
早产儿喂养不耐受临床诊疗指南(2020)
Clinical guidelines for the diagnosis and treatment of feeding intolerance in preterm infants (2020)
早产儿喂养不耐受是目前新生儿最常见的临床问题之一,常导致达全肠内营养时间延迟,住院时间延长。防治早产儿喂养不耐受对提高早产儿存活率有重要意义。该指南基于目前国内外研究,采用证据推荐分级的评估、制定与评价方法(GRADE)进行证据分级制定早产儿喂养不耐受的临床诊疗指南,旨在帮助新生儿科医生、护理人员、营养治疗师等对早产儿喂养不耐受进行早期识别与规范管理。
Feeding intolerance (FI) is one of the most common clinical problems in preterm infant and often leads to the delay in reaching total enteral nutrition and prolonged hospital stay. The prevention and treatment of FI are of great significance in improving the survival rate of preterm infants. With reference to current evidence in China and overseas, the clinical guidelines for the diagnosis and treatment of FI in preterm infants were developed based on Grading of Recommendations Assessment, Development and Evaluation (GRADE), so as to help neonatal pediatricians, nursing staff, and nutritionists with early identification and standard management of FI in preterm infants.
Feeding intolerance / Guideline / Low birth weight infant / Preterm infant
[1] 唐军. 早产儿喂养不耐受:一个重要的临床问题[J]. 中华围产医学杂志, 2020, 23(3):177-181.
[2] Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations[J]. BMJ, 2004, 328(7454):1490.
[3] Ng E, Shah VS. Erythromycin for the prevention and treatment of feeding intolerance in preterm infants[J]. Cochrane Database Syst Rev, 2008(3):CD001815.
[4] Kuzma-O'Reilly B, Duenas ML, Greecher C, et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition[J]. Pediatrics, 2003, 111(4 Pt 2):e461-e470.
[5] Moore TA, Wilson ME. Feeding intolerance:a concept analysis[J]. Adv Neonatal Care, 2011, 11(3):149-154.
[6] Jadcherla SR, Kliegman RM. Studies of feeding intolerance in very low birth weight infants:definition and significance[J]. Pediatrics, 2002, 109(3):516-517.
[7] Dutta S, Singh B, Chessell L, et al. Guidelines for feeding very low birth weight infants[J]. Nutrients, 2015, 7(1):423-442.
[8] Costa S, Maggio L, Alighieri G, et al. Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants:a randomized non-inferiority trial[J]. Ital J Pediatr, 2018, 44(1):96.
[9] Patole S, Rao S, Doherty D. Erythromycin as a prokinetic agent in preterm neonates:a systematic review[J]. Arch Dis Child Fetal Neonatal Ed, 2005, 90(4):F301-F306.
[10] Morgan J, Bombell S, McGuire W. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants[J]. Cochrane Database Syst Rev, 2013(3):CD000504.
[11] Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants[J]. Cochrane Database Syst Rev, 2018, 6(6):CD002971.
[12] Mihatsch WA, von Schoenaich P, Fahnenstich H, et al. The significance of gastric residuals in the early enteral feeding advancement of extremely low birth weight infants[J]. Pediatrics, 2002, 109(3):457-459.
[13] American Academy of Pediatrics. Breastfeeding and the use of human milk[J]. Pediatrics, 2012, 129(3):e827-e841.
[14] World Health Organization. Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries[EB/OL].[2020-08-20]. https://www.who.int/maternal_child_adolescent/documents/infant_feeding_low_bw/en/.
[15] Ford SL, Lohmann P, Preidis GA, et al. Improved feeding tolerance and growth are linked to increased gut microbial community diversity in very-low-birth-weight infants fed mother's own milk compared with donor breast milk[J]. Am J Clin Nutr, 2019, 109(4):1088-1097.
[16] Assad M, Elliott MJ, Abraham JH. Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet[J]. J Perinatol, 2016, 36(3):216-220.
[17] Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products[J]. J Pediatr, 2010, 156(4):562-567.e1.
