早产儿肠内营养管理专家共识（2024年）

doi:10.7499/j.issn.1008-8830.2402039

摘要
图/表
参考文献(63)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (721 KB) [HTML]
输出: BibTeX | EndNote (RIS) 背景资料

摘要为早产儿尤其是极/超早产儿提供充足和均衡的营养是促进其正常生长发育和改善远期预后的物质基础，肠内营养是最佳的营养方式。既往系统回顾性分析显示使用基于循证医学的标准化喂养管理策略可有效促进全肠内喂养的建立，缩短肠外营养时间，改善早产儿的营养结局，而不增加坏死性小肠结肠炎或死亡的发生风险。基于国内外相关研究，该共识制订组采用证据推荐分级的评估、制订与评价方法（Grading of Recommendations Assessment, Development and Evaluation），从早产儿肠内营养的目标、过渡期的肠内营养、稳定生长期的肠内营养、肠内特殊营养素的补充及肠内营养的监测等5个方面提出20条推荐意见，旨在为相关从业人员提供早产儿肠内营养管理的建议，以改善早产儿的临床结局。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	中国医师协会新生儿科医师分会营养专业委员会
	中国医师协会新生儿科医师分会早产儿专业委员会
	中国当代儿科杂志编辑委员会

关键词 ：肠内营养, 全肠内喂养, 营养素, 专家共识, 早产儿

Abstract：Providing adequate and balanced nutrition for preterm infants, especially extremely/very preterm infants, is the material basis for promoting their normal growth and development and improving long-term prognosis. Enteral nutrition is the best way to feed preterm infants. Previous systematic reviews have shown that using evidence-based standardized feeding management strategies can effectively promote the establishment of full enteral feeding, reduce the duration of parenteral nutrition, improve the nutritional outcomes of preterm infants, and not increase the risk of necrotizing enterocolitis or death. Based on relevant research in China and overseas, the consensus working group has developed 20 recommendations in 5 aspects including the goal of enteral nutrition, transitioning to enteral nutrition, stable growth period enteral nutrition, supplementation of special nutrients, and monitoring of enteral nutrition for preterm infants, using the Grading of Recommendations Assessment, Development and Evaluation. The aim is to provide recommendations for healthcare professionals involved in the management of enteral nutrition for preterm infants, in order to improve the clinical outcomes of preterm infants.

Key words： Enteral nutrition Total enteral feeding Nutrient Expert consensus Preterm infant

收稿日期: 2024-02-17

基金资助:北京大学第三医院临床队列建设项目（BYSYDL2019008）。

通讯作者: 童笑梅，女，教授，北京大学第三医院儿科，Email：tongxm2007@126.com E-mail: tongxm2007@126.com

引用本文:

中国医师协会新生儿科医师分会营养专业委员会,中国医师协会新生儿科医师分会早产儿专业委员会,中国当代儿科杂志编辑委员会. 早产儿肠内营养管理专家共识（2024年）[J]. 中国当代儿科杂志, 2024, 26(6): 541-552.

Nutritional Committee of Neonatology Branch of Chinese Medical Doctor Association,Preterm Committee of Neonatology Branch of Chinese Medical Doctor Association,Editorial Committee of Chinese Journal of Contemporary Pediatrics. Expert consensus on enteral nutrition management of preterm infants (2024)[J]. CJCP, 2024, 26(6): 541-552.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2402039 或 http://www.zgddek.com/CN/Y2024/V26/I6/541

