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

描述（由申请方提供）：：众所周知，极低出生体重早产儿（VLBW）出生后最初几周内充分肠内营养的重要性，这对于促进最佳生长和发育以及减少早产相关并发症和医源性并发症是必要的。传统上，这些婴儿在每次喂养前都会进行潜在残留胃内容物（RGC）的常规抽吸。容量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。在重症儿童和成人中，容量增加也被认为与胃分泌物的呼吸吸入有关。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，实际上可能会导致并发症，包括延迟实现完全肠道喂养。与延迟实现完全肠内喂养相关的潜在并发症包括肠外营养（PN）使用增加、肠外营养相关肝病（PNALD）、生长不良、需要中心静脉管路（CVL）的时间延长、迟发性脓毒症（LOS）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是否省略潜在RGC的常规抽吸改善VLBW早产儿的营养结果。拟定的研究将在出生后6周内对种族和经济状况不同的早产VLBW婴儿进行前瞻性队列（N = 120）随访。目的1将确定吸入RGC的风险和受益以及肠内喂养前省略吸入RGC对早产VLBW婴儿营养结局的临床受益，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，将通过测量粪便中的血液和钙卫蛋白来确定常规RGC抽吸对GI粘膜出血和炎症的影响。将使用Aim 3中的肽胃泌素和胃动素的血清水平测量RGC抽吸对GI功能的影响。所有登记的婴儿都将得到同样的照顾，只有一个例外。被随机分配到对照组的动物将在每次喂食前继续进行常规的潜在RGC抽吸，而实验组的动物则不会。将在6周内监测结局指标。结果预计将填补一个重要的空白，在早产儿喂养前抽吸RGC的必要性，是否RGC的抽吸影响短期和长期的结果，以及是否RGC的常规抽吸是有害的早产儿VLBW婴儿的研究。公共卫生相关性：这项研究有可能影响健康政策和实践，可能直接转化为改善早产VLBW婴儿的营养和健康结果。

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. Public Health Relevance: This research has potential to influence health policy and practices that may directly translate to improved nutritional and health outcomes for premature VLBW infants.