Thoene Melissa, Ridgway Lauren, Lyden Elizabeth, Anderson-Berry Ann
Department of Pediatrics, Division of Neonatology, University of Nebraska Medical Center, 981205 Nebraska Medical Center, Omaha, NE 68198, USA.
College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Nutrients. 2024 Nov 26;16(23):4041. doi: 10.3390/nu16234041.
BACKGROUND/OBJECTIVES: Identifying nutritional interventions in extremely low-birth-weight (ELBW) infants (<1000 g) that are associated with favorable clinical outcomes is important. Delayed enteral feeding initiation (>3 days) has been associated with increased odds of developing morbidity. Therefore, the aim of this study is to evaluate the relationship between hour of life at enteral feeding initiation and associated clinical outcomes.
An IRB-approved retrospective chart review evaluated ELBW infants. Birth acuity was evaluated using CRIB II scoring and incidence of various morbidities (bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP)) and mortality was assessed after adjustment. < 0.05 was statistically significant.
A total of 27/61 (44.3%) initiated enteral feeding <12 h of life. CRIB II scores were lower in infants with earlier enteral feeding initiation. There were no statistical differences in NEC, SIP, or death between categories of hour of life at enteral feeding initiation. After adjusting for CRIB II scores, enteral feeding initiation ≥12 h of life was associated with more days receiving oxygen >21% inspired air (β = 32.7; = 0.040), approximately 7-fold higher odds of developing moderate/severe BPD (95% CI 1.2.8-38.28; = 0.025), and 9-fold higher odds of being discharged home while receiving oxygen therapy (95% CI 1.03-79.81; = 0.047).
Timing of enteral feeding initiation may be delayed in ELBW infants with higher clinical acuity, yet later initiation by hour of life is associated with worsened clinical respiratory outcomes. Early initiation within the first 12 h of life is feasible and was not associated with gastrointestinal morbidity in this single-center cohort of ELBW infants.
背景/目的：确定与极低出生体重（ELBW，<1000g）婴儿良好临床结局相关的营养干预措施非常重要。延迟肠内喂养开始时间（>3天）与发病几率增加有关。因此，本研究旨在评估肠内喂养开始时的出生小时数与相关临床结局之间的关系。
一项经机构审查委员会批准的回顾性病历审查对ELBW婴儿进行了评估。使用CRIB II评分评估出生时的病情严重程度，并在调整后评估各种疾病（支气管肺发育不良（BPD）、早产儿视网膜病变（ROP）、坏死性小肠结肠炎（NEC）和自发性肠穿孔（SIP））的发生率及死亡率。P<0.05具有统计学意义。
共有27/61（44.3%）的婴儿在出生后<12小时开始肠内喂养。肠内喂养开始时间较早的婴儿CRIB II评分较低。在肠内喂养开始时的出生小时数类别之间，NEC、SIP或死亡方面没有统计学差异。在调整CRIB II评分后，出生后≥12小时开始肠内喂养与接受>21%吸入氧的天数增加相关（β=32.7；P=0.040），发生中度/重度BPD的几率高出约7倍（95%CI 1.28-38.28；P=0.025），以及在接受氧疗时出院回家的几率高出9倍（95%CI 1.03-79.81；P=0.047）。
临床病情较重的ELBW婴儿可能会延迟肠内喂养开始时间，但出生小时数较晚开始喂养与临床呼吸结局恶化相关。在出生后12小时内尽早开始喂养是可行的，并且在这个单中心ELBW婴儿队列中与胃肠道疾病无关。