	HayWW. 早产儿营养的最优化[J]. 中国当代儿科杂志, 2017, 19(1): 1-21. PMID: 28100316. PMCID: PMC7390124. DOI: 10.7499/j.issn.1008-8830.2017.01.001.
	Hu X, Lu J, Zhang J, et al. Survey on human milk feeding and enteral feeding practices for very-low-birth-weight infants in NICUs in China Neonatal Network[J]. BMC Pediatr, 2023, 23(1): 75. PMID: 36765301. PMCID: PMC9918398. DOI: 10.1186/s12887-023-03862-0.
	3 Schünemann H, Bro?ek J, Guyatt G, et al. GRADE Handbook[EB/OL]. [2020-07-16]. https://gdt.gradepro.org/app/handbook/handbook.html.
	4 GRADEpro GDT. GRADE your evidence and improve your guideline development in health care[EB/OL]. [2020-07-10]. https://gradepro.org.
	5 BalshemH, HelfandM, SchünemannHJ, 等. GRADE指南: Ⅲ.证据质量分级[J]. 中国循证医学杂志, 2011, 11(4): 451-455. DOI: 10.3969/j.issn.1672-2531.2011.04.017.
	Perrone M, Menis C, Piemontese P, et al. Energy expenditure, protein oxidation and body composition in a cohort of very low birth weight infants[J]. Nutrients, 2021, 13(11): 3962. PMID: 34836218. PMCID: PMC8620881. DOI: 10.3390/nu13113962.
	Rigo J, Hasco?t JM, Billeaud C, et al. Growth and nutritional biomarkers of preterm infants fed a new powdered human milk fortifier: a randomized trial[J]. J Pediatr Gastroenterol Nutr, 2017, 65(4): e83-e93. PMID: 28727654. PMCID: PMC5625962. DOI: 10.1097/MPG.0000000000001686.
	Bulut O, Coban A, Uzunhan O, et al. Effects of targeted versus adjustable protein fortification of breast milk on early growth in very low-birth-weight preterm infants: a randomized clinical trial[J]. Nutr Clin Pract, 2020, 35(2): 335-343. PMID: 31025438. DOI: 10.1002/ncp.10307.
	9 中华医学会肠外肠内营养学分会儿科学组, 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外科学组, 等. 中国新生儿营养支持临床应用指南[J]. 中华小儿外科杂志, 2013, 34(10): 782-787. DOI: 10.3760/cma.j.issn.0253-3006.2013.10.016.
	Fenton TR, Al-Wassia H, Premji SS, et al. Higher versus lower protein intake in formula-fed low birth weight infants[J]. Cochrane Database Syst Rev, 2020, 6(6): CD003959. PMID: 32573771. PMCID: PMC7387284. DOI: 10.1002/14651858.CD003959.pub4.
	Maas C, Mathes M, Bleeker C, et al. Effect of increased enteral protein intake on growth in human milk-fed preterm infants: a randomized clinical trial[J]. JAMA Pediatr, 2017, 171(1): 16-22. PMID: 27893064. DOI: 10.1001/jamapediatrics.2016.2681.
	Embleton ND, Jennifer Moltu S, Lapillonne A, et al. Enteral nutrition in preterm infants (2022): a position paper from the ESPGHAN committee on nutrition and invited experts[J]. J Pediatr Gastroenterol Nutr, 2023, 76(2): 248-268. PMID: 36705703. DOI: 10.1097/MPG.0000000000003642.
	Atchley CB, Cloud A, Thompson D, et al. Enhanced protein diet for preterm infants: a prospective, randomized, double-blind, controlled trial[J]. J Pediatr Gastroenterol Nutr, 2019, 69(2): 218-223. PMID: 31058772. DOI: 10.1097/MPG.0000000000002376.
	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.
	王琳, 赵小朋, 刘辉娟, 等. 基于循证的标准化喂养方案可以帮助极早产儿/极低出生体重儿尽早达到全肠道喂养[J]. 中国当代儿科杂志, 2022, 24(6): 648-653. PMID: 35762431. PMCID: PMC9250396. DOI: 10.7499/j.issn.1008-8830.2202121.
	Maas C, Franz AR, von Krogh S, et al. Growth and morbidity of extremely preterm infants after early full enteral nutrition[J]. Arch Dis Child Fetal Neonatal Ed, 2018, 103(1): F79-F81. PMID: 28733478. DOI: 10.1136/archdischild-2017-312917.
