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早期肠内营养支持对体外膜肺氧合危重新生儿的临床效果。

Clinical effect of early enteral nutrition support on critically ill neonates with extracorporeal membrane oxygenation.

机构信息

Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.

出版信息

BMC Pediatr. 2023 Jul 13;23(1):359. doi: 10.1186/s12887-023-04171-2.

Abstract

OBJECTIVE

To investigate the feasibility and clinical outcomes of early enteral nutrition (EN) in critically ill neonates supported by extracorporeal membrane oxygenation (ECMO).

METHODS

We retrospectively analyzed the clinical data of 16 critically ill neonates who received ECMO support for respiratory and circulatory failure from July 2021 to December 2022 at our center. The patients were divided into two groups: the early EN group (< 24 h) and the late EN group (> 24 h). The related clinical and nutrition-related indicators between the groups were compared.

RESULTS

There was a significant difference in the time from ECMO treatment to the start of EN between the early EN group (9 patients, 56.2%) and the late EN group (7 patients, 43.8%) (P < 0.05). However, there were no significant differences in ECMO duration, hospitalization time, vasoactive-inotropic score (VIS), intestinal oxygen saturation, or routine stool occult blood (OB) test between the two groups (all P > 0.05). The incidence of complications such as intestinal obstruction, abdominal distension, diarrhea, and necrotizing enterocolitis (NEC) was slightly lower in the early EN group, but the differences were not statistically significant (all P > 0.05). The early EN group had a shorter time [3.6 (3.5, 5) vs. 7.5 (5.9, 8.5) d] to reach full gastrointestinal nutrition compared to the late EN group (P < 0.05).

CONCLUSION

Providing early nutritional support through enteral feeding to critically ill neonates receiving ECMO treatment is both safe and practical, but close monitoring of clinical and nutritional indicators is essential.

摘要

目的

探讨体外膜肺氧合(ECMO)支持下危重新生儿早期肠内营养(EN)的可行性和临床结局。

方法

回顾性分析 2021 年 7 月至 2022 年 12 月我院收治的 16 例因呼吸和循环衰竭接受 ECMO 支持的危重新生儿的临床资料。患儿分为早期 EN 组(<24 h)和晚期 EN 组(>24 h),比较两组患儿相关临床及营养相关指标。

结果

早期 EN 组(9 例,56.2%)患儿 ECMO 治疗开始 EN 的时间与晚期 EN 组(7 例,43.8%)比较,差异有统计学意义(P<0.05)。两组患儿 ECMO 时间、住院时间、血管活性药物指数(VIS)、肠黏膜氧饱和度及常规大便潜血(OB)试验比较,差异均无统计学意义(均 P>0.05)。早期 EN 组患儿肠梗阻、腹胀、腹泻、坏死性小肠结肠炎(NEC)等并发症的发生率略低,但差异无统计学意义(均 P>0.05)。早期 EN 组患儿达到全胃肠营养的时间[3.6(3.5,5)比 7.5(5.9,8.5)d]短于晚期 EN 组,差异有统计学意义(P<0.05)。

结论

对接受 ECMO 治疗的危重新生儿早期给予肠内营养支持是安全可行的,但需要密切监测临床和营养指标。

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Nutrition Delivery During Pediatric Extracorporeal Membrane Oxygenation Therapy.儿科体外膜肺氧合治疗期间的营养输送。
JPEN J Parenter Enteral Nutr. 2018 Sep;42(7):1133-1138. doi: 10.1002/jpen.1154. Epub 2018 Mar 30.

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