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.
Key words
premature /
feeding intolerance /
apnea /
non-invasive respiratory support
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