肠内喂养与坏死性小肠结肠炎：首次喂养时间和喂养速度是否重要？
Enteral Feeding and Necrotizing Enterocolitis: Does Time of First Feeds and Rate of Advancement Matter?
机构信息
Department of Neonatology.
Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
出版信息
J Pediatr Gastroenterol Nutr. 2021 May 1;72(5):763-768. doi: 10.1097/MPG.0000000000003069.
OBJECTIVE
The aim of the study was to determine if time to initial enteral feeding (EF) and rate of advancement are associated with necrotizing enterocolitis (NEC) or death.
METHODS
Secondary analysis of prospectively collected data of very-low-birth-weight infants (VLBWI: 400--1500 g) born in 26 NEOCOSUR centers between 2000 and 2014.
RESULTS
Among 12,387 VLBWI, 83.7% survived without NEC, 6.6% developed NEC and survived, and 9.6% had NEC and died or died without NEC (NEC/death). After risk adjustment, time to initial EF (median = 2 days) was not associated with NEC; however, delaying it was protective for NEC/death (odds ratio [OR] = 0.96; 95% confidence interval [CI] 0.93--0.99). A slower feeding advancement rate (FAR) was protective for NEC (OR = 0.97; 95% CI = 0.94-0.98) and for NEC/death (OR = 0.98; 95% CI = 0.96-0.99).
CONCLUSIONS
In VLBWI, there was no association between an early initial EF and NEC, although delaying it was associated with less NEC/death. A slower FAR was associated with lower risk of both outcomes.
目的
本研究旨在确定初始肠内喂养（EF）时间和进展速度是否与坏死性小肠结肠炎（NEC）或死亡有关。
方法
对 2000 年至 2014 年间 26 个 NEOCOSUR 中心出生的极低出生体重儿（VLBWI：400-1500g）前瞻性收集的数据进行二次分析。
结果
在 12387 名 VLBWI 中，83.7%无 NEC 存活，6.6%发生 NEC 并存活，9.6%发生 NEC 并死亡或 NEC 以外原因死亡（NEC/死亡）。经过风险调整后，初始 EF 时间（中位数=2 天）与 NEC 无关；然而，延迟 EF 时间对 NEC/死亡具有保护作用（比值比[OR]=0.96；95%置信区间[CI]0.93-0.99）。较慢的喂养进展速度（FAR）对 NEC（OR=0.97；95% CI=0.94-0.98）和 NEC/死亡（OR=0.98；95% CI=0.96-0.99）均具有保护作用。
结论
在 VLBWI 中，早期初始 EF 与 NEC 之间无关联，但延迟 EF 时间与较少的 NEC/死亡相关。较慢的 FAR 与两种结局的风险降低相关。
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