深度水解蛋白配方奶在极/超低出生体重儿肠内营养中的临床观察

A clinical study on the effects of extensively hydrolyzed protein formula enteral nutrition of very/extremely low birth weight infants

目的 探讨深度水解蛋白配方奶（extensively hydrolyzed protein formula,eHPF）和标准早产儿配方奶（standard preterm infant formula,SPF）在极/超低出生体重儿喂养中的临床效果,为极/超低出生体重儿的早期喂养提供理论依据.方法 选取2015年8月至2016年8月我院新生儿重症监护病房收治的极/超低出生体重儿（出生体重〈1500 g、胎龄〈32周）,随机分为eHPF组和SPF组,eHPF组生后予eHPF喂养至校正胎龄32周后改为SPF喂养;SPF组生后予SPF喂养.记录两组早产儿临床资料,恢复出生体重时间、达全肠道营养时间、鼻胃管留置时间,并发症情况及血生化指标.结果 共纳入eHPF组85例,SPF组91例.eHPF组住院时间、体重增长速率、鼻胃管留置时间、恢复出生体重时间、达全肠道营养时间均优于SPF组[（38.4±7.8）d比（42.1±11.0）d,（25.5±10.1）g/d比（21.8±7.8）g/d,（12.1±4.0）d比（16.0±3.8）d,（11.6±3.9）d比（13.0±3.8）d,（9.3±2.2）d比（14.3±1.8）d],差异有统计学意义（P〈0.05）;两组出院体重差异无统计学意义（P〉0.05）.eHPF组胆汁淤积、坏死性小肠结肠炎及喂养不耐受发生率均低于SPF组（22.7%比24.3%,6.8%比7.2%,15.9%比17.1%）,差异有统计学意义（P〈0.05）;两组宫外发育迟缓发生率差异无统计学意义（P〉0.05）.eHPF组第14天血清总胆红素水平低于SPF组[（40.3±23.0）μmol/L比（53.6±26.5）μmol/L],第21天血清总蛋白水平及白蛋白水平高于SPF组[（50.5±3.7）g/L比（46.7±5.3）g/L,（31.3±4.1）g/L比（29.4±5.2）g/L],差异有统计学意义（P〈0.05）;两组第7天血清总胆红素水平差异无统计学意义（P〉0.05）.结论 eHPF可缩短极/超低出生体重儿达全肠道营养时间,更快恢复出生体重,加快胆红素消退,降低喂养不耐受和坏死性小肠结肠炎发生率,是极/超低出生体重儿肠内营养一种安全、有效的选择.

Objective To study the clinical effects of extensively hydrolyzed protein formula （eHPF） and standard preterm infant formula （SPF） in very/extremely low weight （V/ELBW） infants.To provide a theoretical basis for the early feeding of V/ELBW infants.Method From August 2015 to August 2016, V/ELBW infants （gestational age 〈32 w and birth weight 〈1500 g） hospitalized in our neonatal ward were randomly assigned into eHPF group and SPF group .The eHPF group received eHPF feeding from birth to corrected gestational age of 32 weeks, and then fed with SPF;the SPF group was fed with SPF after birth.The clinical data of the two groups were compared including the time needed to regain birth weight , the time needed to achieve total enteral nutrition , the duration of nasogastric tube usage , the complications and blood biochemical indexes .Result A total of 85 cases were included in the eHPF group , and 91 cases in the SPF group.The hospitalization duration , weight increase rate , nasogastric tube duration , the time needed to regain birth weight , the time needed to achieve total enteral nutrition of eHPF group were better than SPF group [ （ 38.4 ±7.8 ） d vs.（ 42.1 ±11.0 ） d, （ 25.5 ±10.1 ） g/d vs.（ 21.8 ±7.8 ） g/d, （12.1 ±4.0） d vs.（16.0 ±3.8） d, （11.6 ±3.9） d vs.（13.0 ±3.8） d, （9.3 ±2.2） d vs.（14.3 ±1.8） d], and the differences were statistically significant （P〈0.05）.No statistically differences existed on discharge weight between the two groups （ P〉0.05 ） .Compared with the SPF group , the incidences of cholestasis, NEC and feeding intolerance were lower in the eHPF group （22.7% vs.24.3%, 6.8% vs. 7.2%, 15.9%vs.17.1%） , and the differences were statistically significant （ P〈0.05 ） .No significant differences existed on the incidence of extrauterine growth retardation between the two groups （P〉0.05）. No significant differences existed on serum total bilirubin level at 7 d after birth between the two groups （ P〉0.05）.Compared with the SPF group , the serum total bilirubin at 14 d was lower in the eHPF group [（40.3 ±23.0）μmol/L vs.（53.6 ±26.5） μmol/L], the serum total protein [（50.5 ±3.7） g/L vs. （46.7 ±5.3） g/L] and albumin[（31.3 ±4.1） g/L vs.（29.4 ±5.2） g/L] at 21 d were higher, the differences were statistically significant （ P〈0.05 ） .Conclusion eHPF can shorten the time needed to achieve total enteral nutrition and regain birth weight , accelerate the regression of hyperbilirubinemia , reduce the incidences of feeding intolerance and NEC , and it is a safe and effective choice for enteral nutrition in V/ELBW infants.