摘要
目的分析北京地区不同级别医院收治胎龄34~36周+6晚期早产儿的肠内营养支持现状及相关影响因素。方法前瞻性纳入2015年10月至2017年10月间北京地区共25家医院收治的晚期早产儿,记录其营养管理及营养相关并发症的数据。分析不同胎龄、不同级别医院的晚期早产儿的纯母乳喂养情况,以及晚期早产儿达足量喂养情况及影响因素。采用t检验、Mann-Whitney U检验、方差分析、Kruskal-Wallis检验、χ^2检验等对数据进行统计学分析。多因素分析时采用二元logistic回归、Cox回归分析。结果(1)研究期间,共1463例晚期早产儿纳入,胎龄(35.6±0.8)周,范围为34.9~36.1周。34~34周+6与35~35周+6及36~36周+6晚期早产儿相比,住院时间更长[10(8~13)与8(7~10)、7(6~9)d,P值均<0.05],最低体重下降幅度更大[4.3%(2.6%~6.3%)与3.8%(2.0%~5.6%)、3.3%(1.9%~5.5%),P值均<0.05],呼吸暂停及新生儿呼吸窘迫综合征发生率更高[分别为5.3%(20/369)与2.1%(12/566)、1.3%(7/528),7.1%(28/369)与3.0%(17/566)、3.2%(17/528),P值均<0.05],出院时未恢复出生体重者比例更低[32.5%(120/369)与38.7%(219/566)、47.9%(253/528),P值均<0.05]。34~34周+6、35~35周+6及36~36周+6晚期早产儿母亲孕期并发症方面,仅胎膜早破的发生率差异有统计学意义[6.2%(23/369)与12.7%(72/566)、11.9%(63/528),χ^2=10.244,P=0.007]。(2)晚期早产儿住院期间加奶速度为13.7(10.5~17.3)ml/(kg·d),且以早产儿配方奶喂养为主(46.0%,673/1463);住院期间纯母乳喂养的比例仅为4.5%(66/1463),出院时纯母乳喂养的比例可升高到14.4%(211/1463)。25家医疗单位出院时母乳喂养的比例差异有统计学意义(χ^2=327.893,P<0.001),纯母乳喂养比例最高的单位可以达到32%,最低为0。(3)logistic回归分析显示,妊娠期糖尿病(OR=2.426,95%CI:1.075~5.473,P=0.033),胎膜早破(OR=8.726,95%CI:1.193~63.802,P=0.033)可能是晚期早产儿纯母乳喂养的独立危险因素。出院时肠内营养量达到150 m
Objective To investigate the status and influencing factors of enteral nutrition support in late preterm infants(34-36^+6 gestational weeks)treated in different grades of hospitals in Beijing.Methods This was a prospective study involving late preterm infants treated in 25 hospitals in Beijing from October 2015 to October 2017.Data about nutritional management and nutrition-related complications were recorded.Exclusive breastfeeding status of the infants by gestational age(GA)and hospital levels was analyzed.The achievement of full enteral feeding and the potential influencing factors were also analyzed.t-test,Mann-Whitney U test,analysis of variance(ANOVA),Kruskal-Wallis test and Chi-square test were used for statistical analysis.Logistic regression and Cox regression analysis were used in multivariate analysis.Results(1)A total of 1463 late preterm infants with GA of 35.6±0.8(ranging from 34.9 to 36.1)weeks was enrolled in this study.Compared with the infants with GA of 35-35+6 and 36-36+6 weeks,those born at 34-34+6 gestational weeks had longer hospital stay[10(8-13)vs 8(7-10)and 7(6-9)d,both P<0.05],greater loss of minimum weight[4.3%(2.6%-6.3%)vs 3.8%(2.0%-5.6%)and 3.3%(1.9%-5.5%),both P<0.05],higher incidence of apnea[5.3%(20/369)vs 2.1%(12/566)and 1.3%(7/528),both P<0.05]and respiratory distress syndrome(RDS)[7.1%(28/369)vs 3.0%(17/566)and 3.2%(17/528),both P<0.05],and lower percentage of failure to regain birth weight at discharge[32.5%(120/369)vs 38.7%(219/566)and 47.9%(253/528),both P<0.05].Only the incidence of premature rupture of membranes among all maternal complications during pregnancy had statistical difference between 34-34+6,35-35+6 and 36-36+6 GA groups[6.2%(23/369)vs 12.7%(72/566)and 11.9%(63/528),χ^2=10.244,P=0.007].(2)The rate of enteral feeding increment in hospital was 13.7(10.5-17.3)ml/(kg·d)and 46.0%(673/1463)of the infants were fed formula.The exclusive breastfeeding rate increased from 4.5%(66/1463)during hospitalization to 14.4%(211/1463)at discharge.The breastfeeding rate at disc
作者
全美盈
李正红
王丹华
杨立
刘捷
秦选光
张欣
韩彤妍
李瑛
付晓辉
Quan Meiying;Li Zhenghong;Wang Danhua;Yang Li;Liu Jie;Qin Xuanguang;Zhang Xin;Han Tongyan;Li Ying;Fu Xiaohui(Department of Pediatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pediatrics,Tongzhou Maternal and Child Health Hospital of Beijing,Beijing 101100,China;Department of Pediatrics,Peking University People's Hospital,Beijing 100044,China;Department of Pediatrics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China;Department of Pediatrics,Haidian Maternal and Child Health Hospital of Beijing,Beijing 100080,China;Department of Pediatrics,Beijing Shangdi Hospital,Beijing 100084,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2020年第3期194-202,共9页
Chinese Journal of Perinatal Medicine
基金
北京市卫生和计划生育委员会科技研发项目(2016001)
中国医学科学院医学与健康科技创新工程(2016-12M-1-008)。
关键词
营养支持
肠内营养
婴儿
早产
多中心研究
喂养不耐受
Nutritional support
Enteral nutrition
Infant,premature
Multicenter study
Feeding intolerance
