目的 探讨实施基于循证的标准化喂养方案能否促进极早产儿/极低出生体重儿全胃肠道营养建立及其对早期临床结局的影响。 方法 回顾性纳入胎龄≤32周或出生体重<1 500 g的早产儿312例为研究对象。根据2020年5月实施早产儿标准化喂养方案前后1年时间将患儿分为对照组（2019年5月1日至2020年4月30日，n=160）和试验组（2020年6月1日至2021年5月31日，n=152），比较两组患儿达到全肠道喂养时间、开始肠内喂养时间、静脉营养持续时间、恢复至出生体重时间、中心静脉留置时间的差异及相关早产儿常见合并症发生率。 结果 试验组达到全肠道喂养时间、肠内喂养开始时间、静脉营养持续时间和中心静脉留置时间均较对照组明显缩短，中心导管相关性血流感染率较对照组明显降低（P<0.05），但Ⅱ~Ⅲ期新生儿坏死性小肠结肠炎等早产儿常见合并症的发生率及病死率在两组间比较差异无统计学意义（P>0.05）。 结论 实施早产儿标准化喂养方案可以帮助极早产儿/极低出生体重儿更快建立全肠道喂养，减少静脉营养使用，降低中心导管相关性血流感染，而不增加新生儿坏死性小肠结肠炎风险。
Abstract
Objective To investigate whether evidence-based standardized nutrition protocol can facilitate the establishment of full enteral nutrition and its effect on short-term clinical outcomes in very preterm/very low birth weight infants. Methods A retrospective analysis was performed on the medical data of 312 preterm infants with a gestational age of ≤32 weeks or a birth weight of <1 500 g. The standardized nutrition protocol for preterm infants was implemented in May 2020; 160 infants who were treated from May 1, 2019 to April 30, 2020 were enrolled as the control group, and 152 infants who were treated from June 1, 2020 to May 31, 2021 were enrolled as the test group. The two groups were compared in terms of the time to full enteral feeding, the time to the start of enteral feeding, duration of parenteral nutrition, the time to recovery to birth weight, the duration of central venous catheterization, and the incidence rates of common complications in preterm infants. Results Compared with the control group, the test group had significantly shorter time to full enteral feeding, time to the start of enteral feeding, duration of parenteral nutrition, and duration of central venous catheterization and a significantly lower incidence rate of catheter-related bloodstream infection (P<0.05). There were no significant differences between the two groups in the mortality rate and the incidence rate of common complications in preterm infants including grade II-III necrotizing enterocolitis (P>0.05). Conclusions Implementation of the standardized nutrition protocol can facilitate the establishment of full enteral feeding, shorten the duration of parenteral nutrition, and reduce catheter-related bloodstream infection in very preterm/very low birth weight infants, without increasing the risk of necrotizing enterocolitis.
关键词
标准化喂养方案 /
肠内喂养 /
极早产儿 /
极低出生体重儿
Key words
Standardized nutrition protocol /
Enteral feeding /
Very preterm infant /
Very low birth weight infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Zhao T, Feng HM, Caicike B, et al. Investigation into the current situation and analysis of the factors influencing extrauterine growth retardation in preterm infants[J]. Front Pediatr, 2021, 9: 643387. PMID: 33996689. PMCID: PMC8119632. DOI: 10.3389/fped.2021.643387.
2 Alshaikh B, Dharel D, Yusuf K, et al. Early total enteral feeding in stable preterm infants: a systematic review and meta-analysis[J]. J Matern Fetal Neonatal Med, 2021, 34(9): 1479-1486. PMID: 31248308. DOI: 10.1080/14767058.2019.1637848.
3 Shah SD, Dereddy N, Jones TL, et al. Early versus delayed human milk fortification in very low birth weight infants—a randomized controlled trial[J]. J Pediatr, 2016, 174: 126-131.e1. PMID: 27112041. DOI: 10.1016/j.jpeds.2016.03.056.
