极低出生体重儿母乳喂养与配方乳喂养的比较

目的探讨极低出生体重儿在进行母乳喂养、早产儿配方乳喂养条件下黄疸消退、体重增长、耐受全胃肠营养的时间及常见并发症的区别。方法对2002年10月至2005年4月我科收治的111例极低出生体重儿提供母乳喂养的39例,另72例采用早产儿配方乳喂养,观察两组在黄疸消退日龄、回升到出生体重日龄、过渡到全胃肠道营养日龄、住院天数等的差别,并比较两组在喂养不耐受、新生儿坏死性小肠结肠炎、酸中毒的发生率方面的不同。结果两组过渡到全胃肠道营养日龄的差异有统计学意义(t=15.06,P<0.01);两组在喂养不耐受和酸中毒发生率的差异也有统计学意义(χ2分别为4.203和4.811,P<0.05);黄疸消退日龄、回升到出生体重日龄差异两组无统计学意义(t值分别为0.70和0.27,P>0.05);新生儿坏死性小肠结肠炎发生率的两组差异也无统计学意义(χ2=0.01,P>0.05)。结论在极低出生体重儿应积极进行母乳喂养,这对于早日过渡到全胃肠道营养、减少喂养不耐受发生率、缩短住院天数、降低酸中毒发生率均有积极作用。     

极低出生体重儿母乳喂养与配方乳喂养的比较

目的 探讨极低出生体重儿在进行母乳喂养、早产儿配方乳喂养条件下黄疸消退、体重增长、耐受全胃肠营养的时间及常见并发症的区别.方法 对2002年10月至2005年4月我科收治的111例极低出生体重儿提供母乳喂养的39例,另72例采用早产儿配方乳喂养,观察两组在黄疸消退日龄、回升到出生体重日龄、过渡到全胃肠道营养日龄、住院天数等的差别,并比较两组在喂养不耐受、新生儿坏死性小肠结肠炎、酸中毒的发生率方面的不同.结果 两组过渡到全胃肠道营养日龄的差异有统计学意义（t=15.06,P＜0.01）;两组在喂养不耐受和酸中毒发生率的差异也有统计学意义（χ2分别为4.203和4.811,P＜0.05）;黄疸消退日龄、回升到出生体重日龄差异两组无统计学意义（t值分别为0.70和0.27, P＞0.05）;新生儿坏死性小肠结肠炎发生率的两组差异也无统计学意义（χ^2=0.01,P＞0.05）.结论 在极低出生体重儿应积极进行母乳喂养,这对于早日过渡到全胃肠道营养、减少喂养不耐受发生率、缩短住院天数、降低酸中毒发生率均有积极作用.     

极低及超低出生体重儿的预后因素分析

目的 分析极低及超低出生体重儿（出生体重≤ 1 200 g）的临床资料,为其预后及临床干预提供预警指标。方法 回顾性分析108 例极低及超低出生体重儿的母孕期病史、新生儿出生时情况、诊治经过及预后,采用非条件logistic 回归分析筛选预后的影响因素。结果 108 例极低及超低出生体重儿,出生体重范围在结论 极低及超低出生体重儿的病死率较高,且随着日龄的增加,影响早产儿生存的预后因素不同,临床上应针对这些因素制定合理的管理方案,提高早产儿生存率。     

极低出生体重儿肠内营养与生长速度的研究进展

本文阐述了极低出生体重儿消化系统特点、肠内营养方式、乳类选择、开始时间、奶量增长速度及理想的生长速度,旨在了解不同的肠内营养开始时间对极低出生体重儿消化功能及生长速度的影响,以期寻找极低出生体重儿适宜的肠内营养开始时间,为临床制定极低出生体重儿肠内营养方案提供依据.     

极低出生体重儿全静脉营养应用

营养是极低体重儿出生后面临的严峻问题之一。极低出生体重儿体内缺少营养储备 ,且发病率高 ,更增加对热卡的需求 ,而绝大部分极低体重儿出生后又不耐受胃肠道喂养 ,须用全静脉营养(ＴＰＮ)。所谓“全” ,不仅指全部经静脉给予 ,而且指６类营养素齐全。本院近２０年来采用ＴＰＮ的５００余例患儿中 ,极低体重儿占８５ %以上 ,ＴＰＮ已经成为极低出生体重儿现代综合治疗中必不可少的一环。本文就极低体重儿ＴＰＮ时能量和营养素的需要以及热卡供应方案作一简介。一、极低体重儿ＴＰＮ时的能量需要极低体重儿每日静息能量需要平均约２０９ｋＪ…     

