Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan 701401, Taiwan.
Nutrients. 2022 Feb 28;14(5):1032. doi: 10.3390/nu14051032.
Establishing the different feeding trajectories based on daily enteral feeding data in preterm infants at different gestational ages (GAs), may help to identify the risks and extrauterine growth restriction (EUGR) outcomes associated with the adverse feeding pattern. In a single center, we retrospectively included 625 infants born at 23-30 weeks of gestation who survived to term-equivalent age (TEA) from 2009 to 2020. The infants were designated into three GA groups: 23-26, 27-28, and 29-30 weeks. The daily enteral feeding amounts in the first 56 postnatal days were analyzed to determine the feeding trajectories. The primary outcomes were EUGR in body weight and head circumference calculated, respectively, by the changes between birth and TEA. Clustering analysis identified two feeding trajectories, namely the improving and adverse patterns in each GA group. The adverse feeding pattern that occurred in 49%, 20%, and 17% of GA 23-26, 27-28, and 29-30 weeks, respectively, was differentiated from the improving feeding pattern as early as day 7 in infants at GA 23-26 and 27-28 weeks, in contrast to day 21 in infants at GA 29-30 weeks. The adverse feeding patterns were associated with sepsis, respiratory, and gastrointestinal morbidities at GA 23-26 weeks; sepsis, hemodynamic and gastrointestinal morbidities at GA 27-28 weeks; and preeclampsia, respiratory, and gastrointestinal morbidities at GA 29-30 weeks. Using the improving feeding group as a reference, the adverse feeding group showed significantly higher adjusted odds ratios of EUGR in body weight and head circumference in infants at GA 23-26 and 27-28 weeks. Identifying the early-life adverse feeding trajectories may help recognize the related EUGR outcomes of preterm infants in a GA-related manner.
基于不同胎龄（GA）早产儿的日常肠内喂养数据建立不同的喂养轨迹，可能有助于识别与不良喂养模式相关的风险和宫外生长受限（EUGR）结局。在一家单中心，我们回顾性纳入了 2009 年至 2020 年间出生于 23-30 周、存活至校正胎龄（TEA）的 625 名婴儿。这些婴儿被分为三组 GA：23-26 周、27-28 周和 29-30 周。分析了出生后前 56 天的每日肠内喂养量，以确定喂养轨迹。主要结局是通过出生至 TEA 之间的变化计算的体重和头围的 EUGR。聚类分析确定了两种喂养轨迹，即每个 GA 组的改善和不良模式。在 GA 23-26、27-28 和 29-30 周的婴儿中，分别有 49%、20%和 17%出现不良喂养模式，而改善喂养模式分别在 GA 23-26 和 27-28 周的婴儿中在第 7 天，而在 GA 29-30 周的婴儿中在第 21 天。不良喂养模式与 GA 23-26 周的败血症、呼吸和胃肠道发病率有关；GA 27-28 周的败血症、血液动力学和胃肠道发病率；以及 GA 29-30 周的子痫前期、呼吸和胃肠道发病率。以改善喂养组为参考，不良喂养组在 GA 23-26 和 27-28 周的婴儿中，体重和头围 EUGR 的调整比值比明显更高。识别早期生命的不良喂养轨迹可能有助于以 GA 相关的方式识别早产儿的相关 EUGR 结局。
