不同喂养方式对早产儿坏死性小肠结肠炎的影响

Effect of different feeding types on Necrotizing Enterocolitis in preterm infants

目的探讨早产儿不同喂养方式(母乳+母乳强化剂、早产儿配方奶、添加益生菌、不同加奶速度)对坏死性小肠结肠炎(NEC)的影响,以寻求更好的NEC防治对策。方法选择我院收治的胎龄28~34周的早产儿为研究对象,分为强化母乳组和早产儿配方奶组,同时以随机原则,根据是否给予益生菌、不同加奶速度的干预,分为添加益生菌组和未添加益生菌组,保守加奶组加奶速度[10~20 mL/(kg·d)]和放宽加奶组[30 mL(kg·d)],分析各组NEC的发生率。结果强化母乳组早产儿的NEC发生率低于早产儿配方奶组,差异有统计学意义(1.5%vs 12.2%,P<0.001),其相对危险度(RR)值为0.123(95%CI为0.038~0.396,P<0.001)。添加益生菌组和未添加益生菌组,放宽加奶组和保守加奶组早产儿NEC的发生率差异无统计学意义。结论母乳+母乳强化剂喂养降低了早产儿NEC的风险。放宽加奶速度并未增加NEC的风险,添加益生菌并未降低NEC的风险。

Objective To investigate the effect of different feeding types including human milk+human milk fortifier,preterm formula,probiotics,and different feed increasing speed on Necrotizing Enterocolitis(NEC)in preterm infants in order to provide prevention and treatment strategies for NEC.Methods Preterm infants with gestational age from 28 to 34 weeks admitted to our hospital were included and divided into two groups according to different feeding types,one of which were fed by human milk fortifier and the other by premature formula.Each group was divided into subgroups depending on whether probiotics were given(probiotic group and non-probiotic group)and different feed increasing speeds randomly(fast speed group with feeding speed increased by 30 mL/(kg·d)and the conservative speed group with feeding speed increased by[10-20 mL/(kg·d)].The incidence of NEC in each group and subgroup was analyzed.Results The incidence of NEC in premature infants fed by human milk fortifier was significantly lower than that in preterm infants fed by preterm formula(1.5%vs 12.2%,V 0.001).The difference was statistically significant.The relative risk(RR)was 0.123(95%CI was 0.038-0.396,P<0.001).There was no significant difference in the incidence of NEC between the probiotics group and the non-added probiotics group,so as the fast speed group[increased by 30 mL/(kg·d)]and the conservative speed group[increased by 10-20 mL/(kg·d)].Conclusion Human milk+human milk Fortifier reduces the risk of NEC in preterm infants.Feed increase by 30 mL/kg/day does not increase the risk of NEC.The addition of probiotics does not reduce the risk of NEC.