量密集型喂养是可行的，耐受性良好，营养目标得以实现。然而，由于本研究设计，尚无法得出关于 PEF 优于标准 PE 喂养在危重症儿童中的益处的任何结论，需要进一步的研究来阐明这一点。
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