Troche B, Harvey-Wilkes K, Engle W D, Nielsen H C, Frantz I D, Mitchell M L, Hermos R J
Boston Perinatal Center, Saint Margaret's Hospital for Women, Mass., USA.
Biol Neonate. 1995;67(3):172-81. doi: 10.1159/000244160.
Critically ill premature infants requiring mechanical ventilation and an umbilical artery catheter usually do not receive enteral feedings during the acute phase of their illness. We studied the safety and benefit of early minimal enteral feedings during this time in a prospective, controlled, and randomized study. Twenty-nine infants were randomly assigned to receive only standard intravenous fluid and nutrition (nothing per OS, NPO group; n = 13), or in addition to receive small-volume hypocaloric continuous feedings (1 ml/kg/h), beginning at 24 h of age (early-feeding group; n = 16). Standard enteral feedings were begun in both groups at the resolution of the acute phase of the illness and advanced by protocol. The two groups were of comparable birth weight, gestational age, and Apgar scores. There were no significant differences in the episodes of feeding intolerance. Two infants in the NPO group developed clinical signs of necrotizing enterocolitis. Serum diamine oxidase and somatomedin C were measured weekly until 30-60 days of age and were not different between the two groups. The early-feeding group required fewer days to reach 120 ml/kg/day enteral intake (early-feeding group 10 +/- 3 days, NPO group 13 +/- 4 days; p < 0.05). On day 30 of life the early-feeding group was 223 +/- 125 g above birth weight, while the NPO group was 95 +/- 161 g above birth weight (p < 0.05). The average intake (kcal/kg/day) from day 6 to day 30 was not different between the two groups. We conclude that early minimal feedings in critically ill very-low-birth-weight infants requiring mechanical ventilation are well tolerated and result in reduced time to reach 120 ml/kg/day of enteral feeding and in a greater weight gain by day 30 of life.
需要机械通气和脐动脉导管的危重新生儿在疾病急性期通常不接受肠内喂养。我们在一项前瞻性、对照和随机研究中，研究了此时早期微量肠内喂养的安全性和益处。29名婴儿被随机分配，仅接受标准静脉输液和营养（经口无进食，禁食组；n = 13），或除接受标准静脉输液和营养外，从出生24小时起接受小容量低热量持续喂养（1毫升/千克/小时）（早期喂养组；n = 16）。两组在疾病急性期结束时均开始标准肠内喂养，并按方案增加喂养量。两组在出生体重、胎龄和阿氏评分方面具有可比性。喂养不耐受的发生率无显著差异。禁食组有2名婴儿出现坏死性小肠结肠炎的临床症状。每周测量血清二胺氧化酶和生长调节素C，直至30 - 60日龄，两组之间无差异。早期喂养组达到120毫升/千克/天肠内摄入量所需的天数较少（早期喂养组10±3天，禁食组13±4天；p<0.05）。出生后第30天，早期喂养组比出生体重高223±125克，而禁食组比出生体重高95±161克（p<0.05）。两组从第6天到第30天的平均摄入量（千卡/千克/天）无差异。我们得出结论，对于需要机械通气的危重新生儿，早期微量喂养耐受性良好，可缩短达到120毫升/千克/天肠内喂养的时间，并在出生后第30天体重增加更多。
