Baker J H, Berseth C L
Department of Pediatrics, Mayo Clinic, Rochester, Minnesota 55905, USA.
Pediatr Res. 1997 Nov;42(5):618-22. doi: 10.1203/00006450-199711000-00012.
Feeding intolerance is frequently reflected in preterm infants by delayed gastric emptying. Gastric emptying is delayed by the physical characteristics of ingested nutrient as well as the rate of feeding. Because gastric emptying is dependent upon duodenal function, the present studies were undertaken to assess duodenal motor responses to feeding of differing nutrient content and rate of feeding. Using a Latin square design we recorded duodenal motor responses in 14 preterm infants given four test feedings in random order over 18 h. Three were given as a 120-min infusion containing no nutrient, a 10 cal/oz formula, and a 20 cal/oz formula. The fourth test feeding consisted of a 20 cal/oz formula given as a bolus over 15 min. Although caloric density was altered, osmotic load and nutrient proportions of the formulas were not. Motor responses were recorded using a low compliance continuous perfusion manometric system. When infants were fed "water" and half-strength formula as a slow infusion, they demonstrated little or no duodenal motor response to feeding. When these infants were fed full-strength formula as a slow infusion, they displayed a brisk increase in motor activity (p < 0.05), but profound motor quiescence when fed the same volume by bolus over 15 min (p < 0.05). Of the four test feedings, only full-strength formula given as a slow infusion triggered adult-like duodenal motor responses to feeding. We speculate that feedings of full-strength formula given slowly by infusion will improve feeding tolerance.
喂养不耐受在早产儿中常表现为胃排空延迟。胃排空会因摄入营养素的物理特性以及喂养速度而延迟。由于胃排空依赖于十二指肠功能，因此开展了本研究以评估十二指肠对不同营养成分和喂养速度的运动反应。我们采用拉丁方设计，记录了14名早产儿在18小时内随机接受四次试验性喂养时的十二指肠运动反应。其中三次喂养分别为持续120分钟的无营养输注、每盎司含10千卡的配方奶和每盎司含20千卡的配方奶。第四次试验性喂养是在15分钟内推注每盎司含20千卡的配方奶。虽然热量密度有所改变，但配方奶的渗透压负荷和营养成分比例未变。使用低顺应性连续灌注测压系统记录运动反应。当给婴儿缓慢输注“水”和半强度配方奶时，他们对喂养几乎没有或没有十二指肠运动反应。当给这些婴儿缓慢输注全强度配方奶时，他们的运动活动迅速增加（p < 0.05），但在15分钟内推注相同体积的全强度配方奶时则出现深度运动静止（p < 0.05）。在四次试验性喂养中，只有缓慢输注全强度配方奶引发了类似成人的十二指肠对喂养的运动反应。我们推测，缓慢输注全强度配方奶将提高喂养耐受性。
