新生儿缺氧缺血性脑病亚低温治疗期间开展肠内营养的回顾性非随机对照研究

Enteral nutrition during hypothermia treatment for hypoxic-ischaemic encephalopathy in neonates:A retrospective non-randomized controlled study

背景亚低温是新生儿缺氧缺血性脑病(HIE)的有效治疗措施,目前国内外对亚低温期间肠内营养的开展尚无共识。目的探讨亚低温治疗期间开展肠内营养的安全性。设计回顾性非随机对照研究。方法2019年1月至2020年6月重庆医科大学附属儿童医院新生儿中心诊断为HIE并实施亚低温治疗的患儿,按照亚低温治疗期间是否行肠内营养分为开奶组和禁奶组,收集患儿的一般情况、临床表现、实验室检查、诊断及治疗等情况,肠内营养开奶日龄、开奶种类、奶量和喂养方式。主要结局指标住院期间NEC的发生率。结果95例HIE患儿进入分析,开奶组51例,禁奶组44例。①开奶组患儿腹胀发生率低于禁奶组(P=0.047),两组呕吐、血便和抽搐发生率差异无统计学意义。②两组患儿在生后1 h内血气分析、入院首次血常规、头颅超声提示出血、头颅MR异常差异均无统计学意义。③开奶组平均静脉营养治疗时间和平均住院时间均短于禁奶组(P均<0.001);两组NEC、喂养不耐受等合并症发生率差异无统计学意义。④开奶组患儿中,60.8%以配方奶开奶,41.1%为日龄1 d开奶,初始平均奶量为19.1 mL·kg-1·d-1,68.6%患儿亚低温期间未加奶。开奶组中1例发生了NEC(Ⅰ期),保守治疗后好转,无死亡病例。结论亚低温期间早期开始微量肠内营养,可减少腹胀的发生,缩短静脉营养治疗时间及住院时间,不增加NEC的发生风险。

Background Hypothermia treatment is now effective treatment for hypoxic ischemic encephalopathy(HIE).Currently,there is still no consensus on enteral nutrition to infants with HIE during therapeutic hypothermia at home and abroad.Objective To study the safety of enteral nutrition during hypothermia treatment for HIE in neonates.Design Retrospective non-randomized controlled study.Methods Neonates with HIE undergoing hypothermia at the Department of neonatology,Children's Hospital of Chongqing Medical University between January 2019 to June 2020 were included in the study.According to whether patients received enteral nutrition during hypothermia treatment,they were divided into enteral nutrition(EN)group and unfed group.Data of general conditions,clinical manifestations,laboratory examinations,diagnosis,treatment,age of starting feeds,type,volume,and mode of enteral nutrition were collected.Main outcome measures Incidence of neonatal necrotizing enterocolitis(NEC)during hospitalization.Results A total of 95 patients with HIE were included in the analysis,including 51 patients in the EN group and 44 patients in the unfed group.Patients in the EN group had lower incidence of abdominal distension than the unfed group(P=0.047)and there were no significant differences in the incidence of vomiting,bloody stools,and convulsion between the two groups.No statistically significant differences were found in blood gas analysis measured within an hour of birth,first blood routine test after admission,intracranial hemorrhage in brain sonography,and abnormalities in cranial magnetic resonance between the two groups.Patients in the EN group had a shorter mean length of parenteral nutrition and hospital stay compared with the unfed group(P<0.001).There were no significant differences between the two groups regarding complications such as NEC and feeding intolerance.In the EN group,60.8%received formula and 41.1%were fed on day 1 of life.The mean total volume was 19.1 mL·kg-1 over a 24 hour period and 68.6%did not increase feeds during hypothermia treatment.One patient developed NEC(I),and improved after conservative medical therapy.No deaths occurred.Conclusion Early minimal enteral nutrition during hypothermia was associated with lower incidence of abdominal distension,a shorter mean length of parenteral nutrition and hospital stay,but did not increase incidence of NEC.