益生菌对早产极低出生体重儿喂养不耐受和早期生长发育的影响

Effects of probiotics on feeding intolerance and early growth and development of preterm and very low birth weight infants

目的探讨益生菌对早产极低出生体重儿(VLBWI)喂养不耐受和早期生长发育的影响。方法纳入2019年3月20日至2022月3月20日河南省儿童医院收治的VLBWI 446例,依据喂养方式和是否接受早期益生菌补充分为母乳组(119例)、母乳+益生菌组(108例)、配方奶组(115例)和配方奶+益生菌组(104例)。各组喂养方案参照2013年《中国新生儿营养支持临床应用指南》及《极低出生体重儿喂养指南》进行,益生菌补充组在此基础上加用酪酸梭菌二联活菌散,用药剂量0.25 g/次,2次/d,共2周,鼻饲或奶瓶给药。观察各组喂养不耐受发生率、恢复出生体质量时间、达全胃肠道喂养时间及住院时间等,并比较出生28 d各组体质量、头围、身长等早期生长发育指标平均增加情况。结果母乳组喂养不耐受发生率、达全胃肠道喂养时间、住院时间均显著低于配方奶组[40.3%比47.8%、(13.2±2.4)比(14.9±1.9)d、(26.5±7.5)比(29.8±9.6)d],出生28 d的体质量、头围、身长平均增加值也均显著低于配方奶组[(15.4±2.7)比(17.7±3.7)g/d、(5.8±1.0)比(6.2±1.0)mm/周、(6.8±0.7)比(7.3±0.8)mm/周],但恢复出生体质量时间显著高于配方奶组[(6.2±1.2)比(5.3±1.4)d](均P<0.05)。母乳+益生菌组喂养不耐受发生率、恢复出生体质量时间、达全胃肠道喂养时间、住院时间均显著低于母乳组[34.3%比40.3%、(5.4±1.2)比(6.2±1.2)d、(10.4±1.9)比(13.2±2.4)d、(22.9±5.6)比(26.5±7.5)d],出生28 d的体质量、头围、身长平均增加值均显著高于母乳组[(17.2±3.5)比(15.4±2.7)g/d、(6.2±1.0)比(5.8±1.0)mm/周、(7.2±0.8)比(6.8±0.7)mm/周](均P<0.05)。母乳+益生菌组喂养不耐受发生率、达全胃肠道喂养时间及住院时间均显著低于配方奶+益生菌组[34.3%比47.1%、(10.4±1.9)比(15.3±2.0)d、(22.9±5.6)比(30.4±8.2)d](均P<0.05),但两组间早期生长发育指标平均增加值差异均无统计学意义(均P>0.05)。配方奶+益生菌组与配方奶组上述指标差异均无统计学意义(均P>0.05)。结论益生菌可改善母乳喂养VLBWI喂养不耐受的临床结局和促进早期生长发育。

Objective To explore the effects of probiotics on feeding intolerance and early growth and development of preterm and very low birth weight infants(VLBWI).Methods A total of 446 patients with VLBWI were enrolled in Henan Children′s Hospital from March 20,2019 to March 20,2022.They were divided into breast milk group(119 cases),breast milk+probiotic group(108 cases),formula group(115 cases)and formula+probiotic group(104 cases)according to the feeding mode and whether they received early probiotic supplement or not.The feeding programs of each group were carried out according to the“2013 Clinical Application Guide of nutritional support for newborn infants”and“the feeding guidelines for VLBWI”.On this basis,the probiotic supplement group was treated with Clostridium butyricum powder at a dose of 0.25 g/twice a day for 2 weeks,nasal feeding or bottle administration.The incidence of feeding intolerance,the time of recovery of birth weight,the time of reaching total gastrointestinal feeding,and the time of hospitalization in each group were observed,and the average increment of body mass,head circumference and body length in each group at 28 days after birth were compared.Results In breast milk group,the incidence of feeding intolerance,total gastrointestinal feeding time,and hospital stay were significantly lower than those in the formula group[40.3%vs 47.8%,(13.2±2.4)vs(14.9±1.9)d,(26.5±7.5)vs(29.8±9.6)d],besides,the average increments of early growth and developmental indexes such as body mass,head circumference,and body length at 28 days of birth were significantly lower than those in the formula group[(15.4±2.7)vs(17.7±3.7)g/d,(5.8±1.0)vs(6.2±1.0)mm/week,(6.8±0.7)vs(7.3±0.8)mm/week],however,the recovery time of birth weight in the breast milk group was significantly higher than that in the formula group[(6.2±1.2)vs(5.3±1.4)d](all P<0.05).The incidence of feeding intolerance,the recovery time of birth weight,the total gastrointestinal feeding time and the hospital stay in the breast milk+probiotics group were significantly lower than those in the breast milk group[34.3%vs 40.3%,(5.4±1.2)vs(6.2±1.2)d,(10.4±1.9)vs(13.2±2.4)d,(22.9±5.6)vs(26.5±7.5)d],besides,the average increments of body mass,head circumference and body length at 28 days of birth was significantly higher than that in the breast milk group[(17.2±3.5)vs(15.4±2.7)g/d,(6.2±1.0)vs(5.8±1.0)mm/week,(7.2±0.8)vs(6.8±0.7)mm/week](all P<0.05).The incidence of feeding intolerance,total gastrointestinal feeding time and hospital stay in breast milk+probiotics group were significantly lower than those in formula+probiotics group[34.3%vs 47.1%,(10.4±1.9)vs(15.3±2.0)d,(22.9±5.6)vs(30.4±8.2)d](all P<0.05),besides,there was no significant difference in the average increments of early growth and developmental indexes between the breast milk+probiotics group and the formula+probiotics group(all P>0.05).There were no significant difference in the above indexes between the formula+probiotics group and the formula group(all P>0.05).Conclusion Probiotics can improve the clinical outcome of feeding intolerance and promote early growth and development of breast feeding VLBWI.