4 McCallie KR, Lee HC, Mayer O, et al. Improved outcomes with a standardized feeding protocol for very low birth weight infants[J]. J Perinatol, 2011, 31 Suppl 1: S61-S67. PMID: 21448207. DOI: 10.1038/jp.2010.185.
5 Patole SK, de Klerk N. Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies[J]. Arch Dis Child Fetal Neonatal Ed, 2005, 90(2): F147-F151. PMID: 15724039. PMCID: PMC1721845. DOI: 10.1136/adc.2004.059741.
6 Hu F, Tang Q, Wang Y, et al. Analysis of nutrition support in very low-birth-weight infants with extrauterine growth restriction[J]. Nutr Clin Pract, 2019, 34(3): 436-443. PMID: 30421458. PMCID: PMC7379204. DOI: 10.1002/ncp.10210.
7 Xiang Y, Tang Q, Wang Y, et al. Nutrition profile of very low birth weight infants with extrauterine growth restriction in NICU[J]. Clin Nutr ESPEN, 2021, 42: 252-257. PMID: 33745588. DOI: 10.1016/j.clnesp.2021.01.027.
8 de Waard M, Li Y, Zhu Y, et al. Time to full enteral feeding for very low-birth-weight infants varies markedly among hospitals worldwide but may not be associated with incidence of necrotizing enterocolitis: the NEOMUNE-NeoNutriNet cohort study[J]. JPEN J Parenter Enteral Nutr, 2019, 43(5): 658-667. PMID: 30465333. PMCID: PMC6531355. DOI: 10.1002/jpen.1466.
9 Su BH. Optimizing nutrition in preterm infants[J]. Pediatr Neonatol, 2014, 55(1): 5-13. PMID: 24050843. DOI: 10.1016/j.pedneo.2013.07.003.
10 Jensen EA, Dysart K, Gantz MG, et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants. An evidence-based approach[J]. Am J Respir Crit Care Med, 2019, 200(6): 751-759. PMID: 30995069. PMCID: PMC6775872. DOI: 10.1164/rccm.201812-2348OC.
11 Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria[J]. Pediatr Clin North Am, 1986, 33(1): 179-201. PMID: 3081865. PMCID: PMC7131118. DOI: 10.1016/s0031-3955(16)34975-6.
12 Dubbink-Verheij GH, Bekker V, Pelsma ICM, et al. Bloodstream infection incidence of different central venous catheters in neonates: a descriptive cohort study[J]. Front Pediatr, 2017, 5: 142. PMID: 28676849. PMCID: PMC5477168. DOI: 10.3389/fped.2017.00142.
13 Tillman EM. Review and clinical update on parenteral nutrition-associated liver disease[J]. Nutr Clin Pract, 2013, 28(1): 30-39. PMID: 23087263. DOI: 10.1177/0884533612462900.
14 常艳美, 林新祝, 张蓉, 等. 早产儿代谢性骨病临床管理专家共识(2021年)[J]. 中国当代儿科杂志, 2021, 23(8): 761-772. PMID: 34511163. PMCID: PMC8428920. DOI: 10.7499/j.issn.1008-8830.2105152.
15 Premji SS, Chessell L, Paes B, et al. A matched cohort study of feeding practice guidelines for infants weighing less than 1,500 g[J]. Adv Neonatal Care, 2002, 2(1): 27-36. PMID: 12903233. DOI: 10.1053/adnc.2002.31510.
16 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. PMID: 12671166.
17 Neu J. Gastrointestinal development and meeting the nutritional needs of premature infants[J]. Am J Clin Nutr, 2007, 85(2): 629S-634S. PMID: 17284768. DOI: 10.1093/ajcn/85.2.629S.
18 Hay WW. Strategies for feeding the preterm infant[J]. Neonatology, 2008, 94(4): 245-254. PMID: 18836284. PMCID: PMC2912291. DOI: 10.1159/000151643.
