早产儿喂养不耐受的影响因素与治疗策略

Influencing factors and treatment strategy of feeding intolerance in preterm infant

目的了解早产儿喂养不耐受的影响因素,探讨有利于早产儿喂养成功的要点。方法收集2014年3月至2014年9月厦门市妇幼保健院新生儿科收治的发生喂养不耐受的早产儿进行回顾性分析。结果共收集到符合入选标准的早产儿病例374例,其中107例发生喂养不耐受,发生率为28.6%。出生体重≤1500 g的早产儿喂养不耐受发生率(71.23%)明显高于出生体重>1500 g的早产儿(18.27%),差异有显著性(P<0.01)。胎龄≤34周的早产儿喂养不耐受发生率(38.82%)高于>34周的早产儿(17.98%),差异有显著性(P<0.05)。>3天开奶的早产儿喂养不耐受发生率(40.59%)高于≤3天开奶的早产儿(18.63%),差异有显著性(P<0.01)。有窒息史的早产儿喂养不耐受发生率(44.76%)高于无窒息史早产儿(22.30%),差异有显著性(P<0.05)。有无呼吸暂停史与早产儿喂养不耐受的发生无相关性(P>0.05)。结论出生体重低、胎龄小、开奶延迟、有窒息史的早产儿易发生喂养不耐受。选择合适的乳类、合理选择开奶时间、早期给予微量喂养和非营养性吸吮、刺激排便、应用微生态制剂等治疗策略,可提高早产儿生存质量。

Objective To understand the influencing factors of feeding intolerance in preterm infants and to investigate key points in favor of success in feeding tolerance of preterm infants.MethodTo analyze relevant factors of feeding in 374 preterm infants who were admitted in our NICU and discharged after recovery from Mar 2013 to Sep 2014.Results107/374(28.6%)preterm infants presented feeding intolerance.The occurrence rate of feeding intolerance is higher in the preterm infants with birth weight≤1 500 g (71.23%) than those with birth weight >1 500 g (18.27%) , and the difference is significant (P<0.01). Compared to the preterm infants with gestational age > 34 w, the infants with gestational age≤ 34 w showed increasing trend of feeding intolerence (P<0.05). The occurrence rate is 40.59% in the preterm infants with delayed feeding above 3 days, which is signiifcantly higher than undelayed (18.63%) (P<0.01).44.76% of the preterm infants with asphyxia showed feeding intolerence, and the rate in higher than those without asphyxia (22.30%) (P<0.05). There is no signiifcant correlation with apnea and feeding intolerance (P>0.05).Conclusions With decreasing birth weight, decreasing gestational age, delayed feeding and higher rate of asphyxia, the incident of feeding incidence in preterm infants delete was increased. Early enteral feeding and active intervention treatment can improve the quality of life in premature infants.