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急性心脏病监护病房中患有便血和坏死性小肠结肠炎婴儿的喂养方式

Feeding Practices in Infants with Hematochezia and Necrotizing Enterocolitis on Acute Care Cardiology Units.

作者信息

Palm Kelsey, Trauth Amiee, Gao Zhiqian, Pradhan Sarah, Schachtner Susan, Strohacker Courtney, Nash Dustin, Marcuccio Elisa

机构信息

Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

出版信息

Pediatr Cardiol. 2025 Feb;46(2):332-338. doi: 10.1007/s00246-024-03406-y. Epub 2024 Feb 15.

Abstract

Infants with congenital heart disease (CHD) are at risk for developing both benign hematochezia and necrotizing enterocolitis (NEC). Despite these risks there are very few studies that investigate modifiable risk factors such as feeding practices. It remains unclear what feeding practices should be avoided due to higher incidence of CHD-NEC. We aim to assess the feeding practices across three high volume tertiary centers to establish a relationship between various feeding practices and development of NEC. A multicenter retrospective review of feeding practices at the time of documented hematochezia event that occurred between 1/2019 and 1/2021 in infants with CHD who were less than 6 months of age. NEC was defined as Bells Stage 2 or greater. Age, weight, ventricular morphology, primary diagnoses, feeding route, feed change, and formula type were evaluated. 176 hematochezia events occurred in 121 patients, 72% of these events were considered benign hematochezia with the remaining 28% being true NEC. Single ventricle (SV) physiology (p < 0.05), younger age, < 45 days of life, (p < 0.001), and feeding route were statistically associated with true NEC (p < 0.01). Formula type and recent change in feed administration were not associated with NEC. The caloric density of feeds at the time of hematochezia was nearing significance. The majority of hematochezia events are benign in nature, however, there should be heightened awareness in patients who are SV, younger in age, and those who are post-pylorically fed. There may be some risk in using higher caloric density feeds (> 24 kcal/oz), however, additional research is needed to fully establish this relationship.

摘要

患有先天性心脏病(CHD)的婴儿有发生良性便血和坏死性小肠结肠炎(NEC)的风险。尽管存在这些风险,但很少有研究调查诸如喂养方式等可改变的风险因素。由于CHD-NEC的发病率较高,目前尚不清楚应避免哪些喂养方式。我们旨在评估三个大型三级医疗中心的喂养方式,以确定各种喂养方式与NEC发生之间的关系。对2019年1月至2021年1月期间6个月以下患有CHD的婴儿在记录到便血事件时的喂养方式进行多中心回顾性研究。NEC被定义为贝尔分期2期或更高。评估了年龄、体重、心室形态、主要诊断、喂养途径、喂养变化和配方奶类型。121例患者发生了176次便血事件,其中72%的事件被认为是良性便血,其余28%为真正的NEC。单心室(SV)生理状态(p<0.05)、年龄较小(<45天,p<0.001)和喂养途径与真正的NEC在统计学上相关(p<0.01)。配方奶类型和近期喂养方式的改变与NEC无关。便血时喂养的热量密度接近显著水平。大多数便血事件本质上是良性的,然而,对于SV患者、年龄较小的患者以及幽门后喂养的患者,应提高警惕。使用高热量密度的喂养(>24千卡/盎司)可能存在一些风险,然而,需要更多的研究来充分确立这种关系。

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