Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan.
Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Japan.
J Perinat Med. 2020 Nov 11;49(3):383-387. doi: 10.1515/jpm-2020-0243. Print 2021 Mar 26.
Gastroesophageal reflux may exacerbate chronic lung disease in preterm infants. We evaluated the short-term effects of transpyloric feeding on respiratory status in preterm infants during mechanical ventilation.
We retrospectively collected data from the hospital information management system. To evaluate the effect of transpyloric feeding on oxygenation, we compared changes in SpO/FiO ratios before and after commencing transpyloric feeding by a piecewise linear regression model.
We examined 33 infants (median gestational age, 25.4 weeks; median birth weight, 656 g) who underwent transpyloric feeding. All tubes were placed at the bedside without fluoroscopy. No cases of unsuccessful placement, gastroduodenal perforation, or tracheal misinsertion occurred. Transpyloric feeding began at a median age of 18 (interquartile range, 15-23) days. Mean SpO/FiO (±SD) ratios were 391 (±49), 371 (±51), 365 (±56), and 366 (±53) 72-96 h before, 0-24 h before, 48-72 h after, and 96-120 h after starting transpyloric feeding, respectively. The rate of change per hour of SpO/FiO ratios increased 48-120 h after compared with 0-96 h before transpyloric feeding (0.03 [95% confidence interval, -0.10 to 0.17] vs. -0.29 [-0.47 to -0.12]) (p=0.007). No apparent changes occurred in the mean airway pressure, amplitude pressure, or pCO.
Transpyloric feeding during mechanical ventilation can prevent the deterioration of oxygenation without major complications at the stage of respiratory exacerbation in preterm infants.
胃食管反流可能会使早产儿的慢性肺病恶化。我们评估了经幽门喂养对机械通气早产儿呼吸状况的短期影响。
我们从医院信息管理系统中回顾性地收集数据。为了评估经幽门喂养对氧合的影响，我们通过分段线性回归模型比较了开始经幽门喂养前后 SpO/FiO 比值的变化。
我们检查了 33 名（中位胎龄 25.4 周；中位出生体重 656 克）接受经幽门喂养的婴儿。所有的管子都是在床边放置的，没有透视。没有发生放置不成功、胃十二指肠穿孔或气管误插的情况。经幽门喂养开始于中位年龄 18（四分位间距 15-23）天。平均 SpO/FiO（±SD）比值分别为 391（±49）、371（±51）、365（±56）和 366（±53），分别为开始经幽门喂养前 72-96 小时、0-24 小时前、48-72 小时后和 96-120 小时后。与开始经幽门喂养前 0-96 小时相比，开始经幽门喂养后 48-120 小时内 SpO/FiO 比值的每小时变化率增加（0.03[-0.10 至 0.17] 与-0.29[-0.47 至-0.12]）（p=0.007）。平均气道压力、振幅压力或 pCO 均无明显变化。
在呼吸恶化阶段，机械通气期间经幽门喂养可以预防早产儿氧合恶化，且无重大并发症。