[18] Ganapathy V, Hay JW, Kim JH. Costs of necrotizing enterocolitis and cost-effectiveness of exclusively human milk-based products in feeding extremely premature infants[J]. Breastfeed Med, 2012, 7(1):29-37.
[19] Surmeli-Onay O, Korkmaz A, Yigit S, et al. Feeding intolerance in preterm infants fed with powdered or liquid formula:a randomized controlled, double-blind, pilot study[J]. Eur J Pediatr, 2013, 172(4):529-536.
[20] Ng DHC, Klassen JR, Embleton ND, et al. Protein hydrolysate versus standard formula for preterm infants[J]. Cochrane Database Syst Rev, 2019, 7(7):CD012412.
[21] 刘瑶, 晁爽, 曾超美, 等. 深度水解蛋白配方在早产儿早期喂养中的疗效观察[J]. 中国新生儿科杂志, 2012, 27(2):86-90.
[22] 刘运启, 何莉霞, 雷月娥, 等. 深度水解蛋白配方乳对极低出生体质量儿早期胃肠功能影响[J]. 中国社区医师(医学专业), 2013, 15(9):206.
[23] Raimondi F, Spera AM, Sellitto M, et al. Amino acid-based formula as a rescue strategy in feeding very-low-birth-weight infants with intrauterine growth restriction[J]. J Pediatr Gastroenterol Nutr, 2012, 54(5):608-612.
[24] Jang HJ, Park JH, Kim CS, et al. Amino acid-based formula in premature infants with feeding intolerance:comparison of fecal calprotectin level[J]. Pediatr Gastroenterol Hepatol Nutr, 2018, 21(3):189-195.
[25] Griffin MP, Hansen JW. Can the elimination of lactose from formula improve feeding tolerance in premature infants?[J]. J Pediatr, 1999, 135(5):587-592.
[26] Tan-Dy CR, Ohlsson A. Lactase treated feeds to promote growth and feeding tolerance in preterm infants[J]. Cochrane Database Syst Rev, 2013, 2013(3):CD004591.
[27] 早产儿母乳强化剂使用专家共识工作组, 中华新生儿科杂志编辑委员会. 早产儿母乳强化剂使用专家共识[J]. 中华新生儿科杂志, 2019, 34(5):321-328.
[28] Yigit S, Akgoz A, Memisoglu A, et al. Breast milk fortification:effect on gastric emptying[J]. J Matern Fetal Neonatal Med, 2008, 21(11):843-846.
[29] 母乳强化剂应用研究协作组. 母乳强化剂在早产儿母乳喂养中应用的多中心研究[J]. 中华儿科杂志, 2012, 50(5):336-342.
[30] Brown JV, Embleton ND, Harding JE, et al. Multi-nutrient fortification of human milk for preterm infants[J]. Cochrane Database Syst Rev, 2016(5):CD000343.
[31] O'Connor DL, Kiss A, Tomlinson C, et al. Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g:a randomized clinical trial[J]. Am J Clin Nutr, 2018, 108(1):108-116.
[32] Eibensteiner F, Auer-Hackenberg L, Jilma B, et al. Growth, feeding tolerance and metabolism in extreme preterm infants under an exclusive human milk diet[J]. Nutrients, 2019, 11(7):1443.
[33] Bertino E, Cavallarin L, Cresi F, et al. A novel donkey milk-derived human milk fortifier in feeding preterm infants:a randomized controlled trial[J]. J Pediatr Gastroenterol Nutr, 2019, 68(1):116-123.
[34] Kim JH, Chan G, Schanler R, et al. Growth and tolerance of preterm infants fed a new extensively hydrolyzed liquid human milk fortifier[J]. J Pediatr Gastroenterol Nutr, 2015, 61(6):665-671.
[35] Moya F, Sisk PM, Walsh KR, et al. A new liquid human milk fortifier and linear growth in preterm infants[J]. Pediatrics, 2012, 130(4):e928-e935.
[36] 蔡威, 汤庆娅, 王莹, 等. 中国新生儿营养支持临床应用指南[J]. 临床儿科杂志, 2013, 31(12):1177-1182.
