目的 探讨不同强化喂养方式对早产极低出生体重儿(VLBWI)营养代谢及生长速率的影响,为改善早产儿的预后提供新思路。方法 纳入2019年1月—2020年12月昆明医科大学第一附属医院新生儿科收治的早产 VLBWI 115 例,根据喂养方式分为强化母乳喂养组(HFM 组)、混合喂养组、早产儿配方奶喂养组(PF 组),分析不同的喂养方式对早产 VLBWI 的营养代谢、生长速率等的影响。结果 1)HFM 组住院时间短于PF组、混合喂养组(t=7.185、6.924,P＜0.05);2)住院期间 HFM 组并发坏死性小肠结肠炎(NEC)的比例低于PF组(P＜0.05),住院期间 HFM 组并发晚发型败血症(LOS)、宫外生长发育迟缓(EUGR)的比例低于PF 组(χ2=5.030、4.147,P＜0.05);并发LOS的比例低于混合喂养组(χ2=6.589,P＜0.05);3)住院期间 HFM 组并发腹胀、便血、嗜酸性粒细胞增高比例低于PF 组(P＜0.05),混合喂养组并发腹胀比例低于PF组(P＜0.05);4)出院时 HFM 组体重、身长增长速率均高于混合喂养组(t=3.722、0.425,P＜0.001)及PF 组(t=6.015、0.496,P＜0.001)。结论 强化母乳喂养能更有效提高早产 VLBWI 的生长速率,改善营养代谢,减少早产儿相关并发症及喂养不良反应,更安全有效。
Abstract
Objective To analyze the effects of different fortified feeding Methods on nutritional metabolism and growth rate of preterm very low birth weight infants (VLBWI), in order to provide new clues for improving the prognosis of the preterm infants. Methods A total of 115 cases of premature VLBWI admitted to Department of Neonatology, The First Affiliated Hospital of Kunming Medical University from January 2019 to December 2020 were included in this study, and were divided into fortified breastfeeding group (HFM group), mixed feeding group, and premature formula feeding group (PF group) based on their feeding methods. The effects of different feeding Methods on the nutritional metabolism and growth rate of premature VLBWI were analyzed. Results 1) The hospitalization time of infants in the HFM group was shorter than that in PF group and mixed feeding group (t=7.185, 6.924, P<0.05). 2) The proportion of necrotizing enterocolitis (NEC) in the HFM group during hospitalization was lower than that in the PF group (P＜0.05); the proportions of late onset septicemia(LOS) and extra uterine growth restriction(EUGR) in the HFM group during hospitalization were lower than those in the PF group (χ2=5.030, 4.147, P＜0.05); the proportion of LOS was lower than that of the mixed feeding group(χ2=6.589, P＜0.05). 3) During hospitalization, the proportions of abdominal distension, bloody stools and increased eosinophils in the HFM group were lower than those in the PF group (P＜0.05), which in mixed feeding group was lower than those in PF group (Fisher exact test, P＜0.05). 4) At discharge, the weight and length growth rate of the HFM group were higher than those of the mixed feeding group (t=3.722, 0.425, P<0.001) and the PF group (t =6.015, 0.496, P< 0.001). Conclusion Fortified breastfeeding can more effectively increase the growth rate of VLBWI in premature infants, improve nutritional metabolism, reduce complications and adverse feeding reactions related to premature infants, and is safer and more effective.
关键词
早产儿 /
极低出生体重 /
喂养 /
营养代谢 /
生长速率
Key words
preterm /
very low birth weight /
feeding /
nutrient metabolism /
growth rate
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参考文献
[1] Figueras-Aloy J, Palet-Trujols C, Matas-Barceló I, et al. Extrauterine growth restriction in very preterm infant: Etiology, diagnosis, and 2-year follow-up[J]. Eur J Pediatr,2020,179(9):1469-1479.
[2] Khasawneh W, Khassawneh M, Mazin M, et al. Clinical and nutritional determinants of extrauterine growth restriction among very low birth weight infants[J]. Int J Gen Med,2020,13:1193-1200.
[3] 超未成熟儿与超低出生体重儿研究协作组. 广东省超未成熟儿与超低出生体重儿临床救治分析[J]. 中华儿科杂志,2019,57(12):934-942.
Cooperative Research Group for Ultra-immature and Ultra-Low Birth Weight Infants. Analysis of clinical treatment of ultra-immature infants and ultra-low birth weight infants in Guangdong Province[J].Chin J Pediatrics, 2019, 57(12): 934-942.(in Chinese)
[4] Embleton ND, Moltu SJ, 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.
[5] Roggero P, Liotto N, Menis C, et al. New insights in preterm nutrition[J]. Nutrients,2020,12(6):1857.
[6] Power VA, Spittle AJ, Lee KJ, et al. Nutrition, growth, brain volume, and neurodevelopment in very preterm children[J]. J Pediatr,2019,215:50-55.