19 Bombell S, McGuire W. Early trophic feeding for very low birth weight infants[J]. Cochrane Database Syst Rev, 2009(3): CD000504. PMID: 19588318. DOI: 10.1002/14651858.CD000504.pub3.
20 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. PMID: 23543508. DOI: 10.1002/14651858.CD000504.pub4.
21 Boyd CA, Quigley MA, Brocklehurst P. Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2007, 92(3): F169-F175. PMID: 16556615. PMCID: PMC2675323. DOI: 10.1136/adc.2005.089490.
22 Klingenberg C, Embleton ND, Jacobs SE, et al. Enteral feeding practices in very preterm infants: an international survey[J]. Arch Dis Child Fetal Neonatal Ed, 2012, 97(1): F56-F61. PMID: 21856644. DOI: 10.1136/adc.2010.204123.
23 An official position statement of the Association of Women's Health, Obstetric and Neonatal Nurses. Breastfeeding and the use of human milk[J]. J Obstet Gynecol Neonatal Nurs, 2021, 50(5): e1-e5. PMID: 34304962. DOI: 10.1016/j.jogn.2021.06.006.
24 Li YF, Lin HC, Torrazza RM, et al. Gastric residual evaluation in preterm neonates: a useful monitoring technique or a hindrance?[J]. Pediatr Neonatol, 2014, 55(5): 335-340. PMID: 25129325. DOI: 10.1016/j.pedneo.2014.02.008.
25 Abiramalatha T, Thanigainathan S, Ninan B. Routine monitoring of gastric residual for prevention of necrotising enterocolitis in preterm infants[J]. Cochrane Database Syst Rev, 2019, 7(7): CD012937. PMID: 31425604. PMCID: PMC6699661. DOI: 10.1002/14651858.CD012937.pub2.
26 Park S, Moon S, Pai H, et al. Appropriate duration of peripherally inserted central catheter maintenance to prevent central line-associated bloodstream infection[J]. PLoS One, 2020, 15(6): e0234966. PMID: 32569313. PMCID: PMC7307762. DOI: 10.1371/journal.pone.0234966.
27 American Academy of Pediatrics Committee on Nutrition: nutritional needs of low-birth-weight infants[J]. Pediatrics, 1985, 75(5): 976-986. PMID: 3921937.
28 Burrin DG, Stoll B. Key nutrients and growth factors for the neonatal gastrointestinal tract[J]. Clin Perinatol, 2002, 29(1): 65-96. PMID: 11917740. DOI: 10.1016/s0095-5108(03)00065-4.
29 Berseth CL. Neonatal small intestinal motility: motor responses to feeding in term and preterm infants[J]. J Pediatr, 1990, 117(5): 777-782. PMID: 2121949. DOI: 10.1016/s0022-3476(05)83343-8.
30 Morgan J, Young L, McGuire W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants[J]. Cochrane Database Syst Rev, 2013(5): CD001970. PMID: 23728636. DOI: 10.1002/14651858.CD001970.pub4.
31 Nangia S, Vadivel V, Thukral A, et al. Early total enteral feeding versus conventional enteral feeding in stable very-low-birth-weight infants: a randomised controlled trial[J]. Neonatology, 2019, 115(3): 256-262. PMID: 30699425. DOI: 10.1159/000496015.
32 Oddie SJ, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants[J]. Cochrane Database Syst Rev, 2021, 8(8): CD001241. PMID: 34427330. PMCID: PMC8407506. DOI: 10.1002/14651858.CD001241.pub8.
33 Flidel-Rimon O, Branski D, Shinwell ES. The fear of necrotizing enterocolitis versus achieving optimal growth in preterm infants—an opinion[J]. Acta Paediatr, 2006, 95(11): 1341-1344. PMID: 17062457. DOI: 10.1080/08035250600719713.
34 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. PMID: 29926476. PMCID: PMC6513381. DOI: 10.1002/14651858.CD002971.pub4.
PDF(565 KB)
