胎龄<32周早产儿喂养不耐受情况回顾性分析

Clinical analysis of feeding intolerance in premature infants with gestational age less than 32 weeks

目的探讨胎龄<32周早产儿喂养不耐受的发病特点和影响因素。方法对2018年1月至2019年1月广州医科大学附属第三医院新生儿科收治的胎龄<32周早产儿进行回顾性分析,按照喂养耐受性分为喂养耐受组(FT组)、生后1周内出现喂养不耐受组(1周内FI组)、出生1周后出现喂养不耐受组(1周后FI组)3组,比较3组早产儿肠内喂养期间的临床表现和相关诊疗措施,分析喂养不耐受的发病特点和影响因素。结果(1)共纳入胎龄<32周早产儿161例,发生喂养不耐受108例(67.1%),多发生于生后2周内,1周内出现的喂养不耐受以腹胀(58.3%,42/72)、残奶多(52.8%,38/72)为突出表现,1周后出现的喂养不耐受以腹胀(86.1%,31/36)、大便潜血(80.6%,29/36)为突出表现;24.1%(26/108)喂养不耐受总时间≥2周;(2)FT组中胎龄<28周、出生体重<1000 g、生后1周内有严重感染或败血症、胎粪排出延迟、生后2周内连续使用抗生素比例均低于两个FI组,住院期间输血次数少于两个FI组,差异有统计学意义(P<0.05);1周内FI组第1周使用有创+无创通气比例大于1周后FI组和FT组,1周内FI组和FT组第2周及以后超3 d不排便比例小于1周后FI组,差异有统计学意义(P<0.05)。(3)动脉导管未闭、胎粪排出延迟是1周内发生喂养不耐受的危险因素(OR=5.814,95%CI 1.335~25.318;OR=3.860,95%CI 1.009~10.997);出生体重大是1周后发生喂养不耐受的保护因素(1000~1250 g:OR=0.044,95%CI 0.003~0.609;1250~1500 g:OR=0.049,95%CI 0.003~0.748),生后第1周使用有创+无创通气是1周后发生喂养不耐受的保护因素(OR=0.074,95%CI 0.012~0.450)。结论胎龄<32周早产儿喂养不耐受发生率较高;1周内以腹胀、残奶多为主,1周后以腹胀、大便潜血为主;动脉导管未闭、胎粪排出延迟可能是1周内发生喂养不耐受的危险因素,出生体重大、生后第1周使用有创+无创辅助通气可能是1周后喂养不耐受的保护因素。

Objective To study the clinical characteristics and risk factors of feeding intolerance(FI)in premature infants with gestational age(GA)<32 weeks.Method From January 2018 to January 2019,preterm infants with GA<32 weeks admitted to our hospital was assigned into three groups:the feeding tolerance group(FT group),FI within 1 week group and FI after 1 week group.Their clinical manifestations,diagnostic and therapeutic data during enteral feeding were analyzed.Result(1)A total of 161 premature infants were included.FI occurred in 108 cases(67.1%),and mostly within 2 weeks after birth.Abdominal distention(58.3%,42/72)and increased gastric retention(52.8%,38/72)were most common within one week after birth,while abdominal distention(86.1%,31/36)and positive fecal occult blood(80.6%,29/36)were most common in the second week.24.1%(26/108)of premature infants had FI for more than 2 weeks.(2)The FT group had lower incidences of the following items than the two FI groups(P<0.05),including GA less than 28 weeks,birth weight(BW)less than 1000 g,severe infection or septicemia within 1 week,delayed meconium excretion,continuous use of antibiotics for two weeks and blood transfusions during hospitalization.FI within 1 week group had higher incidence of invasive and/or non-invasive ventilation in the first week than FI after 1 week group and the FT group(P<0.05).After first week,FI within 1 week group and the FT group had fewer cases of non-defecating for more than 3 days infants than the FI after 1 week group(P<0.05).(3)Patent ductus arteriosus(PDA)and delayed meconium excretion may be risk factors of FI within 1 week(OR=5.814,95%CI 1.335~25.318;OR=3.860,95%CI 1.009~10.997).Larger BW may be the protective factor of FI after 1 week(1000~1250 g:OR=0.044,95%CI 0.003~0.609;1250~1500 g:OR=0.049,95%CI 0.003~0.748).The use of invasive and/or noninvasive ventilation during the first week of life may be a protective factor for FI after 1 week(OR=0.074,95%CI 0.012~0.450).Conclusion The incidence of FI in preterm infants with GA less than 32 weeks is high.Abdominal distention and increased gastric retention are common manifestations of FI within 1 week,abdominal distention and positive fecal occult blood are common for FI after 1 week.PDA and delayed meconium excretion may be risk factors of FI within 1 week.Larger BW and the use of ventilation in the first week may be protective factors of FI after 1 week.