目的 分析深度水解蛋白配方奶治疗早产儿喂养不耐受的效果及对医院感染的影响,为早产儿喂养不耐受的临床治疗提供参考。方法 选取2017年4月—2020年2月于山东菏泽市立医院诊治的208例喂养不耐受的早产儿进入试验资格评估,筛选排除后随机分配,最终研究组、对照组各100例。对照组患儿接受早产儿标准配方奶喂养,研究组患儿接受深度水解蛋白配方奶喂养,对比两组的喂养耐受指标(每日进奶量、胎粪排尽时间、达全胃肠营养时间、复奶后7d内总胃残留次数(GRV1)、复奶后全天胃残余量/全天预计奶量比(GRV2)、生长发育指标(体重、头围增长速度)、并发症发病率(坏死性小肠结肠炎、病理性黄疸、大便潜血阳性或便血)及医院感染的发生率。结果 研究组喂养耐受指标除每日进奶量(t=5.037)高于对照组外,胎粪排尽时间(t=9.217)、达全胃肠营养时间(t=15.833)、GRV1(t=6.737)、GRV2(t=9.956)均低于对照组,差异均有统计学意义(P＜0.05)。研究组体重增长速度(t=2.454)、头围增长速度(t=5.469)均高于对照组,差异有统计学意义(P＜0.05)。研究组的坏死性小肠结肠炎、病理性黄疸及大便潜血阳性或便血三项并发症发病率与医院感染发生率均低于对照组,差异有统计学意义(χ2=4.310、4.688,P＜0.05)。结论 相较于早产儿标准配方奶,深度水解蛋白配方奶可显著改善早产儿喂养不耐受情况,促进生长发育,减少医院感染的发生,临床应用推广价值高。
Abstract
Objective To analyze the effect of extensively hydrolyzed formula(eHF) in the treatment of feeding intolerance in preterm infants and the effect on hospital infection, in order to provide reference for the clinical treatment of feeding intolerance in preterm infants. Methods A total of 208 cases of preterm infants with feeding intolerance diagnosed and treated in Shandong Heze Municipal Hospital from April 2017 to February 2020 were selected into the clinical trial for eligibility assessment, then were randomly assigned into study group(n=100) and control group(n=100) after screening and exclusion. Children in the control group were fed with standard preterm formula, while children in the study group were fed with eHF. Feeding tolerance indicators, including daily milk intake, time to meconium evacuation, time to full gastrointestinal nutrition, total gastric residual counts(GRV1) in the 7-d period after resumption of breastfeeding, ratio of all-day gastric residual counts/all-day estimated milk intake after resumption of breastfeeding(GRV2) were compared between the two groups, and growth indicators(body weight growth rate, head dimension growth rate), complication incidence [necrotizing enterocolitis(NEC), pathological jaundice, positive fecal occult blood or blood in stool] and incidence of hospital-acquired infections. Results The daily milk intake(t=5.037) of the study group was higher than that of the control group, and the time of foetal excretion(t=9.217), the time to reach full gastrointestinal nutrition(t=15.833), GRV1(t=6.737), GRV2(t=9.956) were lower than those of the control group, and the differences were all statistically significant(P<0.05). The rate of weight gain(t=2.454) and head dimension growth(t=5.469) in the study group was significantly higher than those of the control group(P<0.05). The incidence of the three complications of NEC, pathological jaundice and positive fecal occult blood or blood in stool(χ2=4.310) and the incidence of hospital infections(χ2=4.688) were significantly lower in the study group than in the control group(P<0.05). Conclusions Compared with the standard formula milk for preterm infants, eHF can significantly improve the feeding intolerance of preterm infants, promote growth and development, and reduce the occurrence of hospital-acquired infections. Therefore, eHF can be widely used in clinic for preterm infants with feeding intolerance.
关键词
早产儿 /
喂养不耐受 /
深度水解蛋白配方奶 /
医院感染
Key words
premature infants /
feeding intolerance /
extensively hydrolyzed formula /
hospital-acquired infections
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参考文献
[1] 高燕,张瑛,颜新艳.早产儿喂养不耐受的改善策略研究进展[J].新乡医学院学报,2019,36(3):295-298.
Gao Y, Zhang Y, Yan XY. Research progress on improvement strategies of feeding intolerance in preterm infants[J]. Journal of Xinxiang Medical College,2019,36(3):295-298.(in Chinese)
[2] 邢理顺,葛神永.复方嗜酸乳杆菌、抚触结合母乳喂养用于剖宫产低体重早产儿喂养不耐受的临床价值[J].内蒙古医科大学学报,2020,42(4):420-423,435.
Xing LS, Ge SY. Clinical value of compound Lactobacillus acidophilus and touch combined with breastfeeding for cesarean section delivery of low birth weight preterm infants with feeding intolerance[J]. Journal of Inner Mongolia Medical University,2020,42(4):420-423,435.(in Chinese)
[3] Ford SL,Lohmann P, Preidis GA, et al. Improved feeding tolerance and growth are linked to increased gut microbial community diversity in very-low-birth-weight infants fed mother's own milk compared with donor breast milk[J]. Am J Clin Nutr, 2019,109(4):1088-1097.
