肠内推注喂养对早产儿局部肠道氧饱和度的影响具有年龄依赖性：一项纵向观察性研究。
The effect of enteral bolus feeding on regional intestinal oxygen saturation in preterm infants is age-dependent: a longitudinal observational study.
机构信息
University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Surgery, Division of Pediatric Surgery, Groningen, the Netherlands.
出版信息
BMC Pediatr. 2019 Nov 4;19(1):404. doi: 10.1186/s12887-019-1805-z.
BACKGROUND
The factors that determine the effect of enteral feeding on intestinal perfusion after preterm birth remain largely unknown. We aimed to determine the effect of enteral feeding on intestinal oxygen saturation (rSO) in preterm infants and evaluated whether this effect depended on postnatal age (PNA), postmenstrual age (PMA), and/or feeding volumes. We also evaluated whether changes in postprandial rSO affected cerebral oxygen saturation (rSO).
METHODS
In a longitudinal observational pilot study using near-infrared spectroscopy we measured rSO and rSO continuously for two hours on postnatal Days 2 to 5, 8, 15, 22, 29, and 36. We compared preprandial with postprandial values over time using multi-level analyses. To assess the effect of PNA, PMA, and feeding volumes, we performed Wilcoxon signed-rank tests or logistic regression analyses. To evaluate the effect on rSO, we also used logistic regression analyses.
RESULTS
We included 29 infants: median (range) gestational age 28.1 weeks (25.1-30.7) and birth weight 1025 g (580-1495). On Day 5, rSO values decreased postprandially: mean (SE) 44% (10) versus 35% (7), P = .01. On Day 29, rSO values increased: 44% (11) versus 54% (7), P = .01. Infants with a PMA ≥ 32 weeks showed a rSO increase after feeding (37% versus 51%, P = .04) whereas infants with a PMA < 32 weeks did not. Feeding volumes were associated with an increased postprandial rSO (per 10 mL/kg: OR 1.63, 95% CI, 1.02-2.59). We did not find an effect on rSO when rSO increased postprandially.
CONCLUSIONS
Our study suggests that postprandial rSO increases in preterm infants only from the fifth week after birth, particularly at PMA ≥ 32 weeks when greater volumes of enteral feeding are tolerated. We speculate that at young gestational and postmenstrual ages preterm infants are still unable to increase intestinal oxygen saturation after feeding, which might be essential to meet metabolic demands.
TRIAL REGISTRATION
For this prospective longitudinal pilot study we derived patients from a larger observational cohort study: CALIFORNIA-Trial, Dutch Trial Registry NTR4153 .
背景
早产儿出生后肠道灌注受肠内喂养影响的因素仍知之甚少。本研究旨在明确肠内喂养对早产儿肠道氧饱和度（rSO）的影响，并评估这种影响是否取决于出生后年龄（PNA）、校正胎龄（PMA）和/或喂养量。我们还评估了餐后 rSO 的变化是否会影响脑氧饱和度（rSO）。
方法
采用近红外光谱法进行前瞻性纵向观察性研究，连续测量 29 名胎龄 28.1 周（25.1-30.7 周）、出生体重 1025g（580-1495g）的早产儿出生后 2-5 天、8 天、15 天、22 天、29 天和 36 天的 rSO 和 rSO。采用多水平分析比较餐前与餐后 rSO 的时间变化。为评估 PNA、PMA 和喂养量的影响，我们进行了 Wilcoxon 符号秩检验或逻辑回归分析。为评估对 rSO 的影响，我们还进行了逻辑回归分析。
结果
本研究共纳入 29 名患儿：中位（范围）胎龄 28.1 周（25.1-30.7 周），出生体重 1025g（580-1495g）。第 5 天，餐后 rSO 值下降：44%（10）比 35%（7），P=0.01。第 29 天，rSO 值增加：44%（11）比 54%（7），P=0.01。PMA≥32 周的患儿喂养后 rSO 增加（37%比 51%，P=0.04），而 PMA<32 周的患儿 rSO 未增加。喂养量与餐后 rSO 增加相关（每 10ml/kg：OR 1.63，95%CI，1.02-2.59）。我们未发现餐后 rSO 增加对 rSO 有影响。
结论
本研究表明，早产儿只有在出生后第 5 周才会出现餐后 rSO 增加，特别是在 PMA≥32 周时，当能耐受更大的喂养量时。我们推测，在胎龄和月经龄较小的时期，早产儿在喂养后仍无法增加肠道氧饱和度，这可能对满足代谢需求至关重要。
试验注册
本前瞻性纵向观察性研究从更大的观察性队列研究中获取患者：CALIFORNIA 试验，荷兰试验注册 NTR4153。
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