	Abiramalatha T, Thomas N, Gupta V, et al. High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants[J]. Cochrane Database Syst Rev, 2017, 9(9): CD012413. PMID: 28898404. PMCID: PMC6483816. DOI: 10.1002/14651858.CD012413.pub2.
	Travers CP, Wang T, Salas AA, et al. Higher- or usual-volume feedings in infants born very preterm: a randomized clinical trial[J]. J Pediatr, 2020, 224: 66-71.e1. PMID: 32464224. DOI: 10.1016/j.jpeds.2020.05.033.
	Abiramalatha T, Thomas N, Thanigainathan S. High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants[J]. Cochrane Database Syst Rev, 2021, 3(3): CD012413. PMID: 33733486. PMCID: PMC8092452. DOI: 10.1002/14651858.CD012413.pub3.
	Meiliana M, Alexander T, Bloomfield FH, et al. Nutrition guidelines for preterm infants: a systematic review[J]. JPEN J Parenter Enteral Nutr, 2024, 48(1): 11-26. PMID: 37855274. DOI: 10.1002/jpen.2568.
	Young L, Oddie SJ, McGuire W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants[J]. Cochrane Database Syst Rev, 2022, 1(1): CD001970. PMID: 35049036. PMCID: PMC8771918. DOI: 10.1002/14651858.CD001970.pub6.
	Bozzetti V, Martin CR. The practice of enteral nutrition in very low and extremely low birth weight infants[J]. World Rev Nutr Diet, 2021, 122: 265-280. PMID: 34352759. DOI: 10.1159/000514743.
	Dutta S, Singh B, Chessell L, et al. Guidelines for feeding very low birth weight infants[J]. Nutrients, 2015, 7(1): 423-442. PMID: 25580815. PMCID: PMC4303848. DOI: 10.3390/nu7010423.
	Miller J, Tonkin E, Damarell RA, et al. A systematic review and meta-analysis of human milk feeding and morbidity in very low birth weight infants[J]. Nutrients, 2018, 10(6): 707. PMID: 29857555. PMCID: PMC6024377. DOI: 10.3390/nu10060707.
	Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants[J]. Cochrane Database Syst Rev, 2019, 7(7): CD002971. PMID: 31322731. PMCID: PMC6640412. DOI: 10.1002/14651858.CD002971.pub5.
	Fenton TR, Griffin IJ, Groh-Wargo S, et al. Very low birthweight preterm infants: a 2020 evidence analysis center evidence-based nutrition practice guideline[J]. J Acad Nutr Diet, 2022, 122(1): 182-206. PMID: 33820749. DOI: 10.1016/j.jand.2021.02.027.
	27 李正红, 王丹华, 童笑梅, 等. 晚期早产儿营养管理专家共识[J]. 中国循证儿科杂志, 2022, 17(6): 405-413. DOI: 10.3969/j.issn.1673-5501.2022.06.001.
	Watson J, McGuire W. Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants[J]. Cochrane Database Syst Rev, 2013, 2013(2): CD003952. PMID: 23450546. PMCID: PMC7104507. DOI: 10.1002/14651858.CD003952.pub3.
	Sadrudin Premji S, Chessell L, Stewart F. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for preterm infants less than 1500 grams[J]. Cochrane Database Syst Rev, 2021, 6(6): CD001819. PMID: 34165778. PMCID: PMC8223964. DOI: 10.1002/14651858.CD001819.pub3.
	Dawson JA, Summan R, Badawi N, et al. Push versus gravity for intermittent bolus gavage tube feeding of premature and low birth weight infants[J]. Cochrane Database Syst Rev, 2012, 11: CD005249. PMID: 23152230. DOI: 10.1002/14651858.CD005249.pub2.
	Fucile S, Wener E, Dow K. Enhancing breastfeeding establishment in preterm infants: a randomized clinical trial of two non-nutritive sucking approaches[J]. Early Hum Dev, 2021, 156: 105347. PMID: 33714801. DOI: 10.1016/j.earlhumdev.2021.105347.
	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. PMID: 27699765. PMCID: PMC6458048. DOI: 10.1002/14651858.CD001071.pub3.