[37] Premji SS, Chessell L. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams[J]. Cochrane Database Syst Rev, 2011, 2011(11):CD001819.
[38] Rogers SP, Hicks PD, Hamzo M, et al. Continuous feedings of fortified human milk Lead to nutrient losses of fat, calcium and phosphorous[J]. Nutrients, 2010, 2(3):230-240.
[39] Kennedy KA, Tyson JE, Chamnanvanakij S. Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants[J]. Cochrane Database Syst Rev, 2000(2):CD001241.
[40] Rodriguez NA, Meier PP, Groer MW, et al. Oropharyngeal administration of colostrum to extremely low birth weight infants:theoretical perspectives[J]. J Perinatol, 2009, 29(1):1-7.
[41] 李媛媛, 赵旭, 历广招, 等. 应用初乳对早产儿进行口腔护理干预效果的系统评价[J]. 中华护理杂志, 2019, 54(5):753-759.
[42] 许素环, 张巧梅, 但鑫, 等. 口腔免疫疗法对早产儿干预效果的Meta分析[J]. 中国护理管理, 2018, 18(10):1340-1346.
[43] Abd-Elgawad M, Eldegla H, Khashaba M, et al. Oropharyngeal administration of mother's milk prior to gavage feeding in preterm infants:a pilot randomized control trial[J]. JPEN J Parenter Enteral Nutr, 2020, 44(1):92-104.
[44] Rodriguez NA, Vento M, Claud EC, et al. Oropharyngeal administration of mother's colostrum, health outcomes of premature infants:study protocol for a randomized controlled trial[J]. Trials, 2015, 16:453.
[45] Seigel JK, Smith PB, Ashley PL, et al. Early administration of oropharyngeal colostrum to extremely low birth weight infants[J]. Breastfeed Med, 2013, 8(6):491-495.
[46] Watson J, McGuire W. Transpyloric versus gastric tube feeding for preterm infants[J]. Cochrane Database Syst Rev, 2013, 2013(2):CD003487.
[47] Athalye-Jape G, Deshpande G, Rao S, et al. Benefits of probiotics on enteral nutrition in preterm neonates:a systematic review[J]. Am J Clin Nutr, 2014, 100(6):1508-1519.
[48] Peeters T, Matthijs G, Depoortere I, et al. Erythromycin is a motilin receptor agonist[J]. Am J Physiol, 1989, 257(3 Pt 1):G470-G474.
[49] Enriquez A, Bolisetty S, Patole S, et al. Randomised controlled trial of cisapride in feed intolerance in preterm infants[J]. Arch Dis Child Fetal Neonatal Ed, 1998, 79(2):F110-F113.
[50] Ward RM, Lemons JA, Molteni RA. Cisapride:a survey of the frequency of use and adverse events in premature newborns[J]. Pediatrics, 1999, 103(2):469-472.
[51] Mussavi M, Asadollahi K, Abangah G. Effects of metoclopramide on feeding intolerance among preterm neonates; a randomized controlled trial[J]. Iran J Pediatr, 2014, 24(5):630-636.
[52] Eras Z, O?uz SS, Dilmen U. Is metoclopramide safe for the premature infant?[J]. Eur Rev Med Pharmacol Sci, 2013, 17(12):1655-1657.
[53] Gounaris A, Costalos C, Varchalama E, et al. Gastric emptying of preterm neonates receiving domperidone[J]. Neonatology, 2010, 97(1):56-60.
[54] 张成云, 李晓艳, 安丽花. 多潘立酮预防早产儿喂养不耐受疗效观察[J]. 临床医学, 2009, 29(7):70-71.
[55] Juul SE, Yachnis AT, Christensen RD. Tissue distribution of erythropoietin and erythropoietin receptor in the developing human fetus[J]. Early Hum Dev, 1998, 52(3):235-249.
[56] McPherson RJ, Juul SE. High-dose erythropoietin inhibits apoptosis and stimulates proliferation in neonatal rat intestine[J]. Growth Horm IGF Res, 2007, 17(5):424-430.
