Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
Neonatal Service, Christchurch Women's Hospital, Christchurch, New Zealand.
J Perinatol. 2019 Jun;39(6):837-841. doi: 10.1038/s41372-019-0372-3. Epub 2019 Apr 9.
Neonatal transpyloric feeding (TPF) has not been rigorously studied since the 1980s. Our objective was to evaluate early TPF, defined as TPF initiated within the first week after birth, among preterm infants in the setting of modern neonatal practice.
A retrospective cohort study was conducted between 2013 and 2017 for all extremely low birth weight (ELBW) infants born in a tertiary neonatal intensive care unit where early TPF is a common practice. Infants were excluded if they did not receive enteral feeding within the first week after birth or if they died prior to initiation of enteral feeding. The primary outcome was death or bronchopulmonary dysplasia (BPD). The association between early TPF and the primary outcome was assessed using multivariable logistic regression, with adjustment for gestational age, birth weight, and intubation status.
The study sample included 368 ELBW infants. Twenty-seven percent received early TPF. Death or BPD occurred in 58% of infants who received early TPF compared with 67% of infants who received gastric feeding, adjusted odds ratio 0.6, 95% confidence interval 0.3-0.9. Growth and adverse gastrointestinal outcomes did not differ between the two groups.
Early TPF is associated with reduced risk of death or BPD among ELBW infants. Further investigation in the form of a randomized controlled trial is required to confirm a causal association between early TPF and improved clinical outcomes.
自 20 世纪 80 年代以来，尚未对新生儿经幽门喂养（TPF）进行严格研究。我们的目的是评估现代新生儿实践中早产儿的早期 TPF，即出生后第一周内开始的 TPF。
本研究为 2013 年至 2017 年间进行的回顾性队列研究，纳入了在三级新生儿重症监护病房出生的所有极低出生体重儿（ELBW），该病房中早期 TPF 是一种常见的做法。如果婴儿在出生后第一周内未接受肠内喂养或在开始肠内喂养前死亡，则将其排除在外。主要结局为死亡或支气管肺发育不良（BPD）。使用多变量逻辑回归评估早期 TPF 与主要结局之间的关联，并根据胎龄、出生体重和插管状态进行调整。
本研究样本包括 368 名 ELBW 婴儿。27%的婴儿接受了早期 TPF。与接受胃饲的婴儿（67%）相比，接受早期 TPF 的婴儿死亡或发生 BPD 的比例为 58%，调整后的比值比为 0.6，95%置信区间为 0.3-0.9。两组之间的生长和不良胃肠道结局无差异。
在 ELBW 婴儿中，早期 TPF 与降低死亡或 BPD 风险相关。需要进一步进行随机对照试验来确认早期 TPF 与改善临床结局之间的因果关系。
