Frakaloss G, Burke G, Sanders M R
Department of Pediatrics, University of Connecticut School of Medicine, Farmington, USA.
J Pediatr Gastroenterol Nutr. 1998 Feb;26(2):146-50. doi: 10.1097/00005176-199802000-00005.
Gastroesophageal reflux (GER) is associated with failure to thrive in term infants with severe GER; however, this association has not been shown in premature infants. A retrospective case-control study of growth velocities, caloric intake, and length of hospital stay in premature infants with GER was conducted to determine the impact of GER on their growth.
Twenty-three patients with clinically significant GER were identified from a database containing records for all infants admitted to the University of Connecticut Health Center Neonatal Intensive Care Unit. Patients and control subjects (n = 23) were matched for gestational age, birth weight, gender, and severity of bronchopulmonary dysplasia. Each infant's average weekly weight gain and average weekly caloric intake were calculated, using daily bedside nursing flow sheets. Comparisons were also made of the number of days it took each infant to achieve full oral feedings, number of days from full oral feedings to discharge, and length of hospital stay.
There were no significant differences between patients and control subjects for each week in average weekly weight gain, caloric intake, grams gained per calorie given, or weekly increments gained in length and head circumference. There were, however, significant differences in time required to achieve full oral feedings (32 +/- 13 days versus 19 +/- 12 days; p < 0.0008) and length of hospital stay (99 +/- 27 days versus 70 +/- 31 days; p < 0.002) as well as postmenstrual age (PMA) at discharge (43 +/- 3 weeks versus 39 +/- 3 weeks, p < 0.001).
GER did not have a significant impact on caloric intake, effective use of calories, or growth velocities in the study population. It is more likely that the constant monitoring of weight gain and caloric intake while in the intensive care environment protects against the failure to thrive often seen in older infants with GER. Premature infants with GER had a significantly increased length of hospital stay. More aggressive medical management and consideration of alternative feeding strategies may help facilitate discharge for premature infants diagnosed with GER.
胃食管反流（GER）与足月重度GER婴儿的生长发育不良有关；然而，这种关联在早产儿中尚未得到证实。我们进行了一项回顾性病例对照研究，以确定GER对早产儿生长速度、热量摄入和住院时间的影响。
从一个包含康涅狄格大学健康中心新生儿重症监护病房所有婴儿记录的数据库中，识别出23例具有临床意义的GER患者。患者和对照者（n = 23）在胎龄、出生体重、性别和支气管肺发育不良的严重程度方面进行匹配。使用每日床边护理记录表计算每个婴儿的平均每周体重增加量和平均每周热量摄入量。还比较了每个婴儿实现完全经口喂养所需的天数、从完全经口喂养到出院的天数以及住院时间。
患者和对照者在平均每周体重增加量、热量摄入量、每给予一卡路里所增加的克数，或长度和头围的每周增加量方面，每周均无显著差异。然而，在实现完全经口喂养所需的时间（32±13天对19±12天；p < 0.0008）、住院时间（99±27天对70±31天；p < 0.002）以及出院时的月经后年龄（PMA）（43±3周对39±3周，p < 0.001）方面存在显著差异。
GER对研究人群的热量摄入、热量的有效利用或生长速度没有显著影响。更有可能的是，在重症监护环境中对体重增加和热量摄入的持续监测可防止GER较大婴儿中常见的生长发育不良。患有GER的早产儿住院时间显著延长。更积极的医疗管理和考虑替代喂养策略可能有助于促进诊断为GER的早产儿出院。
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