[57] El-Ganzoury M, Awad H, El-Gammasy T, et al. The impact of enteral granulocyte colony stimulating factor and erythropoietin on feeding tolerance in preterm infants[J]. Haematologica, 2012, 1:434.
[58] Omar OM, Massoud MN, Ghazal H, et al. Effect of enteral erythropoietin on feeding-related complications in preterm newborns:a pilot randomized controlled study[J]. Arab J Gastroenterol, 2020, 21(1):37-42.
[59] Meetze WH, Palazzolo VL, Bowling D, et al. Meconium passage in very-low-birth-weight infants[J]. JPEN J Parenter Enteral Nutr, 1993, 17(6):537-540.
[60] 肖东凡, 陈蓉, 许天兰. 115例胎龄≤ 32周早产儿喂养不耐受影响因素的病例对照分析[J]. 贵州医药, 2019, 43(6):926-929.
[61] Anabrees J, Shah VS, AlOsaimi A, et al. Glycerin laxatives for prevention or treatment of feeding intolerance in very low birth weight infants[J]. Cochrane Database Syst Rev, 2015(9):CD010464.
[62] Deshmukh M, Balasubramanian H, Patole S. Meconium evacuation for facilitating feed tolerance in preterm neonates:a systematic review and meta-analysis[J]. Neonatology, 2016, 110(1):55-65.
[63] Beckman Oral Motor. About Beckman oral motor intervention[EB/OL].[2020-08-20]. http://www.beckmanoralmotor.com/about.html.
[64] Foster JP, Psaila K, Patterson T. Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants[J]. Cochrane Database Syst Rev, 2016, 10(10):CD001071.
[65] Widström AM, Marchini G, Matthiesen AS, et al. Nonnutritive sucking in tube-fed preterm infants:effects on gastric motility and gastric contents of somatostatin[J]. J Pediatr Gastroenterol Nutr, 1988, 7(4):517-523.
[66] 刘晓娜, 杜志方, 李娜. 新生儿口腔运动干预研究现状[J]. 发育医学电子杂志, 2019, 7(1):60-63.
[67] Greene Z, O'Donnell CP, Walshe M. Oral stimulation for promoting oral feeding in preterm infants[J]. Cochrane Database Syst Rev, 2016, 9(9):CD009720.
[68] 彭东风, 仇宁, 范莉莉. 非营养性吸吮联合口腔按摩刺激对早产儿经口喂养效果的系统评价[J]. 安徽医学, 2018, 39(11):1363-1366.
[69] 郝莹. 袋鼠式护理干预在喂养不耐受早产儿中的应用[J]. 河南医学研究, 2020, 29(11):2103-2104.
[70] 黄晓睿, 向建文, 王越. 袋鼠式护理防治早产儿喂养不耐受的临床观察[J]. 国际医药卫生导报, 2018, 24(21):3356-3358.
[71] Seiiedi-Biarag L, Mirghafourvand M. The effect of massage on feeding intolerance in preterm infants:a systematic review and meta-analysis study[J]. Ital J Pediatr, 2020, 46(1):52.
[72] Tekgündüz K?, Gürol A, Apay SE, et al. Effect of abdomen massage for prevention of feeding intolerance in preterm infants[J]. Ital J Pediatr, 2014, 40:89.
[73] 金嘉鋆, 黄丽萍, 曹洁, 等. 不同体位鼻饲喂养早产儿的安全性比较[J]. 中国新生儿科杂志, 2013, 28(5):307-311.
[74] Yayan EH, Kucukoglu S, Dag YS, et al. Does the post-feeding position affect gastric residue in preterm infants?[J]. Breastfeed Med, 2018, 13(6):438-443.
[75] American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome:diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk[J]. Pediatrics, 2005, 116(5):1245-1255.
[76] Corvaglia L, Rotatori R, Ferlini M, et al. The effect of body positioning on gastroesophageal reflux in premature infants:evaluation by combined impedance and pH monitoring[J]. J Pediatr, 2007, 151(6):591-596, 561.e1.
国家临床重点专科(儿科新生儿专业)建设项目(1311200003303)。