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42第5期
极低出生体质量早产儿早期肠内喂养支持的临床研究对照
Clinical study control of early enteral feeding support for very low birth weight premature infants
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DOI:
作者:
黄碧茵、刘郴州、郭青云 左雪梅 许小慧 谭宝莹
黄碧茵、刘郴州、郭青云 左雪梅 许小慧 谭宝莹
作者单位:
江门市中心医院
江门市中心医院/中山大学附属江门医院
关键词:
肠内营养;早产儿;母乳强化
enteral nutrition;premature infants;breast milk fortifier
摘要:
目的 通过前瞻性随机对照研究评价比较早期不同肠内喂养方式下,极低出生体质量早产儿住院期间的体格生长、血液生化和喂养安全性。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出生体重小于37周、出生体质量小于1500g的160例早产儿随机分为母乳全强化剂组(59例、母乳强化剂全量添加于100ml/kg)、母乳半量强化剂组(41例、母乳强化剂半量添加于50ml/kg)和早产奶组(60例)。比较各组的体格生长、静脉营养应用时间、住院时间、日均住院费用、血液生化指标,以及宫外发育迟缓(EUGR)、感染、喂养不耐受、NEC、PNAC等发生率等项目。结果 早产奶组、母乳全强化组、母乳半强化组体质量增长速率分别为(16.78±4.33)g/(kg.d)、(14.17±2.44)g/(kg.d)、(14.23±5.72)g/(kg.d),三组间均存在显著差异(P<0.01),早产奶组优于后两组。静脉营养应用时间分别为(15.62±8.81)d、(20.61±10.90)d、(24.83±14.63)d;住院时间分别为(39.42±13.80)d、(48.19±15.80)d、(52.85±17.50)d;日均住院费用分别为(0.13±0.03)万元、(0.17±0.03)万元、(0.16±0.04)万元;以上统计三组间均存在显著差异(P<0.01),早产奶组少于后两组。而头围增长速度、恢复出生体重时间和出院时EUGR发生率、住院期间感染、喂养不耐受、PNAC、NEC等各组间并无统计学差异。出生3d和14d各组间血液尿素氮、肌酐、碱性磷酸酶、白蛋白水平相似,均无统计学差异。结论 极低出生体质量早产儿早期采用早产奶喂养的体重增长速率均优于全强化母乳喂养和早期半量添加母乳强化剂。早期积极的强化母乳不能显著提高早产儿体重增长速度,而对NEC、喂养不耐受发生并无影响。
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 the starting time of breast milk fortifier,160 premature infants with birth weight less than 37 weeks and birth weight less than 1500g 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 comparison was made of ratio physical growth, time of intravenous nutrition, hospitalization time, average daily hospitalization cost, blood biochemical index,incidence of extra-uterine growth retardation(EUGR),infection,feeding intolerance,necrotizing enterocolitis(NEC) and parenteral nutrition associated cholestasis(PNAC) among different groups. Results the growth rate of body mass in preterm formula group, breast milk fortified group and half breast milk fortified group were (16.78 ±4.33) g / (kg.d), (14.17 ±2.44) g / (kg.d), (14.23 ±5.72) g / (kg.d).There were significant differences among the three groups (P < 0. 01). The duration of intravenous nutrition was (15.62 ±8.81) d, (20.61 ±10.90) d, (24.83 ±14.63) days.The hospitalization time was (39.42 ±13.80) d, ( 48.19 ±15.80) d, (52.85 ±17.50 days.The average daily hospitalization cost was (0.13 ±0.03) Yuan, (0.17 ±0.03) Yuan, (0.16 ±0.04) Yuan. There was significant difference among three groups as those of preterm formula group are less than those of breast milk fortified group and half breast milk fortified group.And there was no significant difference in growth rate of the head circumference,the time of rebirth weight,the incidence of EUGR at discharge, infection during hospitalization, feeding intolerance,PNAC,NEC. The levels of blood urea nitrogen, creatinine, alkaline phosphatase and albumin were similar between 3 and 14 days of birth. Conclusion The rate of weight gain of very low birth weight premature infants with preterm formula feeding is better than those of breast milk fortifier and early half breast milk fortifier feeding. Early breast milk fortifier feeding did not significantly increase the weight growth rate of preterm infants, but had no effect on the development of NEC, feeding intolerance.
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