初乳口腔免疫疗法在极低出生体重儿喂养中的应用

Application of colostrum oral immunotherapy in feeding of very low birth weight infants

目的探讨二联益生菌制剂及初乳口腔免疫疗法对改善极低出生体重儿喂养不耐受的应用效果。方法采用系统抽样法选取2017年12月—2018年12月新生儿监护病房(NICU)收治的173例极低出生体重儿,按照随机数表法分为A组56例、B组59例和C组58例。A组患儿实施常规护理,给予肠外营养、肠内营养、母乳微量喂养;B组患儿在常规护理基础上给予二联益生菌制剂;C组患儿在常规护理基础上给予初乳口腔免疫疗法。干预7 d后观察喂养不耐受改善情况,比较干预3、5、7 d时3组喂养不耐受率。比较肠道菌群、并发症发生率、NICU住院时间和恢复出生体重速度。结果B组和C组患儿的摄入奶量均多于A组患儿,潴留奶量、潴留次数和腹胀持续时间均短于A组患儿,C组患儿的潴留次数和腹胀持续时间短于B组患者,差异均有统计学意义(P<0.05)。干预3、5、7 d时,3组喂养不耐受率均持续下降,B组和C组喂养不耐受率均低于A组,且干预3 d时C组喂养不耐受率低于B组,差异均有统计学意义(P<0.05)。B组和C组的屎肠球菌数量、枯草杆菌数量以及双歧杆菌数量对数值与大肠杆菌数量对数值的比值(B/E值)均高于A组,B组和C组的败血症、坏死性小肠结肠炎的发生率均低于A组,差异均有统计学意义(P<0.05)。NICU住院时间由长到短为A组、B组、C组,恢复出生体重速度由慢到快为A组、B组、C组,差异均有统计学意义(P<0.05)。结论初乳口腔免疫疗法可以改善极低出生体重儿的喂养不耐受,减少早产相关并发症,促进患儿生长发育,缩短NICU住院时间,临床效果比益生菌制剂略佳。

Objective To explore the application effects of dual probiotic preparation and colostrum oral immunotherapy on improving feeding intolerance in very low birth weight infants.Methods A systematic sampling method was used to select 173 very low birth weight infants who were admitted to the Neonatal Intensive Care Unit(NICU)from December 2017 to December 2018.According to the random number table method,they were divided into in group A(n=56),group B(n=59)and group C(n=58).Group A was given routine nursing,parenteral nutrition and enteral nutrition and minimal breast feeding.Group B was given dual probiotic preparation on the basis of routine nursing.Group C was given colostrum oral immunotherapy on the basis of routine nursing.After 7 days of intervention,the improvement of feeding intolerance was observed,and the feeding intolerance rates were compared among the three groups after 3 d,5 d and 7 d of intervention.Intestinal flora,incidence of complications,length of NICU stay and speed of birth weight recovery were compared.Results The intake of milk in group B and group C were higher than those in group A,and the retention milk volume,retention times and duration of abdominal distension were all lower than those in group A,while retention times and duration of abdominal distension in group C were shorter than those of group B,and the differences were statistically significant(P<0.05).On the 3rd,5th and 7th day of intervention,the feeding intolerance rates of the three groups continued to decrease.The feeding intolerance rates of group B and C were lower than those of group A,and the feeding intolerance rate of group C was lower than that of group B on the 3rd day of intervention,and the differences were statistically significant(P<0.05).The number of Enterococcus faecium,the number of Bacillus subtilis and the ratio of the logarithmic number of bifidobacteria to the logarithmic number of Escherichia coli(B/E value)in groups B and C were all higher than those in group A,and the incidences of sepsis and necrotizing enterocolitis in group B and group C were lower than those in group A,and the differences were statistically significant(P<0.05).The length of stay in NICU was ranked from long to short as Group A,Group B,and group C,and the speed of birth weight recovery was ranked from slow to fast as group A,Group B,and group C,and the differences were statistically significant(P<0.05).Conclusions Colostrum oral immunotherapy can improve the feeding intolerance of very low birth weight infants,reduce complications related to premature delivery,promote the growth and development of neonates and shorten the length of stay in NICU.The clinical effect is slightly better than that of probiotics.