Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Clinical Nutrition, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China.
Clin Nutr ESPEN. 2021 Apr;42:252-257. doi: 10.1016/j.clnesp.2021.01.027. Epub 2021 Feb 9.
BACKGROUND & AIMS: Extrauterine growth restriction (EUGR) is associated with long-term complications such as neurodevelopmental dysplasia, increased mortality, and chronic metabolic disease. The incidence of EUGR in very low birth weight infants (VLBWIs) is generally high. This study's objectives were to (1) evaluate the nutritional support of VLBWIs with EUGR in our hospital NICU in the past 2 y and (2) provide guidance for improving clinical practice.
Preterm infants (birth weight < 1500 g) admitted to our hospital from February 2017 to July 2019 were enrolled in the study. Nutrient intakes were recorded daily, and growth parameters were regularly measured. Based on whether the infants reached the 10th percentile of the 2013 Fenton growth curve at discharge, the infants were divided into a EUGR group (n = 134) and a non-EUGR group (n = 34) and their nutrition support were compared with current ESPGHAN guidelines.
A total of 138 VLBWIs were enrolled in the study. Growth restriction was 18.1% at birth and 75.4% at discharge for weight. Enteral nutrition (EN) was initiated late compared with the guidelines. The cumulative EN interruption time was long, especially in the EUGR group. Insufficient energy and amino acid intakes were prevalent, and cumulative energy and amino acid deficits failed to be compensated at discharge. Lower Z-score at birth (OR = 0.055, 95% CI = 0.018-0.172, p < 0.001) and long cumulative interruption time (OR = 1.058, 95% CI = 1.001-1.119, p = 0.046) were risk factors for EUGR incidence.
In general, the nutritional support for VLBWIs was inadequate, conservative enteral feeding was the main reason.
宫外生长受限（EUGR）与神经发育障碍、死亡率增加和慢性代谢疾病等长期并发症有关。极低出生体重儿（VLBWI）的 EUGR 发生率通常较高。本研究的目的是：（1）评估我院新生儿重症监护病房（NICU）过去 2 年 EUGR 极低出生体重儿（VLBWI）的营养支持情况；（2）为改善临床实践提供指导。
纳入 2017 年 2 月至 2019 年 7 月我院收治的胎龄<1500g 的早产儿，每日记录营养素摄入量，定期测量生长参数。根据出院时婴儿是否达到 2013 年 Fenton 生长曲线的第 10 百分位，将婴儿分为 EUGR 组（n=134）和非 EUGR 组（n=34），并与目前 ESPGHAN 指南进行比较。
共纳入 138 例 VLBWI，出生时生长受限发生率为 18.1%，出院时体重生长受限发生率为 75.4%。与指南相比，肠内营养（EN）启动较晚。EN 中断时间长，尤其是 EUGR 组。能量和氨基酸摄入普遍不足，出院时未能弥补累计能量和氨基酸不足。出生时 Z 评分较低（OR=0.055，95%CI=0.018-0.172，p<0.001）和累计中断时间较长（OR=1.058，95%CI=1.001-1.119，p=0.046）是 EUGR 发生率的危险因素。
总体而言，VLBWI 的营养支持不足，保守的肠内喂养是主要原因。
