Objective To investigate the condition of enteral feeding and the incidence of feeding intolerance (FI) in extremely low birth weight (ELBW) infants with a gestational age (GA) of < 28 weeks versus ≥ 28 weeks. Methods A retrospective analysis was performed for the ELBW infants who were admitted to the Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, from January 2018 to January 2020. According to GA, they were divided into two groups:GA < 28 weeks (n=41) and GA ≥ 28 weeks (n=38). The two groups were compared in terms of enteral feeding and incidence rate of FI during hospitalization. Results Among the 41 infants in the GA < 28 weeks group, 2 (5%) were small-for-gestational-age (SGA) infants, while among the 38 infants in the GA ≥ 28 weeks group, 24 (63%) were SGA infants. Compared with the GA ≥ 28 weeks group, the GA < 28 weeks group had significantly longer initial and final time to full enteral feeding (P < 0.05). The GA < 28 weeks group had a significantly higher recurrence rate of FI than the GA ≥ 28 weeks group (54% vs 32%, P < 0.05). Compared with the GA < 28 weeks group, the GA ≥ 28 weeks group had a significantly lower incidence rate of FI within 1-2 weeks after birth (5% vs 29%, P < 0.05) and a significantly shorter duration of FI (P < 0.05). The ELBW infants in the GA ≥ 28 weeks group had a higher velocity of weight gain, a shorter length of hospital stay, and a lower incidence rate of bronchopulmonary dysplasia, but a higher incidence rate of extrauterine growth retardation (EUGR) than the GA < 28 weeks group at discharge (P < 0.05). Conclusions Compared with the ELBW infants with a GA of < 28 weeks, the ELBW infants with a GA of ≥ 28 weeks have a lower recurrence rate of FI and can achieve full enteral feeding earlier, but with a higher incidence rate of EUGR, suggesting that enteral feeding needs to be more active for the ELBW infants with a GA of ≥ 28 weeks.
Key words
Feeding intolerance /
Enteral feeding /
Extrauterine growth retardation /
Extremely low birth weight infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] 超未成熟儿与超低出生体重儿研究协作组. 广东省新生儿科超未成熟儿与超低出生体重儿存活情况分析[J]. 中华儿科杂志, 2014, 52(10):729-735. DOI:10.3760/cma.j.issn.0578-1310.2014.10.003. PMID:25537536.
[2] 全美盈, 王长燕, 张玉, 等. 超低出生体重早产儿早期营养支持及生长状况十年变化分析[J]. 中华新生儿科杂志, 2017, 32(3):180-184. DOI:10.3760/cma.j.issn.2096-2932.2017.03.005.
[3] 庄思齐. 中国新生儿营养支持临床应用指南(2013年更新版)解读[J]. 临床儿科杂志, 2014, 32(9):801-803. DOI:10.3969/j.issn.1000-3606.2014.09.001.
[4] Dutta S, Singh B, Chessell L, et al. Guidelines for feeding very low birth weight infants[J]. Nutrients, 2015, 7(1):423-442. DOI:10.3390/nu7010423. PMID:25580815. PMCID:PMC4303848.
[5] 黄希, 陈琼, 彭文涛. 早产儿喂养不耐受的临床特征及其危险因素[J]. 中南大学学报(医学版), 2018, 43(7):797-804. DOI:10.11817/j.issn.1672-7347.2018.07.016. PMID:30124218.
[6] 中国医师协会新生儿科医师分会循证专业委员会. 早产儿喂养不耐受临床诊疗指南(2020)[J]. 中国当代儿科杂志, 2020, 22(10):1047-1055. DOI:10.7499/j.issn.1008-8830.2008132. PMID:33059799. PMCID:PMC7568993.
[7] Fanaro S. Feeding intolerance in the preterm infant[J]. Early Hum Dev, 2013, 89(Suppl 2):S13-S20. DOI:10.1016/j.earlhumdev.2013.07.013. PMID:23962482.
[8] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京:人民卫生出版社, 2019:57-1140.
[9] Patel AL, Engstrom JL, Meier PP, et al. Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants[J]. J Perinatol, 2009, 29(9):618-622. DOI:10.1038/jp.2009.55. PMID:19461590. PMCID:PMC2767524.
[10] 谢幸, 苟文丽. 妇产科学[M]. 8版. 北京:人民卫生出版社, 2013:64-79.
[11] 古吉燕, 王念蓉, 司丽娜, 等. 5岁前6个时点的身高、体重数据对5岁时肥胖和正常男童影响的回顾性队列研究[J]. 中国循证儿科杂志, 2020, 15(4):289-292. DOI:10.3969/j.issn.1673-5501.2020.04.009.
[12] 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. DOI:10.1007/s00431-012-1922-2. PMID:23292034.
[13] Thoene MK, Lyden E, Anderson-Berry A. Improving nutrition outcomes for infants < 1500 grams with a progressive, evidenced-based enteral feeding protocol[J]. Nutr Clin Pract, 2018, 33(5):647-655. DOI:10.1002/ncp.10081. PMID:29603412.
[14] Shi YC, Guo H, Chen J, et al. Initial meconium microbiome in Chinese neonates delivered naturally or by cesarean section[J]. Sci Rep, 2018, 8(1):3255. DOI:10.1038/s41598-018-21657-7. PMID:29459704. PMCID:PMC5818670.
[15] Beghetti I, Biagi E, Martini S, et al. Human milk's hidden gift:implications of the milk microbiome for preterm infants' health[J]. Nutrients, 2019, 11(12):2944. DOI:10.3390/nu11122944. PMID:31817057. PMCID:PMC6950588.
[16] Patwardhan G, Soni A, Rachwani N, et al. Factors associated with time to full feeds in preterm very low birth weight infants[J]. J Trop Pediatr, 2018, 64(6):495-500. DOI:10.1093/tropej/fmx102. PMID:29300996.
[17] 胡晓艳, 常艳美, 李在玲. 早产儿喂养不耐受的临床特征及危险因素[J]. 中华围产医学杂志, 2020, 23(3):182-187. DOI:10.3760/cma.j.cn113903-20190831-00527. PMID:21849110.
[18] Bozzetti V, Tagliabue PE. Enteral feeding of intrauterine growth restriction preterm infants:theoretical risks and practical implications[J]. Pediatr Med Chir, 2017, 39(2):160. DOI:10.4081/pmc.2017.160. PMID:28673081.
[19] 邬方彦, 贲晓明. 早产儿临床营养支持策略[J]. 中华实用儿科临床杂志, 2015, 30(2):81-84. DOI:10.3760/cma.j.issn.2095-428X.2015.02.001.
[20] Uberos J, Jimenez-Montilla S, Molina-Oya M, et al. Early energy restriction in premature infants and bronchopulmonary dysplasia:a cohort study[J]. Br J Nutr, 2020, 123(9):1024-1031. DOI:10.1017/S0007114520000240. PMID:31964427.
[21] Bozzetti V, De Angelis C, Tagliabue PE. Nutritional approach to preterm infants on noninvasive ventilation:an update[J]. Nutrition, 2017, 37:14-17. DOI:10.1016/j.nut.2016.12.010. PMID:28359356.
[22] Embleton ND, Berrington JE, Dorling J, et al. Mechanisms affecting the gut of preterm infants in enteral feeding trials[J]. Front Nutr, 2017, 4:14. DOI:10.3389/fnut.2017.00014. PMID:28534028. PMCID:PMC5420562.
PDF(1062 KB)