34周以下早产儿宫外生长发育迟缓发生的影响因素

目的　研究34周以下早产儿宫外生长发育迟缓(EUGR)发生的相关因素。方法　选取<34周早产儿694例, 根据出院时体重分为EUGR组和非EUGR组, 回顾性分析两组早产儿的围生期资料、住院期间生长、营养摄入情况及相关合并症等资料。结果　694例早产儿中, 发生EUGR 284例(40.9%)。宫内生长发育迟缓(IUGR)患儿发生EUGR的比例明显高于非IUGR组(P<0.01); 极低出生体重儿发生EUGR比例明显高于非极低出生体重儿(P<0.01)。胎龄越小、出生体重越低的早产儿EUGR的发生率越高(P<0.01)。EUGR组早产儿禁食天数、静脉营养持续天数、首次肠内营养的日龄、全肠内营养的日龄均大于非EUGR组(P<0.01)。EUGR组患儿生后第1周蛋白质累积损失量与热卡累积损失量均大于非EUGR组(P<0.05)。EUGR组生后发生呼吸窘迫综合征、呼吸暂停、坏死性小肠结肠炎、败血症等并发症的比例高于非EUGR组(P<0.05)。Logistic回归分析显示, 出生体重、出生胎龄及IUGR是EUGR发生的独立危险因素。结论 34周以下早产儿EUGR发生率较高, 尤其是已经存在IUGR的早产儿或极低出生体重儿; 生后早期积极的营养支持, 预防呼吸暂停、败血症等并发症将会在一定程度上减少EUGR的发生。     

早期或晚期使用枸橼酸咖啡因防治极低出生体重儿呼吸暂停的临床分析

目的 比较早期或晚期使用枸橼酸咖啡因防治极低出生体重儿呼吸暂停的临床效果。方法 选取2015年6月至2017年5月于新生儿重症监护室住院治疗的极低出生体重儿共82例为研究对象,按开始使用枸橼酸咖啡因的日龄分为早期治疗组（日龄 < 3 d）（n=22）和晚期治疗组（3 d ≤ 日龄<10 d）（n=60）,回顾性收集并比较两组患儿围产期的基本情况、治疗过程情况及临床结局。结果 早期治疗组的出生体重明显低于晚期治疗组（P=0.004）;早期治疗组机械通气时间及吸氧时间明显短于晚期治疗组（P < 0.05）;早期治疗组支气管肺发育不良（BPD）的发生率明显低于晚期治疗组（P=0.032）。其余基本情况、治疗过程情况及临床结局在两组间比较差异均无统计学意义（P > 0.05）。结论 早期使用枸橼酸咖啡因可改善极低出生体重儿的预后。     

机械通气对极低出生体重儿脑室内出血影响的研究

目的 探讨机械通气对极低出生体重儿脑室内出血的影响及机制.方法 选取2003年1月至2005年12月在深圳市人民医院儿科住院的机械通气极低出生体重儿33例及同期住院的无机械通气极低出生体重儿33例,比较两者脑室内出血的发生率,并通过对机械通气下极低出生体重儿发生脑室内出血(11例)与无脑室内出血22例)的PIP、PEEP、MAP、通气天数及低血压比较,探讨机械通气对极低出生体重儿脑室内出血影响的发生机制.结果 机械通气的极低出生体重儿脑室内出血和重度脑室内出血的发生率为66.7%和18.2%;无机械通气的极低出生体重儿脑室内出血发生率为33.3%,无重度脑室内出血.机械通气下极低出生体重儿发生脑室内出血与无脑室内出血者吸气峰压、呼吸末正压、平均气道压力、通气天数的比较无明显差异,当收缩压低于45mmHg时,极低出生体重儿发生脑室内出血较不发生脑室内出血明显增多.结论 机械通气是导致极低出生体重儿脑室内出血发生和加重的危险因素,临床使用机械通气时,尽量维持患儿收缩压45mmGg以上,避免或减轻脑室内出血的发生或发展.     

极低/超低出生体重儿迟发型败血症发生情况及其危险因素分析

目的探讨新生儿重症监护病房(NICU)极低/超低出生体重儿迟发型败血症(LOS)的发生情况及危险因素。方法收集2011年1月至2013年12月入住NICU的极低或超低出生体重儿的临床资料,根据是否合并LOS分为两组:LOS组和无LOS组。回顾性分析LOS的发生率、病死率、常见病原菌及危险因素。结果纳入的226例极低/超低出生体重儿中,117例(51.8%)发生了LOS,其中45例为确诊LOS,72例为临床诊断LOS。LOS组患儿病死率为13.7%(16/117),明显高于无LOS组(5/109,4.6%),差异有统计学意义(P0.05)。共培养出51株病原菌,其中32株(63%)为革兰阴性细菌,16株(31%)为革兰阳性细菌,3株(6%)为真菌。多因素logistic回归分析显示,胎龄、小于胎龄儿、肠外营养持续时间、经外周静脉穿刺中心静脉置管(PICC)、机械通气是极低/超低出生体重儿LOS发生的独立影响因素(OR分别为:0.84、1.59、1.34、3.11、4.55,均P0.05)。结论极低/超低出生体重儿LOS的发生率及病死率较高。LOS常见病原菌为革兰阴性细菌。胎龄低、肠外营养持续时间长、小于胎龄儿、PICC或机械通气的极低/超低出生体重儿LOS的发生危险可能增加。     

