Department of Neonatology, University Children's Hospital, Eberhard Karls University, Tuebingen, Calwerstr. 7, 72076, Tuebingen, Germany.
Center for Pediatric Clinical Studies, University Children's Hospital, Eberhard Karls University, Tuebingen, Germany.
BMC Pediatr. 2021 Sep 23;21(1):420. doi: 10.1186/s12887-021-02878-8.
In-utero weight gain can be achieved in very preterm infants through rapid advancement of enteral feeds without increasing risk of necrotizing enterocolitis. There are concerns, however, that such rapid weight gain may lead to an increased childhood adiposity risk, although long-term data are sparse.
This retrospective observational study included two well-characterized cohorts comprising 145 infants born at < 28 weeks or with < 1000 g birth weight. We investigated associations between advancing enteral feeding volumes in daily increments of 15-20 ml/kg (Cohort 1, n = 84, born in 2006/2007) vs. 25-30 ml/kg (Cohort 2, n = 61, born in 2010) and growth up to 5 years of age.
There was no significant difference in anthropometric parameters post discharge to 5 years between both cohorts. Standard deviation score (SDS) weight and SDS BMI at the age of 5 years remained lower than in the reference population. SDS weight decreased from discharge to about 10-12 months postnatal age and returned to birth values by age 5 years. There was a catch-up for SDS length/height from discharge to 5 years; SDS head circumference decreased from birth to 5 years. Multiple regression analyses revealed that for all anthropometric parameters SDS at birth was the most important predictor for SDS at 5 years. Early parenteral protein intake may be another important factor, at least for head growth.
Growth was similar in both cohorts without benefit from more accelerated feeding advancement in cohort 2. In both cohorts, early enteral nutrition was associated with in-hospital weight gain as in utero, a drop in weight SDS post discharge and catch-up to birth SDS until age 5 years, remaining below the reference population. Length showed catch-up form discharge to 5 years, whereas head circumference progressively deviated from the reference population. Increased parenteral protein supplementation may be needed to accompany early enteral feeding advancements.
在极早产儿中，通过快速推进肠内喂养而不增加坏死性小肠结肠炎的风险，可以实现宫内体重增加。然而，人们担心这种快速的体重增加可能会导致儿童肥胖风险增加，尽管长期数据很少。
本回顾性观察研究包括两个特征明确的队列，共纳入 145 名出生于<28 周或出生体重<1000g 的婴儿。我们研究了以每日 15-20ml/kg（队列 1，n=84，出生于 2006/2007 年）或 25-30ml/kg（队列 2，n=61，出生于 2010 年）递增的肠内喂养量与 5 岁时生长之间的关系。
两组在出院后至 5 岁时的人体测量参数均无显著差异。5 岁时的体重标准差评分（SDS）和体重指数（BMI）SDS 仍低于参考人群。体重 SDS 从出院到大约 10-12 个月的新生儿年龄下降，并在 5 岁时恢复到出生值。从出院到 5 岁时，身高/长度 SDS 有追赶生长；头围 SDS 从出生到 5 岁时下降。多元回归分析表明，对于所有人体测量参数，出生时的 SDS 是 5 岁时 SDS 的最重要预测因素。早期肠外蛋白质摄入可能是另一个重要因素，至少对头围生长是如此。
两组的生长情况相似，在队列 2 中，加速喂养进展并没有带来益处。在两组中，早期肠内营养与住院期间体重增加有关，出院后体重 SDS 下降，直到 5 岁时追赶至出生时 SDS，但仍低于参考人群。从出院到 5 岁时，身高逐渐追赶，但头围逐渐偏离参考人群。可能需要增加肠外蛋白质补充来配合早期肠内喂养进展。