[7] 郑水英, 罗艳赟. 早产儿喂养不耐受的临床表现及相关影响因素[J]. 中国儿童保健杂志,2023,31(4):461-464.
Zheng SY, Luo YY. Clinical manifestations and related influencing factors of feeding intolerance in premature infants[J]. Chin J Child Health Care, 2023,31(4):461-464. (in Chinese)
[8] 李颖, 吴繁. 胎龄＜28周和≥28周超低出生体重儿肠内喂养情况的比较[J]. 中国当代儿科杂志,2021,23(7):690-695.
Li Y, Wu F. Comparison of enteral feeding in ultra-low birth weight infants with gestational age <28 weeks and≥28 weeks[J]. Chin J Contemp Pediatr, 2021,23(7):690-695. (in Chinese)
[9] Elia S, Ciarcià M, Miselli F, et al. Effect of selective gastric residual monitoring on enteral intake in preterm infants[J]. Ital J Pediatr,2022,48(1):30.
[10] 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.
Cai W, Tang QY, Wang Y, et al. Guidelines for the clinical application of neonatal nutrition support in China[J]. J Clin Pediatr, 2013,31 (12): 1177-1182. (in Chinese)
[11] 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.
Pediatrics Group of Parenteral and Enteral Nutrition Branch of Chinese Medical Association, Neonatal Group of Pediatrics Branch of Chinese Medical Association, Neonatal Surgery Group of Pediatric Surgery Branch of Chinese Medical Association, et al. Clinical application of nutritional support for newborns in China Guidelines[J]. Chin J Pediatr Surg, 2013,34(10):782-787. (in Chinese)
[12] 《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.
Editorial Committee of Chinese Journal of Pediatrics, Child Health Care Group of Pediatrics Branch ofChinese Medical Association, Neonatology Group of Pediatrics Branch of Chinese Medical Association.Feeding recommendations for premature and low birth weight infants after discharge[J].Chin J Pediatrics, 2016,54 (1): 6-12. (in Chinese)
[13] 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(中英文),2019,34(5):321-328.
Expert Consensus Working Group on the Use of Human Milk Fortifiers in Preterm Infants, Editorial Committee of Chinese Journal of Neonatology. Expert consensus on the use of human milk fortifiers in preterm infants[J]. Chin J Neonatol(Chinese and English), 2019,34(5):321-328.(in Chinese)
[14] 丘小汕, 邵肖梅, 叶鸿瑁.实用新生儿学[M]. 5版. 北京:人民卫生出版社, 2019.
Qiu XS, Shao XM, Ye HM. Practical neonatology[M].5th ed.Beijing: People's Health Publishing House,2019.
[15] Chen Y, Wang Y, Chen Z, et al. The effects of rapid growth on body mass index and percent body fat: A meta-analysis[J]. Clin Nutr,2020,39(11):3262-3272.
[16] Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants[J]. BMC Pediatr,2013,13:59.
[17] 施丽萍. 救治技术的改进对极低出生体重儿生存的影响[J]. 浙江医学,2020,42(17):1791-1794,1808.
Shi LP. The impact of the improvement of treatment techniques on the survival of very low birth weight infants[J]. Zhejiang Medicine, 2020,42(17):1791-1794,1808. (in Chinese)
[18] Passini R Jr, Tedesco RP, Marba ST, et al. Brazilian multicenter study on prevalence of preterm birth and associated factors[J]. BMC Pregnancy Childbirth, 2010, 10: 22.
[19] 沈蔚, 郑直, 林新祝, 等. 住院极早产儿宫外生长迟缓及相关因素的多中心前瞻性研究[J]. 中国当代儿科杂志,2022,24(2):132-140.
Shen W, Zheng Z, Lin XZ, et al. A multicenter prospective study of extrauterine growth retardation and related factors in hospitalized extremely premature infants[J]. Chin J Contemp Pediatr, 2022,24(2):132-140. (in Chinese)
[20] Nutrient needs and feeding of premature infants. Nutrition Committee, Canadian Paediatric Society[J]. CMAJ,1995,152(11):1765-1785.
[21] Cooke RJ. Postnatal growth and development in the preterm and small for gestational age infant[J]. Nestle Nutr Workshop Ser Pediatr Program,2010,65:85-95.
[22] 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.
[23] Dutta S, Singh B, Chessell L, et al. Guidelines for feeding very low birth weight infants[J]. Nutrients,2015,7(1):423-442.
[24] Cheong J, Burnett AC, Treyvaud K, et al. Early environment and long-term outcomes of preterm infants[J]. J Neural Transm (Vienna),2020,127(1):1-8.
基金
云南省医疗卫生内设研究机构项目(2018NS0144);云南省科技厅—昆明医科大学应用基础研究联合专项资金面上项目[2019FE001(-050)];云南省高层次卫生技术人才培养(学科带头人)基金资助项目(RLMY20200007)
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