Improved outcomes with a standardized feeding protocol for very low birth weight infants
Improved outcomes with a standardized feeding protocol for very low birth weight infants
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DOI：
10.1038/jp.2010.185
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发表时间：
2011-04-01
影响因子：
2.9
通讯作者：
Rhine, W. D.
中科院分区：
文献类型：
--
作者：
McCallie, K. R.;Lee, H. C.;Rhine, W. D.
目的：本研究的目的是评估极低出生体重 (VLBW) 婴儿的标准化肠内喂养方案对营养、临床和生长结果的影响。研究设计：对开始标准化喂养方案（包括 6-8 天的营养性喂养，随后增加 20 ml/kg/天）前后 9 个月的 VLBW 队列进行回顾性分析。主要结果是达到完全肠内喂养的天数，定义为 160 毫升/公斤/天。次要结局包括坏死性小肠结肠炎和培养证实的败血症的发生率、肠外营养天数和生长终点。结果：对 147 名接受肠内喂养的 VLBW 婴儿进行了数据分析，其中 83 名在喂养方案开始前（“之前”），64 名在喂养方案开始后（“之后”）。治疗后组中的极低出生体重 (ELBW) 婴儿的肠内容量达到 120 毫升/公斤/天（治疗前 43.9 天 vs 治疗后 32.8 天，P = 0.02）和 160 毫升/公斤/天（治疗前 48.5 天 vs 治疗后 35.8 天，P = 0.02），且接受肠外营养的天数显着减少（治疗前 46.2 天 vs 治疗后 31.3 天）。 P = 0.01）。 VLBW（15/83，治疗前 18% vs 2/64，治疗后 3%，P = 0.005）和 ELBW 婴儿（11/31，治疗前 35% vs 2/26，治疗后 8%，P = 0.01）中，坏死性小肠结肠炎减少。晚发性脓毒症在治疗后组中显着减少（治疗前为 26/83，31%，治疗后为 6/64，9%，P = 0.001）。排除出生时体重<第3个百分位的患者，出院时体重<第3个百分位的比例在方案开始后显着下降（之前为35％，之后为17％，P = 0.03）。结论：这些数据表明，对VLBW婴儿实施标准化喂养方案可以更早地成功进行肠内喂养，而不会增加主要发病率。围产期杂志（2011）31，S61-S67； doi：10.1038/jp.2010.185
Objective: The objective of this study was to evaluate the impact of a standardized enteral feeding protocol for very low birth weight (VLBW) infants on nutritional, clinical and growth outcomes.Study Design: Retrospective analysis of VLBW cohorts 9 months before and after initiation of a standardized feeding protocol consisting of 6-8 days of trophic feedings, followed by an increase of 20 ml/kg/day. The primary outcome was days to reach full enteral feeds defined as 160 ml/kg/day. Secondary outcomes included rates of necrotizing enterocolitis and culture-proven sepsis, days of parenteral nutrition and growth end points.Result: Data were analyzed on 147 VLBW infants who received enteral feedings, 83 before ('Before') and 64 subsequent to ('After') feeding protocol initiation. Extremely low birth weight (ELBW) infants in the After group attained enteral volumes of 120 ml/kg/day (43.9 days Before vs 32.8 days After, P = 0.02) and 160 ml/kg/day (48.5 days Before vs 35.8 days After, P = 0.02) significantly faster and received significantly fewer days of parenteral nutrition (46.2 days Before vs 31.3 days After, P = 0.01). Necrotizing enterocolitis decreased in the After group among VLBW (15/83, 18% Before vs 2/64, 3% After, P = 0.005) and ELBW infants (11/31, 35% Before vs 2/26, 8% After, P = 0.01). Late-onset sepsis decreased significantly in the After group (26/83, 31% Before vs 6/64, 9% After, P = 0.001). Excluding those with weight < 3rd percentile at birth, the proportion with weight < 3rd percentile at discharge decreased significantly after protocol initiation (35% Before vs 17% After, P = 0.03).Conclusion: These data suggest that implementation of a standardized feeding protocol for VLBW infants results in earlier successful enteral feeding without increased rates of major morbidities. Journal of Perinatology (2011) 31, S61-S67; doi: 10.1038/jp.2010.185