中美两家医院早产儿营养策略的对照研究

Comparison of feeding pattern of preterm infants between two hospitals in China and the United States

目的对比中美两家医院的早产儿营养支持数据,以期找到差距及改善方法。方法对2011年1月至2012年5月北京协和医院儿科NICU(PUMCH组)及2011年1月至2012年1月美国辛辛那提儿童医学中心辛辛那提大学医院NICU(CCHMC组)收治的胎龄<32周早产儿的肠内外营养数据进行回顾性对比研究。结果 PUMCH组74例、CCHMC组82例纳入研究。PUMCH组胎龄和出生体重均显著大于CCHMC组(P<0.01)。PUMCH组应用氨基酸和脂肪乳的总量均显著高于CCHMC组[分别为58±30 g/kg vs 24.0(19.6,32.8)g/kg,P<0.01;35±16 g/kg vs 14.0(11.0,22.5)g/kg,P<0.01],肠外营养时间显著长于CCHMC组[24±10 d vs 8.0(6.0,11.0)d,P<0.01]。PUMCH组母乳喂养率显著低于CCHMC组(10%vs 94%,P<0.01),达到足量喂养时间显著迟于CCHMC组[22±9 d vs 12.0(10.0,14.0)d,P<0.01]。CCHMC组坏死性小肠结肠炎发生率显著高于PUMCH组(13%vs 3%,P=0.018)。PUMCH组败血症发生率显著高于CCHMC组(32%vs 12%,P<0.01)。结论 PUMCH组较CCHMC组肠外营养时间延长、院内感染发生增加。需要推进强化母乳喂养、采取更积极的喂养方案以加快喂养进程。

Objective To compare the feeding pattern of preterm infants between two hospitals in China and the United States. Methods A retrospective cohort study was conducted. Infants 32 weeks were enrolled from Cincinnati Children＇s Hospital Center Cincinnati University Hospital（CCHMC group） between January 2011 and January 2012 and Peking Union Medical College Hospital（PUMCH group） between January 2011 and May 2012. Enteral and parenteral feeding data of the two groups was compared. Results Eighty-two infants in the CCHMC group and 74 infants in the PUMCH group were enrolled. The gestational age and birth weight of infants in the CCHMC group were smaller than the PUMCH group（P〈0.01）. The total dosage of amino acid（58±30 g/kg vs 24.0（19.6, 32.8） g/kg; P〈0.01） and fat [35±16 g/kg vs 14.0（11.0, 22.5） g/kg; P〈0.01], in the PUMCH group were higher than the CCHMC group. The duration of parenteral nutrition in the PUMCH group was longer than the CCHMC group[（24±10 d vs 8.0（6.0, 11.0） d; P〈0.01]. The breast feeding rate in the CCHMC group was higher（94% vs 10%; P〈0.01） than in the PUMCH group. The time for achieving full enteral feeding in the CCHMC group was shorter [12.0（10.0, 14.0） d vs 22.4±9.3 d, P〈0.01] than in the PUMCH group. The incidences of necrotizing enterocolitis（13% vs 3%; P〈0.05） and sepsis（32% vs 12%; P〈0.01） in the CCHMC group were higher than in the PUMCH group. Conclusions Preterm infants in the PUMCH group have a prolonged duration of parenteral nutrition and an increased incidence of sepsis compared to the CCHMC group. Fortified human milk feeding and more aggressive enteral feeding proposal in PUMCH is recommended.