NICU机械通气早产儿喂养不耐受发生现状及其影响因素分析

Analysis on the occurrence and influencing factors of feeding intolerance in premature infants with NICU mechanical ventilation

目的探讨新生儿重症监护病房(NICU)机械通气早产儿喂养不耐受(FI)发生现状及其影响因素。方法选择2021年2月至2023年10月在江西省儿童医院NICU行机械通气早产儿88例,收集资料,调查NICU机械通气早产儿FI发生现状,将发生FI患儿纳入FI组,未发生FI患儿纳入非FI组,两组资料,对有统计学差异项目行Logistic回归分析,明确影响NICU机械通气早产儿FI发生的危险因素。结果88例NICU机械通气早产儿中发生FI 29例(32.95%),未发生FI 59例(67.05%);单因素分析显示,NICU机械通气早产儿宫内窘迫、胎龄、出生体质量、黄疸、开奶时间、新生儿呼吸窘迫、加奶量与其发生FI有关(P<0.05);性别、胎膜早破、宫内感染、喂养方式、新生儿肺炎、贫血与其发生无关(P>0.05);多Logistic回归分析显示,胎龄<32周(OR=16.900,95%CI:4.555~62.699)、出生体质量<1500g(OR=2.879,95%CI:1.139~7.278)、宫内窘迫(OR=4.114,95%CI:1.208~14.017)、开奶时间≥72h(OR=3.291,95%CI:1.102~9.835)、黄疸(OR=5.180,95%CI:1.822~14.721)、新生儿呼吸窘迫(OR=4.415,95%CI:1.673~11.650)、加奶量>20ml/kg(OR=3.355,95%CI:1.153~9.768)是NICU机械通气早产儿FI发生的高危因素(P<0.05)。结论NICU机械通气早产儿易发生FI,其发生与胎龄、出生体质量、宫内窘迫、开奶时间、黄疸、新生儿呼吸窘迫、加奶量多因素有关,针对上述因素制定相应的干预对策,可能减少或避免早产儿发生FI。

Objective To investigate the occurrence and influencing factors of feeding intolerance(FI)in mechanically ventilated premature infants in neonatal intensive care unit(NICU).Methods A total of 88 premature infants receiving mechanical ventilation in NICU of Jiangxi Children's Hospital from February 2021 to October 2023 were selected to collect data and investigate the occurrence of FI in premature infants with mechanical ventilation in NICU.Children with FI were included in FI group and those without FI were included in non-FI group.Logistic regression analysis was performed for items with statistical differences to identify the risk factors affecting the occurrence of FI in premature infants with NICU mechanical ventilation.Results FI occurred in 29(32.95%)of the 88 neonates ventilated by NICU,while FI did not occur in 59(67.05%).Univariate analysis showed that FI was associated with intrauterine distress,gestational age,birth weight,jaundice,milk opening time,neonatal respiratory distress and milk dosage in neonates with NICU mechanical ventilation(P<0.05).Gender,premature rupture of membranes,intrauterine infection,feeding pattern,neonatal pneumonia and anemia were not associated with the occurrence(P>0.05).Multiple Logistic regression analysis showed that gestational age<32 weeks(OR=16.900,95%CI:4.555~62.699),birth weight<1500g(OR=2.879,95%CI:1.139~7.278),intrauterine distress(OR=4.114,95%CI:1.208~14.017),milk opening time≥72h(OR=3.291,95%CI:1.102~9.835),jaundice(OR=5.180,95%CI:1.822~14.721),neonatal respiratory distress(OR=4.415,95%CI:1.673~11.650)and milk dosage>20ml/kg(OR=3.355,95%CI:1.153~9.768)were high risk factors for FI in premature infants mechanically ventilated by NICU(P<0.05).Conclusion Premature infants with NICU mechanical ventilation are prone to FI,and its occurrence is related to gestational age,birth weight,intrauterine distress,milk opening time,jaundice,neonatal respiratory distress,and milk dosage.According to the above factors,the development of corresponding intervention strategies may reduce or avoid FI in premature infants.