早期肠道喂养进展缓慢与极早产儿纵向头围生长迟缓和神经发育障碍的结局相关。

Early-Life Slow Enteral Feeding Progression Pattern Is Associated with Longitudinal Head-Size Growth Faltering and Neurodevelopmental Impairment Outcomes in Extremely Preterm Infants.

机构信息

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.

出版信息

Nutrients. 2023 Mar 4;15(5):1277. doi: 10.3390/nu15051277.

DOI:10.3390/nu15051277

PMID:36904276

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10005088/

Abstract

OBJECTIVE

To determine whether feeding progression patterns in the first eight postnatal weeks, depicted by clustering analysis of daily enteral feeding volume, are associated with longitudinal head-circumference (HC) growth and neurodevelopmental outcomes in extremely preterm (EP) infants.

METHODS

200 infants who were admitted at gestational ages 23-27 weeks between 2011 and 2018; survived to discharge; and underwent longitudinal HC growth measurements at birth, term-equivalent age (TEA), corrected age (CA) 6-month, 12-month, and 24-month; and neurodevelopmental assessment using the Bayley Scales of Infant Development at CA 24 months were included for analysis.

RESULTS

kmlShape analysis identified two distinct enteral feeding progression patterns: fast progression in 131 (66%) infants and slow progression in 69 (34%) infants. Compared to the fast progression group, the slow progression group showed significantly lower daily enteral volumes after day 13, was older in postnatal age reaching full feeding, had a higher rate of Delta z scores of HC (zHC) < -1 ( < 0.001) between birth and TEA, and displayed lower longitudinal zHC from TEA to CA 24 months. The slow progression group also showed higher rates of microcephaly [42% vs. 16%, < 0.001; adjusted odd ratio (aOR): 3.269, = 0.001] and neurodevelopmental impairment (NDI) (38% vs. 19%, = 0.007; aOR: 2.095, = 0.035) at CA 24 months. For NDI, the model including feeding progression patterns showed a lower Akaike information criterion score and a better goodness of fit than the model that did not include feeding patterns.

CONCLUSION

Characterizing feeding progression pattern may help identify EP infants at high-risk of head-size growth faltering and NDI at early childhood.

摘要

目的

通过对每日肠内喂养量的聚类分析，确定生后 8 周内喂养进展模式是否与极早产儿（extremely preterm，EP）的头围（head-circumference，HC）纵向生长和神经发育结局相关。

方法

纳入 2011 年至 2018 年间胎龄 23-27 周入院、存活至出院、并在出生时、校正胎龄（corrected age，CA）6 月龄、12 月龄和 24 月龄时进行了 HC 纵向生长测量、CA 24 月龄时进行了贝利婴幼儿发育量表（Bayley Scales of Infant Development）神经发育评估的 200 例 EP 婴儿。

结果

kmlShape 分析确定了两种不同的肠内喂养进展模式：131 例（66%）婴儿快速进展，69 例（34%）婴儿缓慢进展。与快速进展组相比，缓慢进展组在生后第 13 天以后的每日肠内喂养量明显较低，达到完全喂养的日龄较大，出生至 TEA 期 HC 的 Delta z 评分（zHC）< -1（<0.001）的比例较高，从 TEA 到 CA 24 月龄的 zHC 纵向变化较低。缓慢进展组的小头畸形发生率也较高[42% vs. 16%，<0.001；调整后的比值比（odds ratio，OR）：3.269，=0.001]和 CA 24 月龄时的神经发育损伤（neurodevelopmental impairment，NDI）发生率较高[38% vs. 19%，=0.007；调整 OR：2.095，=0.035]。对于 NDI，纳入喂养进展模式的模型的赤池信息量准则（Akaike information criterion，AIC）评分较低，拟合优度较好。