目的 分析出生胎龄＜37周早产儿喂养不耐受(FI)的临床特征及影响因素,为临床早识别、早干预提供依据。方法 回顾性分析2020年1—12月南京市妇幼保健院新生儿科收治的814例出生胎龄＜37周早产儿的临床资料,根据是否发生FI分为FI组与喂养耐受组,分析FI的临床特征及影响因素。结果 FI组128例(15.7%),喂养耐受组686例(84.3%);其中,＜32周早产儿FI 70例(30.3%),32～＜34周28例(20.4%),≥34周30例(6.7%);＜1 500 g 早产儿FI 56例(32.6%),1 500～＜2 500 g 64例(12.7%),≥2 500 g 8例(5.8%)。出生胎龄、体重越小,FI的发生率越高(χ2=66.593、50.621,P＜0.001)。FI的临床表现以胃潴留(85.9%)、腹胀(66.4%)、呕吐(43.8%)为主,其中超/极早产儿FI临床表现以胃潴留、腹胀为主,晚期早产儿FI临床表现以腹胀、呕吐为主。单因素分析结果显示,FI组平均出生胎龄、平均出生体重明显低于喂养耐受组(t=8.028、8.588, P＜0.001);FI组早产儿窒息、宫内感染、生后24 h内接受有创呼吸支持、生后24 h内接受无创CPAP呼吸支持、呼吸暂停、小于胎龄儿、脐带异常比例明显高于喂养耐受组(χ2值分别为16.676、24.771、7.961、83.757、86.275、3.878、5.259,P＜0.05)。多因素Logistic回归分析显示生后24 h内接受无创CPAP呼吸支持(OR=3.269,95%CI:1.821～5.868)、呼吸暂停(OR=3.405,95%CI:2.106～5.505)是早产儿发生FI的独立危险因素(P＜0.05)。结论 早产儿FI的发生率随着出生胎龄、出生体重的增加而降低,临床表现也因出生胎龄的不同而存在差异。生后24 h内接受无创CPAP呼吸支持及呼吸暂停是早产儿发生FI的独立危险因素,应尽早干预,改善喂养耐受性。
Abstract
Objective To analyze the clinical features and influencing factors of feeding intolerance(FI) in preterm infants with gestational age ＜37 weeks, in order to provide reference for early identification and early intervention in clinic. Methods The clinical data of 814 premature infants with gestational age ＜37 weeks who were hospitalized in Nanjing Maternal and Child Health Hospital from January to December 2020 were retrospectively analyzed. Infants were divided into FI group and feeding tolerance group. The clinical characteristics and influencing factors of FI in premature infants were analyzed. Results There were 128(15.7%) infants in FI group and 686(84.3%) infants in feeding tolerance group. The prevalence rates of FI in infants with gestational age ＜32 weeks, 32～＜34 weeks and ≥34 weeks were 30.3%(70/231), 20.4%(28/137) and 6.7%(30/446), respectively. The prevalence rates of FI in infants with birth weight ＜1 500 g, 1 500 - ＜ 2 500 g and ≥2 500 g were 32.6%(56/172), 12.7%(64/503), and 5.8%(8/139), respectively. The smaller the gestational age and the lower birth weight, the higher prevalence rate of FI(χ2=66.593, 50.621, P＜0.001). The clinical manifestations of FI were mainly gastric retention(85.9%), abdominal distension(66.4%) and vomiting(43.8%). The clinical manifestations of FI in super/extremely preterm infants were mainly gastric retention and abdominal distension, which were mainly abdominal distention and vomiting in late preterm infants.Univariate analysis showed that the average gestational age and average birth weight of infants in FI group were significantly lower than those in feeding tolerance group(t=8.028, 8.588, P＜0.001). The proportions of asphyxia, intrauterine infection, invasive respiratory support within 24 hours after birth, non-invasive continuous postive airway pressure(CPAP) support within 24 hours after birth, apnea, small-for-gestational-age infants and abnormal umbilical cord in FI group were significantly higher than those in feeding tolerance group(χ2=16.676, 24.771, 7.961, 83.757, 86.275, 3.878, 5.259, P＜0.05).Multivariate Logistic regression analysis showed that non-invasive CPAP support within 24 hours after birth(OR=3.269, 95%CI:1.821 - 5.868) and apnea(OR=3.405, 95%CI:2.106 - 5.505) were independent risk factors of FI in premature infants(P＜0.05). Conclusions The prevalence rate of FI in preterm infants decreases with the increasing gestational age and birth weight, and the clinical manifestations also vary according to gestational age. Non-invasive CPAP support within 24 hours after birth and apnea are independent risk factors of FI in preterm infants. Infants with those risk factors should be intervened early as soon as possible to improve feeding tolerance.
关键词
早产 /
喂养不耐受 /
呼吸暂停 /
无创呼吸支持
Key words
premature /
feeding intolerance /
apnea /
non-invasive respiratory support
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