	Binchy á, Moore Z, Patton D. Feeding intervals in premature infants ≤1750 g: an integrative review[J]. Adv Neonatal Care, 2018, 18(3): 168-178. PMID: 29799820. DOI: 10.1097/ANC.0000000000000486.
	Ibrahim NR, Van Rostenberghe H, Ho JJ, et al. Short versus long feeding interval for bolus feedings in very preterm infants[J]. Cochrane Database Syst Rev, 2021, 8(8): CD012322. PMID: 34415568. PMCID: PMC8407504. DOI: 10.1002/14651858.CD012322.pub2.
	35 Fernandes CJ, Pammi M, Katakam L, et al. Guidelines for Acute Care of the Neonate[M]. 29th edition. 2021: 191-194.
	Salas AA, Li P, Parks K, et al. Early progressive feeding in extremely preterm infants: a randomized trial[J]. Am J Clin Nutr, 2018, 107(3): 365-370. PMID: 29529231. PMCID: PMC6692650. DOI: 10.1093/ajcn/nqy012.
	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, 2014, 2014(12): CD001970. PMID: 25436902. PMCID: PMC7063979. DOI: 10.1002/14651858.CD001970.pub5.
	Krishnamurthy S, Gupta P, Debnath S, et al. Slow versus rapid enteral feeding advancement in preterm newborn infants 1000-1499 g: a randomized controlled trial[J]. Acta Paediatr, 2010, 99(1): 42-46. PMID: 20002013. DOI: 10.1111/j.1651-2227.2009.01519.x.
	Dorling J, Abbott J, Berrington J, et al. Controlled trial of two incremental milk-feeding rates in preterm infants[J]. N Engl J Med, 2019, 381(15): 1434-1443. PMID: 31597020. DOI: 10.1056/NEJMoa1816654.
	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.
	Strobel NA, Adams C, McAullay DR, et al. Mother's own milk compared with formula milk for feeding preterm or low birth weight infants: systematic review and meta-analysis[J]. Pediatrics, 2022, 150(Suppl 1): e2022057092D. PMID: 35921674. DOI: 10.1542/peds.2022-057092D.
	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.
	Thanigainathan S, Abiramalatha T. Early fortification of human milk versus late fortification to promote growth in preterm infants[J]. Cochrane Database Syst Rev, 2020, 7(7): CD013392. PMID: 32726863. PMCID: PMC7390609. DOI: 10.1002/14651858.CD013392.pub2.
	44 WHO. WHO recommendations for care of the preterm or low-birth-weight infant[EB/OL]. (2022-11-15)[2022-11-15]. https://www.who.int/publications/i/item/9789240058262.
	Rochow N, Fusch G, Ali A, et al. Individualized target fortification of breast milk with protein, carbohydrates, and fat for preterm infants: a double-blind randomized controlled trial[J]. Clin Nutr, 2021, 40(1): 54-63. PMID: 32446787. DOI: 10.1016/j.clnu.2020.04.031.
	Arslanoglu S, Boquien CY, King C, et al. Fortification of human milk for preterm infants: update and recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification[J]. Front Pediatr, 2019, 7: 76. PMID: 30968003. PMCID: PMC6439523. DOI: 10.3389/fped.2019.00076.
	Rakshasbhuvankar AA, Pillow JJ, Simmer KN, et al. Vitamin A supplementation in very-preterm or very-low-birth-weight infants to prevent morbidity and mortality: a systematic review and meta-analysis of randomized trials[J]. Am J Clin Nutr, 2021, 114(6): 2084-2096. PMID: 34582542. DOI: 10.1093/ajcn/nqab294.
	Oliver C, Watson C, Crowley E, et al. Vitamin and mineral supplementation practices in preterm infants: a survey of Australian and New Zealand neonatal intensive and special care units[J]. Nutrients, 2019, 12(1): 51. PMID: 31878077. PMCID: PMC7019934. DOI: 10.3390/nu12010051.
