Department of Paediatrics & Child Health, Stellenbosch University, Tygerberg Hospital, Cape Town 7500, South Africa.
J Trop Pediatr. 2021 Jan 29;67(1). doi: 10.1093/tropej/fmaa119.
To determine the growth and prevalence of extrauterine growth restriction (EUGR) in extremely low birth weight (ELBW) infants receiving enteral-only nutrition in a resource-restricted (RR) environment.
Information on nutritional intake, provided largely from fortified breastmilk, was collected retrospectively for 72 ELBW (<1000 g) infants admitted to Tygerberg Hospital, Cape Town, South Africa over a 1 year period. Anthropometric data for the first 49 postnatal days were compared to gender-specific INTERGROWTH-21st standards.
Full enteral feeds (150 ml/kg) were reached by Day 10-14 with energy >100 Kcal/kg/day from Day 10, and protein >3.5 mg/kg/day from Day 14, onwards. Growth velocity remained below 15 g/kg/day at Day 49. INTERGROWTH-21st Z-scores decreased from -0.8 ± 1.1 at birth to -2.4 ± 1.5 at Day 49. Adequate weight growth velocity (≥15 g/kg/day) was associated with maternal hypertension, completed antenatal steroids, caesarean section delivery and small for gestational age status.
This is the first study to evaluate growth of ELBW infants in a RR setting where enteral-only nutrition, principally from fortified breastmilk, was the primary feeding option. The incidence of EUGR, although high, was similar to the incidence in well-resourced settings, where total parenteral nutrition is routinely provided. Lay summaryExtra-uterine growth restriction (EUGR) is high in extremely low birth weight infants receiving enteral-only nutrition. However, EUGR rates are similar to infants receiving parenteral nutrition. Despite developmental immaturity, it is possible for these infants to achieve fetal growth rates. More aggressive feeding and fortification strategies may be necessary and will need to be balanced against the risk and fear of necrotizing enterocolitis. Enteral-only feeding regimens, especially in resource-restricted environments, should be audited regularly to ensure provision of feeds with the most optimal protein, and protein to energy ratios possible.
在资源有限（RR）环境中，通过肠内营养仅为极早产儿（ELBW）提供营养，确定宫外生长受限（EUGR）的生长和流行情况。
回顾性收集了 72 名在南非开普敦 Tygerberg 医院住院的极低出生体重（ELBW）婴儿（<1000g）在 1 年内的营养摄入信息，这些婴儿主要通过强化母乳提供营养。比较了前 49 天的人体测量数据与性别特异性 INTERGROWTH-21 标准。
在第 10-14 天达到完全肠内喂养（150ml/kg），第 10 天起能量>100kcal/kg/d，第 14 天起蛋白质>3.5mg/kg/d。第 49 天体重增长速度仍低于 15g/kg/d。INTERGROWTH-21 评分从出生时的-0.8±1.1 降至第 49 天的-2.4±1.5。足够的体重增长速度（≥15g/kg/d）与母亲高血压、完成产前类固醇、剖宫产分娩和小于胎龄儿有关。
这是第一份在 RR 环境中评估 ELBW 婴儿生长情况的研究，该环境中肠内营养（主要来自强化母乳）是主要的喂养选择。EUGR 的发生率虽然较高，但与全肠外营养常规提供的资源丰富环境中的发生率相似。
极早产儿接受肠内营养时，宫外生长受限（EUGR）发生率较高。然而，EUGR 的发生率与接受肠外营养的婴儿相似。尽管发育不成熟，但这些婴儿有可能达到胎儿的生长速度。可能需要更积极的喂养和强化策略，但需要平衡坏死性小肠结肠炎的风险和恐惧。在资源有限的环境中，应定期审查肠内营养方案，以确保提供最优化蛋白质和蛋白质与能量比的喂养。
