Routine Aspiration of Residual Gastric Contents in Very Low Birth Weight Infants

描述（由申请人提供）：：对于极低出生体重（VLBW）早产儿，出生后最初几周内充足肠内营养的重要性是众所周知的，对于促进最佳生长和发育以及减少早产相关和医源性并发症是必要的。传统上，在这些婴儿每次喂养之前都会对潜在的残留胃内容物（RGC）进行常规抽吸。体积增加被认为与喂养不耐受或坏死性小肠结肠炎的早期症状有关。在危重儿童和成人中，蜜蜂数量的增加也被认为与呼吸道吸入胃分泌物有关。然而，没有确凿的证据表明这种做法可以改善护理或减少并发症，并且实际上可能会导致并发症，包括延迟实现完全肠内喂养。延迟实现全肠内喂养相关的潜在并发症包括肠外营养 (PN) 的使用增加、肠外营养相关性肝病 (PNALD)、生长不良、需要中心静脉导管 (CVL) 的时间更长、迟发性败血症 (LOS) 的风险增加、住院时间延长以及胃肠道 (GI) 完整性和功能紊乱。 这项为期 4 年的研究的总体目标是确定省略潜在 RGC 的常规抽吸是否可以改善 VLBW 早产儿的营养结果。拟议的研究将在出生后 6 周内对种族和经济多样化的早产极低出生体重儿进行前瞻性队列研究（N = 120）。目标 1 将确定抽吸 RGC 的风险和益处，以及在肠内喂养前省略 RGC 抽吸对早产 VLBW 婴儿营养结果的临床益处，包括每周肠内摄入量、达到完全肠内喂养的时间、生长指数、TPN 小时数、PNALD 发生率、CVL 小时数、LOS 发生率和住院时间。对于目标 2，常规 RGC 抽吸对胃肠道粘膜出血和炎症的影响将通过测量粪便中的血液和钙卫蛋白来确定。在目标 3 中，将使用肽胃泌素和胃动素的血清水平来测量 RGC 吸入对胃肠功能的影响。除一名例外外，所有登记的婴儿将接受相同的护理。随机分配到对照组的那些人将在每次喂食之前继续对潜在的 RGC 进行常规抽吸，而实验组中的那些则不会。结果措施将在 6 周内受到监测。预计结果将填补有关早产 VLBW 婴儿喂养前抽吸 RGC 的必要性、抽吸 RGC 是否影响短期和长期结果以及常规抽吸 RGC 是否对早产 VLBW 婴儿有害等研究的重要空白。

DESCRIPTION (provided by applicant)::The importance of adequate enteral nutrition during the first few weeks following birth in premature very low birth weight (VLBW) infants is well known and necessary to facilitate optimal growth and development and reduce both premature birth-related and iatrogenic complications. Routine aspiration of potential residual gastric contents (RGC) has traditionally been performed prior to every feeding in these infants. Increased volumes have been thought to be related to feeding intolerance or an early symptom of necrotizing enterocolitis. In critically ill children and adults increased volumes have also bee thought to be associated with respiratory aspiration of gastric secretions. However, there is no conclusive evidence that this practice improves care or reduces complications and may actually contribute to complications including a delay in achievement of full enteral feedings. Potential complications related to delaying attainment of full enteral feedings include increased use of parenteral nutrition (PN), parenteral nutrition associated liver disease (PNALD), poor growth, more hours requiring a central venous line (CVL), increased risk of late onset sepsis (LOS), prolonged hospitalization, as well as disturbances in gastrointestinal (GI) integrity and function. The overall objective of this 4-year study is to determine whether omission of routine aspiration of potential RGC improves nutritional outcomes of VLBW premature infants. The proposed study will follow a prospective cohort (N = 120) of racially and economically diverse premature VLBW infants for 6 weeks following birth. Aim 1 will determine the risks and benefits of aspirating RGC and the clinical benefits of omitting aspiration of RGC prior to enteral feedings on nutritional outcomes of premature VLBW infants including weekly enteral intake, time to reach full enteral feedings, growth indices, hours of TPN, incidence of PNALD, hours with a CVL, incidence of LOS, and length of stay. For Aim 2, the effect of routine RGC aspiration on GI mucosal bleeding and inflammation will be determined through measurement of blood and calprotectin in the stool. The effect of aspiration of RGC on GI function will be measured using serum levels of the peptides gastrin and motilin in Aim 3. All enrolled infants will receive the same care with one exception. Those randomly assigned to the Control Group will continue to have routine aspiration of potential RGC prior to every feeding and those in the Experimental Group will not. Outcomes measures will be monitored over 6 weeks. Results are expected to fill an important gap in research regarding the necessity of aspirating RGC prior to feeding in premature VLBW infants, whether aspiration of RGC influences short and long term outcomes and whether routine aspiration of RGC is detrimental to premature VLBW infants.