早产低出生体质量儿早期积极营养支持的临床研究

Effect of early and aggressive nutritional support on low birth weight infants

目的探讨早产低出生体质量儿(LBWI)住院期间早期给予积极营养支持策略的影响。方法选择2 315例早产儿均为胎龄>28周,出生体质量<2500 g,生后12 h内大院、住院时间超过14 d、无畸形或严重并发症且存活出院,分为对照组1 023例和改良组1 292例。对照组患儿采用常规保守的营养支持方式;改良组患儿采取生后12 h内开奶、足量静脉营养支持方案。比较2组患儿进乳量、摄入的3大营养素及热卡,并比较LBWI的生长速度及宫外生长发育迟缓的发生情况。结果改良组患儿生后第3天和第7天进乳量和静脉使用碳水化合物的量均高于对照组(P<0.05,P<0.01)。改良组患儿生后第3天静脉使用氨基酸、脂肪乳的量均明显高于对照组(P<0.05,0.01);第7天改良组与对照组比较,使用氨基酸、脂肪乳的量差异无统计学意义(P>0.05)。改良组患儿生后第3天、第7天总热卡均高于对照组(P<0.05)。住院期间改良组患儿较对照组体质量下降幅度降低,恢复出生体质量的时间缩短,体质量平均增长速度增快(P<0.05,0.01)。出院时改良组患儿宫外生长发育迟缓发生率(41.8%)显著低于对照组(52.3%),差异有统计学意义(x^2=25.78,P<0.001)。结论早期积极营养支持策略增加了LBWI进乳量和3大营养素的摄入,明显改善了LBWI生长状况,减少了宫外生长发育迟缓的发生率。

Objective To explore the effect of early and aggressive nutritional support on low birth weight infants（LB-WI）. Methods Two thousand three hundred and fifteen infants with birth weight less than 2 500 g and with gestational age above 28 weeks,transfered to neonatal intensive care unit within 12 hours after birth,length of stay ^2 weeks,were divided into control group（1 023 cases） and improved group（1 292 cases）.Conventional conservative way of nutritional support was adopted in control group,and infants in improved group took milk as early as possible,and adequate intravenous nutritional support was accepted.The comparison of volume of baby formula,three major nutrients and calories intake between the two groups were analyzed.The growth velocity and the incidence of LBWI associated with extrauterine growth retardation（EUGR）of LBWI were investigated.Results Compared to control group,the infants in improved group were consumed greater volume of baby formula and were given more carbohydrate on the 3^（rd） and 7^（th） day of life（P 0.05,0.01）;the volumn of amine acid and fat emulsion in improved group was more on the 3^（rd）（P 0.05,0.01）;but there wasn＇t statistically significant in the volumn of amine acid and fat emulsion between the two groups on the 7^（th） day（P 0.05）.Total energy intake on the 3^（rd） and 7^（th） day in improved group was higher than that in control group（P 0.05）.Compared with control group,the extent of birth weight descent was decreased, the time of return to birth weight was shorten and the velocity of increase of the average weight was increased（P 0.05,0.01）.The incidence of EUGR in improved group was lower than control group,and there was a significant difference between the two groups（41.8%vs 52.3%;χ~2 = 25.78,P 0.001）.Conclusion Early and more aggressive nutritional support strategy can be able to provide enough energy and nutrients to satisfy the needs for LBWI＇s body growth and reduce the rate of EUGR.