[4] 刘燕,张春丽.母乳喂养联合益生菌对早产儿喂养耐受及胆汁淤积的影响[J].医学综述,2019,25(2):408-411,416.
Liu Y, Zhang CL. Effects of breastfeeding combined with probiotics on feeding tolerance and cholestasis in preterm infants[J]. Medical Review,2019,25(2):408-411,416.(in Chinese)
[5] 张串串,徐兵,白利,等.深度水解蛋白质配方奶在极低出生体质量儿早期喂养中的应用价值[J].临床医药实践,2021,30(11):855-858.
Zhang CC, Xu B, Bai L, et al. The value of deeply hydrolysed protein formula in the early feeding of very low birth mass children[J]. Clinical Medicine Practice,2021,30(11):855-858.(in Chinese)
[6] Fanaro S. Feeding intolerance in the preterm infant[J]. Early Hum Dev, 2013, 89(Suppl 2): 13-20.
[7] 范敏,陈信,张阵,等.早产儿喂养不耐受临床特征及相关影响因素的研究[J].中华全科医学,2022,20(3):431-434,449.
Fan M, Chen X, Zhang Z, et al. Study on clinical characteristics and related influencing factors of feeding intolerance in preterm infants[J]. Chinese Family Medicine,2022,20(3):431-434,449.(in Chinese)
[8] 闫雅红.深度水解蛋白奶粉在儿童过敏性腹泻饮食控制中对生长发育的影响研究[J].山西医药杂志,2019,48(5):570-572.
Yan YH. Study on the effect of deeply hydrolysed protein milk powder on growth and development in the dietary control of allergic diarrhoea in children[J]. Shanxi Medical Journal,2019,48(5):570-572.(in Chinese)
[9] 张亚丽,毛国顺,叶玉兰,等.深度水解蛋白配方奶在不同体重早产儿喂养中的临床效果观察[J].现代生物医学进展,2019,19(21):4116-4119.
Zhang YL, Mao GS, Ye YL, et al. Observation on the clinical effect of deeply hydrolysed protein formula milk in feeding preterm infants of different weights[J]. Modern Biomedical Progress,2019,19(21):4116-4119.(in Chinese)
[10] Vandenplas Y, Z·ołnowska M, Berni Canani R, et al. Cinnamon study investigator group. Effects of an extensively hydrolyzed formula supplemented with two human milk oligosaccharides on growth, tolerability, safety and infection risk in infants with cow's milk protein allergy: A randomized, multi-center trial[J]. Nutrients, 2022,14(3):530.
[11] 荣道香,方姗姗,陈信,等.深度水解蛋白过渡期喂养极早/非常早产儿应用的临床观察[J].皖南医学院学报,2020,39(1):54-57.
Rong DX, Fang SS, Chen X, et al. Clinical observation on the use of deep hydrolysed protein in transition feeding of very early/very preterm infants[J]. Journal of Wannan Medical College,2020,39(1):54-57. in Chinese)
[12] 金蜜蜜,胡小叶,郑双利,等.深度水解乳清蛋白配方奶粉对先天性巨结肠患儿灌肠效果的影响[J].中国妇幼保健,2022,37(8):1436-1438.
Jin MM, Hu XY, Zheng SL, et al. Effect of deeply hydrolysed whey protein formula on the effect of enema in children with congenital megacolon[J]. China Maternal and Child Health Care,2022,37(8):1436-1438.(in Chinese)
[13] 何为,潘家华.深度水解蛋白配方奶喂养早产儿327例临床观察[J].中国当代儿科杂志,2017,19(8):856-860.
He W, Pan JH. Clinical observation of 327 cases of preterm infants fed with deeply hydrolysed protein formula[J].Chin J Contemp Pediatr,2017,19(8):856-860.(in Chinese)
[14] Hamilton E. Massey C, Ross J, et al.Eariy enteral feeding in very low birth weight infants[J]. Early Hum Dev, 2014, 90(3): 227-230.
[15] 顾春燕,蒋慧芬,王金秀.深度水解蛋白配方奶喂养对极低/超低出生体重儿生长发育的影响[J].中国当代儿科杂志,2017,19(8):852-855.
Gu CY, Jiang HF, Wang JX. Effects of deeply hydrolysed protein formula feeding on growth and development of very low/ultra low birth weight infants[J].Chin J Contemp Pediatr,2017,19(8):852-855.(in Chinese)
[16] 封云,赵莉,程锐.超低/极低出生体质量儿个体化营养支持的近期临床结局[J].肠外与肠内营养,2018,25(4):223-227.
Feng Y, Zhao L, Cheng R. Recent clinical outcomes of individualised nutritional support for ultra-low/very low birth mass children[J]. Parenteral and Enteral Nutrition,2018,25(4):223-227.(in Chinese)
基金
山东省高等学校科技计划项目(J17KB084)
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