早期营养支持对极低出生体重儿体格生长及视网膜发育的影响

THE EFFECT ON THE GROWTH AND IMMATURE RETINA OF VERY LOW BIRTH WEIGHT INFANTS WITH EARLY NUTRITIONAL SUPPORT

目的：探讨早期营养支持对极低出生体重儿住院期间体格生长、视网膜发育及并发症的影响。方法回顾性分析我院2003年1月～2013年12月收治的出生体重＜1500 g、无先天畸形、住院2 w以上、存活出院的360例早产儿临床资料。其中2010年1月～2013年12月为 A组（ n＝200），于生后12 h内予6.7％小儿氨基酸1.6 g/（kg· d）[1.0 g/（kg· d）递增]，24 h内予20％脂肪乳1.0 g/（kg· d）[1.0 g/（kg· d）递增]；2003年1月～2009年12月为B组（n＝168），于生后12～24 h内予6.7％小儿氨基酸0.5 g/（kg· d）[0.5 g/（kg· d）递增]，48 h内予20％脂肪乳0.5 g/（ kg· d）[0.5 g/（ kg· d）递增]。比较两组出生时一般情况、生后肠内外营养摄入、体格增长与视网膜发育、并发症的发生率等。结果两组性别、胎龄、出生体重、身长、头围、生后1分钟Apgar评分、禁食时间、开奶时间、胃肠外营养持续时间、达全胃肠喂养日龄、住院期间平均头围与身长增长等差异均无统计学意义（ p＜0.05）。 A组体重下降幅度比B组低[（6.12±1.15）％ vs （8.85±2.35）％，p＝0.032]；摄入能量达120 kCal/（kg· d）日龄比B组早[（10.02±4.99） d vs （14.79±6.04） d，p＝0.029]；恢复至出生体重的日龄比B组早[（9.0±3.5） d vs （12.5±4.5） d， p＝0.023]；平均每日体重增长高于B组[（20±5.2） g/kg· d vs （14.1±34.6）g/kg· d， p＝0.002）；平均住院时间比B组短[（30.9±10.5） d vs （40.5±13.5） d， p＝0.048]；差异均有统计学意义（p＜0.05）。两组并发症的发生，包括呼吸窘迫综合症、坏死性小肠结肠炎、脑室周围-脑室内出血、胆汁淤积、医院感染、需要机械通气及时间、氧疗时间与喂养不耐受的差异均无统计学意义（p＞0.05）。纠正胎龄34 w时视网膜不成熟与早产儿视网膜病的发生率A组低于B组，差异有统计学意义（ p＜0.05）。结论早期应用氨基酸等积极营养支持能够降低早产儿生后早期的体重下降幅度，更早恢复至出生体重，加速住院期间的体重增长，缩短住院时间，促进视网膜成熟和与减少ROP的发生，并不增加其他并发症的发生。

Objective To investigate the effect of early nutritional support on the growth and immature retinal vessels of very low birth infants.Methods Total 360 infants, admitted to our hospital from January 2003 to December 2013, who were born with birth weight lower than 1500g, without congenital malformation, being hospitalized for at least two weeks and safely discharged, were recruited.They were divided into 2 groups according to their time of hospitalization.200 infants ad-mitted from January 2010 to December 2013 were involved as group A and were given amino acid [ initial dose 1.6g/（ kg· d）, increased at 1.0 g/（kg· d）]in 12 h after birth and fat emulsion [initial dose 1.0 g/（kg· d）, increased at 1.0 g/（kg · d） ] in 24 h after birth.168 infants admitted from January 2003 to December 2009 were involved as group B and were giv-en amino acid [initial dose 0.5 g/（kg· d）, increased at 0.5 g/（Kg· d）] in 12～24 h after birth and fat emulsion [initial dose 0.5 g/（kg·d）, increased at 0.5 g/（kg· d）] in 24h after birth.General condition at birth, enteral and parenteral nutrition intake, growth parameters, retinal vessels development and other complications between two groups were retrospectively compared.Results No statistically significant differences（p〉0.05） were found in gestational age, gender, general condi-tions at birth, faster time, average growth rate of Length and heat circumference, occurrences of complications, such as re-spiratory distress syndrome （RDS）, necrotising enterocolitis （NEC）, periventricular-intraventricular hemorrhage（PVH -IVH）, parenteral nutrition associated cholestasis, infection, and the duration of oxygen therapy and mechanical ventilation between the groups.Group A compared to Group B, had less weight decrease [（6.12 ±1.15） vs （8.85 ±2.35）%, p =0.032]） ] and less time to regain birth weight [（9.0 ±3.5 ） vs （12.5 ±4.5） d ]and to reach 120 kCal/（Kg· d）[（10.02 ±4.99） vs （14.79 ±6.04） d,p=0.029）], had higher average weight growth rate after regain birth weight[（20 ±5.2 ） vs＆amp;nbsp;（14.1 ±4.6） g/（Kg· d）], had shorter hospital stay[（ 30.9 ±10.5 ） vs （ 40.5 ±13.5） d ] and lower rate of immature retina at gestational age 34 weeks and retinopathy of prematurity（ROP）.These comparisons were all statistically significance （ p〈0.05 ） .Conclusion Early nutritional support can improve the growth velocity and visual function of very low birth weight infants, and reduce the incidence of immature retina at gestational age 34 weeks and retinopathy of prematurity （ROP）, shorten hospital stays, and had no influence on the occurrences of other complication.