极低出生体重儿出生时血清25-羟维生素D水平与其生后早期喂养不耐受关系的临床分析

Relationship between serum 25(OH)D levels at birth and early feeding intolerance in very low birth weight infants

目的探讨极低出生体重儿(VLBWI)出生时,血清25-羟维生素D[25(OH)D]水平与其生后7 d内(以下简称为生后早期)喂养不耐受(FI)的关系。方法选择2020年9月至2022年4月于徐州医科大学附属医院新生儿重症监护病房(NICU)收治的161例VLBWI为研究对象。采取回顾性分析法,根据生后早期是否发生FI,将其分为FI组(n=82)和喂养耐受(FT)组(n=79)。检测2组VLBWI出生时的血清25(OH)D水平,收集2组VLBWI临床相关资料。采用χ^(2)检验及独立样本t检验,以及多因素非条件logistic回归分析法,对本研究VLBWI生后早期FI影响因素,分别进行单因素及多因素分析。本研究经徐州医科大学附属医院医学伦理委员会审核通过(审批文号:XYFY2022-KL044),并征得所有患儿监护人同意、签署知情同意书。结果①单因素分析结果显示:FI组VLBWI的胎儿宫内窘迫、出生时轻度窒息、机械通气治疗时间>96 h、开奶延迟及胎粪排出延迟发生率,均显著高于FT组;而出生时血清25(OH)D水平,则显著低于FT组,并且差异均有统计学意义(P<0.05)。②多因素非条件logistic回归分析结果显示:机械通气治疗时间>96 h(OR=4.483,95%CI:1.449~13.865,P=0.009),开奶延迟(OR=5.908,95%CI:1.599~21.823,P=0.008)及胎粪排出延迟(OR=5.248,95%CI:1.539~17.898,P=0.008),均是VLBWI生后早期发生FI的独立危险因素;而出生时血清25(OH)D水平较高(OR=0.474,95%CI:0.367~0.614,P<0.001),是VLBWI生后早期发生FI的保护因素。结论VLBWI出生时血清25(OH)D水平低,可能增加其生后早期FI发病风险。生后早期合理补充维生素D,或可降低VLBWI的生后早期FI发病率。

Objective To investigate the relationship between serum 25-hydroxy vitamin D[25(OH)D]levels at birth and feeding intolerance(FI)within 7 d after birth(hereinafter referred to as early postnatal period)in very low birth weight infants(VLBWI).Methods A total of 161 VLBWI admitted to the Neonatal Intensive Care Unit(NICU)of the Affiliated Hospital of Xuzhou Medical University from September 2020 to April 2022 were included in this study,retrospective analysis was conducted.According to whether FI occurred in early postnatal period,they were divided into FI group(n=82)and feeding tolerance(FT)group(n=79).Serum 25(OH)D levels of VLBWI at birth were detected in 2 groups,and clinical data of 2 groups were collected.Univariate and multivariate analysis of the influencing factors of FI in early postnatal period in VLBWI in this study were performed by chi-square test and independent sample t test,and multivariate unconditional logistic regression analysis,respectively.This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Xuzhou Medical University(Approval No.XYFY2022-KL044),and all the guardians of the children with the consent and signed informed consents were obtained.Results①Results of univariate analysis showed that:the incidence rates of fetal distress,mild asphyxia at birth,mechanical ventilation treatment duration>96 h,delayed timing of initiation of feeds and delayed meconium excretion in FI group were higher than those in FT group;while the level of serum 25(OH)D at birth was lower than that in FT group,and the differences were all statistically significant(P<0.05).②Multivariate unconditional logistic regression analysis showed that mechanical ventilation treatment duration>96 h(OR=4.483,95%CI:1.449-13.865,P=0.009),delayed timing of initiation of feeds(OR=5.908,95%CI:1.599-21.823,P=0.008)and delayed meconium excretion(OR=5.248,95%CI:1.539-17.898,P=0.008)were all independent risk factors of FI occurrence in early postnatal period in VLBWI.A higher level of serum 25(OH)D at birth(OR=0.474,95%CI:0.367-0.614,P<0.001)was a protective factor of FI occurrence in early postnatal period in VLBWI.Conclusions Low serum 25(OH)D level at birth in VLBWI may increase the risk of FI in early postnatal period.Reasonable supplementation of vitamin D in early postnatal period may reduce the incidence of FI in early postnatal period in VLBWI.