	Jung JH, Kim EA, Lee SY, et al. Vitamin D status and factors associated with vitamin D deficiency during the first year of life in preterm infants[J]. Nutrients, 2021, 13(6): 2019. PMID: 34208333. PMCID: PMC8231173. DOI: 10.3390/nu13062019.
	中华儿科杂志》编辑委员会, 中华医学会儿科学分会儿童保健学组, 中华医学会儿科学分会新生儿学组. 早产、低出生体重儿出院后喂养建议[J]. 中华儿科杂志, 2016, 54(1): 6-12. PMID: 27470474. DOI: 10.3760/cma.j.issn.0578-1310.2016.01.003.
	徐琳, 李明燕, 沈岳良. 铁缺乏对早产儿神经发育影响的研究进展[J]. 中国当代儿科杂志, 2018, 20(12): 1070-1074. PMID: 30573000. PMCID: PMC7389500. DOI: 10.7499/j.issn.1008-8830.2018.12.017.
	Bahr TM, Carr NR, Christensen TR, et al. Early iron supplementation and iron sufficiency at one month of age in NICU patients at-risk for iron deficiency[J]. Blood Cells Mol Dis, 2021, 90: 102575. PMID: 33989937. PMCID: PMC9132591. DOI: 10.1016/j.bcmd.2021.102575.
	Agostoni C, Buonocore G, Carnielli VP, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition[J]. J Pediatr Gastroenterol Nutr, 2010, 50(1): 85-91. PMID: 19881390. DOI: 10.1097/MPG.0b013e3181adaee0.
	Costeloe K, Bowler U, Brocklehurst P, et al. A randomised controlled trial of the probiotic Bifidobacterium breve BBG-001 in preterm babies to prevent sepsis, necrotising enterocolitis and death: the probiotics in preterm infants (PiPS) trial[J]. Health Technol Assess, 2016, 20(66): 1-194. PMID: 27594381. PMCID: PMC5027379. DOI: 10.3310/hta20660.
	Upadhyay RP, Taneja S, Chowdhury R, et al. Effect of prebiotic and probiotic supplementation on neurodevelopment in preterm very low birth weight infants: findings from a meta-analysis[J]. Pediatr Res, 2020, 87(5): 811-822. PMID: 30353041. DOI: 10.1038/s41390-018-0211-9.
	Zhang GQ, Hu HJ, Liu CY, et al. Prmpliant systematic review and meta-analysis of randomized controlled trials[J]. Medicine (Baltimore), 2016, 95(8): e2581. PMID: 26937897. PMCID: PMC4778994. DOI: 10.1097/MD.0000000000002581.
	Wang Y, Florez ID, Morgan RL, et al. Probiotics, prebiotics, lactoferrin, and combination products for prevention of mortality and morbidity in preterm infants: a systematic review and network meta-analysis[J]. JAMA Pediatr, 2023, 177(11): 1158-1167. PMID: 37782505. PMCID: PMC10546299. DOI: 10.1001/jamapediatrics.2023.3849.
	van den Akker CHP, van Goudoever JB, Shamir R, et al. Probiotics and preterm infants: a position paper by the European Society for Paediatric Gastroenterology Hepatology and Nutrition Committee on Nutrition and the European Society for Paediatric Gastroenterology Hepatology and Nutrition Working Group for Probiotics and Prebiotics[J]. J Pediatr Gastroenterol Nutr, 2020, 70(5): 664-680. PMID: 32332478. DOI: 10.1097/MPG.0000000000002655.
	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.
	60 中华人民共和国国家卫生健康委员会. 不同胎龄新生儿出生时生长评价标准: WS/T 800-2022[S]. 北京: 中华人民共和国国家卫生健康委员会, 2022.
	Molony CL, Hiscock R, Kaufman J, et al. Growth trajectory of preterm small-for-gestational-age neonates[J]. J Matern Fetal Neonatal Med, 2022, 35(25): 8400-8406. PMID: 34503371. DOI: 10.1080/14767058.2021.1974835.
	Poindexter BB, Cormack BE, Bloomfield FH. Approaches to growth faltering[J]. World Rev Nutr Diet, 2021, 122: 312-324. PMID: 34352781. DOI: 10.1159/000514877.
	Landau-Crangle E, Rochow N, Fenton TR, et al. Individualized postnatal growth trajectories for preterm infants[J]. JPEN J Parenter Enteral Nutr, 2018, 42(6): 1084-1092. PMID: 29419902. DOI: 10.1002/jpen.1138.