极低出生体重早产儿早期肠内喂养支持的临床随机对照研究

A randomized controlled study on early enteral feeding support for very low birth weight premature infants

目的通过前瞻性随机对照研究,比较早期不同肠内喂养方式下极低出生体重早产儿住院期间的体格发育情况、血液生化指标和喂养安全性,为完善医院早产儿喂养方案提供参考。方法按照早期不同喂养方式和母乳强化剂添加的起始时间将胎龄<37周、出生体重1 000~1 500 g的160例极低出生体重早产儿随机分为早产奶组(60例,予院内专用配方液态奶喂养)、全强化母乳组(59例,在母乳喂养的同时以全强化比例添加母乳强化剂)和半强化母乳组(41例,在母乳喂养的同时以半强化比例添加母乳强化剂)。比较3组的一般情况,包括早产儿的性别构成、出生体重、头围、胎龄,以及出生时的合并症;住院情况,包括入院时宫内发育迟缓(IUGR)发生率、恢复至正常出生体重的时间、肠外营养应用时间、住院时间和日均住院费用;体格发育情况,包括体重增长速率、头围增长速率和宫外生长发育迟缓(EUGR)发生率;血液生化指标,如出生后3和14 d的白蛋白、尿素氮和碱性磷酸酶水平;住院期间不良事件发生情况,如住院期间发生感染、喂养不耐受、胃肠外营养相关胆汁淤积(PNAC)、坏死性小肠结肠炎(NEC)等不良事件的发生率。结果 3组早产儿的性别和出生时的合并症构成,出生体重、头围、胎龄,入院时IUGR发生率和恢复至正常出生体重的时间,头围增长速率和出院时EUGR发生率,出生后3和14 d的白蛋白、尿素氮和碱性磷酸酶水平,以及住院期间感染、喂养不耐受、PNAC、NEC的发生率的差异均无统计学意义(P值均>0.05)。早产奶组的肠外营养应用时间、住院时间和日均住院费用均显著少于全强化母乳组和半强化母乳组(P值均<0.01),体重增长速率显著高于全强化母乳组和半强化母乳组(P值均<0.01),而全强化母乳组与半强化母乳组间的差异均无统计学意义(P值均>0.05)。3组早产儿出生后14 d的白蛋白和碱性磷酸酶水平分别显著高于同组出生后3 d(P值均<0.05)。结论早期积极的强化母乳喂养的安全性可,但并不能显著提高极低出生体重早产儿的体重增长速度,院内早产儿配方奶喂养较强化母乳喂养对早产儿体重增长的效果更佳。

Objective To evaluate the physical growth,blood biochemistry and feeding safety of very low birth weight premature infants during hospitalization by prospective randomized controlled study.Methods According to different feeding methods and starting time of breast milk fortifier,160 premature infants with gestational age less than 37 weeks and birth weight of 1 000―1 500 g were randomly divided into three groups:breast milk fortifier group(n=59),half breast milk fortifier group(n=41)and preterm formula group(n=60).The general information(sex,birth weight,head circumference,gestational age)were compared among the three groups,so were the following parameters:morbidity at birth and during hospitalization(incidence of intrauterine growth retardation[IUGR]at admission,the time of getting normal birth weight,the duration of parenteral nutrition,hospital stay and hospitalization cost),physical development(body weight growth rate,head circumference growth rate and incidence of extrauterine growth retardation[EUGR]),blood biochemical indexes(such as albumin,urea nitrogen and alkaline phosphatase levels at 3 and 14 days after birth),and incidence of adverse events during hospitalization(infection,feeding intolerance,parenteral nutrition-associated cholestasis[PNAC],necrotizing enterocolitis[NEC]).Results There were no significant differences between groups in terms of sex,diseases at birth,birth weight,head circumference,gestational age,the incidence of IUGR at admission,the time of getting normal birth weight,the rate of head circumference increase,the incidence of EUGR at discharge,levels of albumin,urea nitrogen or alkaline phosphatase at 3 and 14 days after birth,infection during hospitalization,feeding intolerance,or the incidence of PNAC or NEC(all P>0.05).The duration of parenteral nutrition,hospital stay and average hospitalization cost in preterm milk group were significantly lower than those in the other two groups(all P<0.01),while the rate of weight gain in preterm milk group was significantly higher than those in the other two groups(both P<0.01).However,there were no significant differences in the above-mentioned parameters between fully fortified breast milk group and semi-fortified breast milk group(all P>0.05).The levels of albumin and alkaline phosphatase on the 14th day were significantly higher than those on the 3rd day after birth in the infants of the three groups(all P<0.05).Conclusion The rate of weight gain of very low birth weight premature infants with preterm formula feeding is superior to those with breast milk fortifier.Early breast milk fortifier feeding can not significantly increase the weight growth rate of preterm infants,although it has good feeding safety.(Shanghai Med J,2019,42:278-282)