摘要
目的观察早期微量喂养对极低出生体重儿(VLBWI)生后6周宫外生长与预后的影响。方法选择2007年1月至2009年1月无锡市儿童医院与南京医科大学附属南京儿童医院NICU收治的出生体重(1500g且需要辅助通气和静脉营养的VLBWI为研究对象,根据单双病床号分为早期微量喂养组和对照组。早期微量喂养组:在静脉营养的同时从生后第3天开始经鼻饲管给予早产儿配方乳0.5～1mL.h-1,直至辅助通气结束;对照组:仅予静脉营养直至辅助通气结束。监测生后6周内的能量摄入、生长状况、脓毒症(血培养阳性)发生率、肝功能、喂养耐受情况、辅助通气时间、住院时间和喂养相关并发症的发生率。结果早期微量喂养组18例,对照组22例进入分析。早期微量喂养组入组时胎龄、出生体重和新生儿临床危险指数评分与对照组差异均无统计学意义。①早期微量喂养组生后6周内总能量摄入显著高于对照组,平均差异为261.1kJ.kg-1,P=0.03。②早期微量喂养组生后6周时点体重增长值显著高于对照组,两组差异为120g,P=0.02;头围增长值显著高于对照组,平均差异为0.6cm,P=0.04;中臂围两组差异为0.30cm,P=0.48;三头肌皮肤皱褶厚度两组差异为0.22mm,P=0.51。③两组生后6周内肝功能指标与黄疸持续时间差异无统计学意义;早期微量喂养组生后6周内脓毒症发生率显著低于对照组,P=0.03。④早期微量喂养组需要静脉营养的时间显著少于对照组,P=0.03;过渡到完全肠内营养的时间显著少于对照组,P=0.03。⑤早期微量喂养组需氧时间显著少于对照组,P=0.02;平均住院时间显著少于对照组,P=0.03。⑥两组生后6周内各种喂养相关并发症(腹胀、呕吐、坏死性小肠结肠炎和吸入性肺炎)的发生率差异无统计学意义。结论早期微量喂养可改善VLBWI生后6周宫外生长状况。
Objective To investigate the effect of early trophic feeding on clinical outcomes in very low birth weight infants（VLBWI）.Methods A controlled,prospective study on preterm infants,weighting less than 1 500 g at birth and requiring ventilatory support and parenteral nutrition,was performed in the NICU of Nanjing Children＇s Hospital Affiliated to Nanjing Medical School from January 2007 to January 2009.Preterm infants enrolled into the study were divided into trophic feeding group and control group according to odd and even numbers.Trophic feeding group received trophic feeding from day 3（0.5-1 mL·h^-1） along with parenteral nutrition until ventilatory support was finished.Control group received parenteral nutrition alone.＂Nutritive＂ milk feeding was then introduced to both groups.Clinical outcomes were measured including total energy intake and growth over the first six postnatal weeks,sepsis incidence,liver function,milk tolerance,duration of respiratory support,duration of hospital stay and feeding related complications incidence.Results According to the inclusion and exclusion criteria,40 VLBWI hospitalized in the NICU were enrolled into the study,18 in trophic feeding group and 22 in control group.There were no significant differences in birth weight,gestational age and neonatal clinical risk index scores（CRIB） between the two groups.There were significant differences in energy intake（mean difference=261.1 kJ·kg^-1,P=0.03）,weight gain（mean difference=120 g,P=0.02）,head circumference gain（mean difference=0.6 cm,P=0.04）,fewer episodes of culture confirmed sepsis（mean difference=35%,P=0.02）,less parenteral nutrition（mean difference=9.5 days,P=0.03）,tolerated full milk feeding（150 mL·kg^-1·d^-1） earlier（mean difference=12 days,P=0.03）,reduced requirement for supplemental oxygen（mean difference=21.5 days,P=0.02） and being discharged from hospital earlier（mean difference=20.5 days,P=0.03） between trophic feeding group and control group.There was no significan
出处
《中国循证儿科杂志》
CSCD
2010年第2期100-103,共4页
Chinese Journal of Evidence Based Pediatrics
关键词
微量喂养
肠内喂养
静脉营养
早产儿
极低出生体重儿
半随机对照试验
Trophic feeding
Enteral feeding
Parenteral nutrition
Preterm infants
Very low birth weight infants
Quasi-randomized controlled trial
