目的 探讨喂养因素对早产儿坏死性小肠结肠炎(NEC)发病的影响, 为NEC的临床防治提供参考。方法 以2019年6月—2021年6月北京儿童医院新生儿中心内科住院的早产儿为研究对象,患有NEC者为病例组,以1∶2匹配同期住院的非NEC早产儿为对照组。比较两组早产儿的喂养方式(母乳、混合、配方奶喂养)以及喂养因素(生后开始肠内喂养时间、禁食时间、肠外营养时间等)的差异,采用单因素及多因素Logistic分析这些因素对NEC发病的影响。结果 病例组纳入47例早产儿(Ⅱ期 30例,Ⅲ期17例),对照组纳入94例早产儿,两组一般资料差异均无统计学意义。单因素分析显示两组早产儿肠内喂养类型 (χ2=24.871)、禁食时间(Z=-10.062)、肠外营养时间(Z=-2.217)及生后开始肠内喂养的时间(Z＝-15.772)差异有统计学意义(P＜0.01)。多因素Logistic回归分析显示母乳喂养为早产儿NEC的保护性因素(P＜0.01),延长禁食时间(OR=8.109,95%CI:5.477～12.007)、生后延迟肠内喂养(OR=17.710,95%CI:11.748～26.699)为早产儿NEC发病的危险因素(P＜0.001)。结论 配方奶喂养、生后延迟肠内喂养是早产儿NEC发病的高危因素。大力提倡母乳喂养、生后尽早开始肠内喂养可以减少早产儿NEC的发生。
Abstract
Objective To explore the influence of feeding factors on the development of necrotizing enterocolitis (NEC) in preterm infants with gestational age less than 37 weeks, so as to provide reference for clinical management of NEC. Methods Preterm infants hospitalized in Neonatal Center of Beijing Children's Hospital from June 2019 to June 2021 were enrolled in this study. Infants with NEC were selected into the case group, meanwhile non-NEC infants matched by 1∶2 were selected as controls. The differences in feeding patterns (breast, mixed, formula feeding) and feeding factors (the onset time to enteral feeding after birth, fasting duration and parenteral feeding duration, etc.) were compared between the two groups of preterm infants, and the effects of these factors on the development of NEC were analyzed using univariate and multivariate Logistic analysis. Results There were 47 cases in the experimental group (30 cases in stage Ⅱ and 17 cases in stage Ⅲ), and 94 cases in the control group. There were no statistically significant differences in the general characteristics between the two groups (P＞0.05).Univariate analysis showed significant differences in the type of enteral feeding (χ2＝ 24.871), duration of fasting (Z＝-10.062), duration of parenteral feeding (Z＝-2.217) and the onset time to enteral feeding after birth (Z＝-15.772) in the two groups of preterm infants (P<0.01). Multifactorial Logistic regression analysis showed that breastfeeding was a protective factor for the development of NEC in preterm infants (P<0.01), prolonged fasting time (OR＝ 8.109, 95%CI:5.477 - 12.007), delayed enteral feeding after birth (OR＝ 17.710, 95%CI:11.748 - 26.699) were risk factors for the development of NEC in preterm infants (P<0.001). Conclusions Formula feeding and prolonged parenteral feeding are associated with the increased risk of NEC. Breastfeeding and enteral feeding early after birth may reduce the incidence of NEC in premature infants.
关键词
坏死性小肠结肠炎 /
早产儿 /
喂养
Key words
necrotizing enterocolitis /
preterm infants /
feeding
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参考文献
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