目的:探讨早产儿喂养不耐受的临床特征,为早产儿喂养不耐受的防治提供临床依据。方法:2007年1月至2009年12月入住新疆医科大学第一附属医院的早产儿716例为研究对象,对其临床特征进行回顾性分析。结果:①716例早产儿中197例(27.5%)发生喂养不耐受,其中极低出生体重儿喂养不耐受发生比率高达77.6%。临床表现中以单纯胃潴留所占比例最高(47.2%)。②喂养不耐受出现时间集中在开始喂养后3 d内。③喂养不耐受组早产儿胎龄和出生体重低于耐受组、开奶时间晚于耐受组、早产儿合并窒息及呼吸性疾病比例高于耐受组(P<0.05);而民族、性别、孕母年龄、分娩方式、有无宫内窘迫两组差别无统计学意义(P>0.05)。随着胎龄增大、出生体重增加、尽早开始喂养,早产儿喂养不耐受发生风险降低。结论:早产儿喂养不耐受的发生与患儿胎龄、出生体重、开奶时间及合并症有关。
Abstract
OBJECTIVE: To study the clinical features of feeding intolerance in preterm infants in order to provide clinical evidence for preventing feeding intolerance. METHODS: A total of 716 preterm infants hospitalized in the First Affiliated Hospital of Xinjiang Medical University between January 2007 and December 2009 were enrolled. The clinical data of the infants were retrospectively studied. RESULTS: Feeding intolerance occurred in 197 (27.5%) out of 716 infants, with an incidence of 76.4% in the very low birth weight infants. Simple gastric retention (47.2%) was found as the most common clinical manifestation. Feeding intolerance usually occurred within 3 days after feeding. Compared with the preterm infants with feeding success, the preterm infants with feeding intolerance showed lower gestational age and birth weight, more delayed feeding and higher rate of asphyxia and respiratory diseases (P<0.05). There were no significant differences in the gender, maternal age, ethnic group, delivery way and the incidence of fetal distress between the two groups. With increasing gestational age, increasing birth weight, early feeding, the incidence of feeding intolerance in preterm infants was reduced. CONCLUSIONS: The low gestational age, low birth weight, delayed feeding and complications may be associated with the development of feeding intolerance in preterm infants.
关键词
喂养不耐受 /
胎龄 /
出生体重 /
早产儿
Key words
Feeding intolerance /
Gestational age /
Birth weight /
Preterm infants
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].第4版.北京:人民卫生出版社,2011:46-47.
[2]中华医学会肠外肠内营养学分会儿科协作组,中华医学会儿科学分会新生儿学组,中华医学会小儿外科学分会新生儿学组.中国新生儿营养支持临床应用指南[J].中国当代儿科杂志,2006,8(5):352-356.
[3]Ben XM.Nutritional management of newborn infants: practical guidelines[J]. World J Gastroenterol, 2008,14(40):6133-6139.
[4]汤庆娅.适合早产儿代谢特征的合理营养管理[J].临床儿科杂志,2009,3(27):217-221.
[5]董梅,王丹华,丁国芳,刘艳云,赵时敏,王智凤.极低出生体重儿胃肠喂养的临床观察[ J ].中华儿科杂志,2003,41(2):87-90.
[6]Bora R, Mukhopadhyay K, Saxena AK, Jain V, Narang A. Prediction of feed intolerance and necrotizing enterocolitis in neonates with absent end diastolic flow in umbilical artery and the correlation of feed intolerance with postnatal superior mesenteric artery flow[J]. J Matern Fetal Neonatal Med, 2009, 22(11): 1092-1096.
[7]常艳美,刘惠丽,葛美茹,王红梅,童笑梅,朴梅花,等.早产儿喂养不耐受临床特征分析[J].中国新生儿科杂志,2006,21(5):268-270.
[8]Ng E, Shah VS. Erythromycin for the prevention and treatment of feeding intolerance in preterm infants[J]. Cochrane Database Syst Rev, 2008, (3):CD001815.
[9]Mihatsch WA, von Schoenaich P, Fahnenstich H, Dehne N, Ebbecke H, Plath C, 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.
[10]杨华姿,黄东明,高建慧,朱建萍,杨冰岩,龙晓玲,等.早产儿血中胃泌素水平与胃肠道发育研究[J].中国实用儿科杂志,2001,16(10):607-609.
[11]Neu J, Zhang L. Feeding intolerance in very-low-birth weight infants: what is it and what can we do about it?[J]. Acta Paediatr Suppl, 2005, 94(449): 93-99.
[12]张昌明,张建龙,张琼,张铸,张海平,孙清超,等.新疆汉族、维吾尔族及哈萨克族食管癌血清蛋白质指纹图谱[J].世界华人消化杂志,2010,18(17):1773-1779.
[13]余章斌,韩树萍,陈玉林,邱玉芳,董小玥.我国早产儿喂养不耐受危险因素的Meta分析[J].中国新生儿科杂志,2010,25 (6):346-350.
[14]Neu J. Gastrointestinal development and meeting the nutritional needs of premature infant[J].Am J Clin Nutr, 2007, 85(2):629S-634S.
[15]Marie FLC, Carole R, Dominique D, Jean CR, Gilles P, Christele GL. Intestinal microbiota in neonates and preterm infants: a review[J].Curr Pediatr Rev, 2007, 3(10):21-34.
[16] 张庆丽,孙志洪,张恩平,贺志雄,谭支良. 哺乳动物胃肠道发育特征和早期营养调控研究进展[J]. 基因组学与应用生物学,2009,28(3):594-600.
[17]邵宪花,杨震英,陈震.极低出生体重儿早期经口微量喂养的临床研究[J].中国当代儿科杂志,2005,6(5):535-536.
[18]李在玲,叶鸿瑁,王继山,韩彤妍,王新利.危重症早产儿早期微量喂养与血清胃泌素动态变化及临床情况的研究[J].中华儿科杂志,2008,46(4):243-246.
[19]陈宏香,林日亮,温伟珍,江栋昌.极低出生体重儿早期微量喂养的临床效果分析[J].中华围产医学杂志,2005,8(2):131-132.