早期微量母乳喂养在新生儿中重度缺氧缺血性脑病中的应用

The Application of Early Enteral Breast in Feeding in Neonates with Moderate and Severe Hypoxic-ischemic Encephalopathy

目的探讨新生儿中重度缺氧缺血性脑病(HIE)早期微量母乳喂养的可行性和疗效。方法将31例中重度HIE的新生儿随机分为早期微量母乳喂养(治疗组)18例和早期全静脉营养(TPN对照组)13例2组。观察2组新生儿达全量胃肠道营养时间、胆红素水平、胃肠道功能紊乱、坏死性小肠结肠炎(NEC),吸入性肺炎发生率、继发感染发生率等。结果2组胃肠道功能紊乱、NEC、吸入性肺炎发生率影响无显著性差异(P>0.05),但治疗组达全量胃肠道营养时间、胆红素水平、继发感染率均明显低于对照组。结论早期微量母乳喂养可促进胃肠道发育成熟,不增加胃肠功能紊乱的发生率,并可缩短达足量喂养的时间,减轻胆红素水平、减少继发感染的发生率。中重度HIE新生儿进行早期微量母乳喂养是可行和有效的。

OBJECTIVE To investigate the feasibility and effect of early minimal enteral breast feeding （MEBF） in neonates with moderate and severe hypoxic-ischemic encephalopathy （HIE） , METHODS 31 neonates with moderate and severe HIE were randomised to two groups： 18 neonates were fed by a combination of early enteral and parenteral means （the raputive group）, and 13 neonates were fed by totally parenteral nutrition （TPN casecontrol group） , At last, the time when the infant were complete fed enterally, the level of billrubin, and theincident rate of gastrointestinal disorders, neonatal necrotizingenterocolitis （NEC）, aspiration pneumonia, and secondary infections were observed. RESULTS There were no significant difference between the two groups in the incident rate of gastrointestinal disorders, NEC, andaspiration pneumonia （P〉0.05） . But the time when the neonates were complete fed enterally, the level of billrubin, and the incident rate of secondary infections of the theraputive group were significantly less than the TPN ease-control group. CONCLUSIONS Our findings suggest that early minimal enteral breast feeding may trigger the gastrointestinal development and maturation, without increasing incident rate of gastrointestinal diasorders, shorter the time that the neonates could be fed totally enterally, lessen the level of billirubin, and cut down the incident rate of secondary infection. In conclusion, early MEBF in neonates with moderate and severe HIE should be feasible and effective.