极低出生体重儿尽早达到足量肠内营养喂养策略——《极低出生体重儿喂养指南》解读

极低出生体重儿的营养和喂养不仅对减少初生早期的合并症而且对远期预后产生重要影响。营养和喂养的目标是在保证安全的前提下,尽早建立肠内喂养,尽快地达到全肠内营养。2015年加拿大麦克马斯特大学儿童医院发表了《极低出生体重儿喂养指南》,内容涉及到临床上极低出生体重儿的营养和喂养经常遇到的问题,包括极低出生体重儿达到足量肠内营养的时间、开奶时间和喂养频次、出生早期肠内营养喂养方式的选择、奶量增加的速度、喂养耐受性的评估、胃内残余奶量的管理,以及早产儿胃食管反流等。     

Optimising nutrition of preterm and term infants in the neonatal intensive care unit

Optimum nutrition leads to improved long-term neurodevelopmental outcomes in both preterm and term infants admitted to the neonatal intensive care (NICU). This review delineates the phases of nutritional management from full parenteral nutrition, transitioning to enteral nutrition and on to full enteral feeds. It describes the essential components of best nutritional care in the neonatal periods and provides practical tips in the management of nutrition in these infants. The authors make recommendations for care based on national and international guidelines and personal expertise of working in a tertiary NICU.     

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??Sepsis is one of important reasons for the death of children in intensive care unit. Although anti-infection and active symptomatic treatment are the key to treatment??whether nutrition support is rational and effective or not can also affect clinical prognosis. Sepsis children are in stress status??so nutrition support needs to meet the demand for energy??protein and other nutrients without increasing the burden of organs. Although intestinal function is damaged because of systemic infection??enteral nutrition??EN?? is still the first choice by actively creating conditions. If the EN is not enough??supplemental parenteral nutrition??PN?? should be given. In the process of nutrition support??immune nutrients can be added to regulate immune function and attenuate inflammation.     

关注疾病状态下儿童的营养支持

患儿的营养状况将影响其疾病康复和预后。在我国,对儿科营养重要性的认识和规范化应用,远远落后于发达国家。为进一步提高我国临床各科对此问题的认识,本刊特设此专题进行讨论,十分必要。下面就国内外相关情况     

Accuracy of declared nutrient content on labels of commercial complementary food products in Cambodia,Indonesia and Senegal

Commercially produced complementary foods (CPCF) have the potential to fill nutritional gaps in the diets of older infants and young children. This study evaluated the accuracy of nutrient declarations on labels of 43 commonly available CPCF in three peri-urban/urban locations: Khsach Kandal district, Cambodia (n = 11); Bandung, Indonesia (n = 11) and Guédiawaye and Dakar departments, Senegal (n = 21). Label values (LV) from product nutrient declarations were compared to analytical values (AV) derived from laboratory nutrient analysis for macronutrients (carbohydrate, protein and total fat), nutrients of public health concern (saturated fat, total sugar and sodium), and micronutrients of interest (calcium, iron and zinc). European Union guidance for nutrition label accuracy was used to set tolerance ranges for each nutrient LV relative to AV. LV were missing for one or more nutrients in 88.4% (n = 38) of the CPCF products and no CPCF met EU tolerance thresholds for all nine nutrients assessed. Over half of products with LV for key micronutrients (55.6%, n = 10/18) and macronutrients (54.8%, n = 23/42) met tolerances for LV accuracy. Eighty-five percent (n = 11/13) of products with LV for nutrients of public health concern were determined to be accurate. Nutrient content claims for iron appeared on 19 (44.2%) of the 43 products. Of the products which made an iron content claim, 26.3% had inaccurate LV with the majority of these containing less iron than declared. Regulatory action is needed to ensure that CPCF labelling communicates complete and accurate nutrient content information that enables caregivers to make informed decisions for feeding older infants and young children.     

Reduction in postnatal cumulative nutritional deficit and improvement of growth in extremely preterm infants

Aim: To evaluate the influence of gestational age (GA) on cumulative nutritional deficit and postnatal growth in extremely preterm (EPT) infants after optimizing nutritional protocol as recently recommended. Methods: A prospective, nonrandomized, observational study in extremely preterm (EPT, <28 weeks) and very preterm (VPT, 28–30 weeks) infants. Results: Eighty‐four infants were included (BW: 978 ± 156 g, GA: 27.8 ± 1.3 weeks). Cumulative nutritional deficit increased during first week of life to ?290 ± 84 and ?285 ± 117 kcal/kg and ?4.2 ± 3.1 and ?4.8 ± 3.9 g/kg of protein in EPT and VPT groups, respectively. After 6 weeks, only cumulative energy deficit in EPT group remained significant (p < 0.05) even when 96% of theoretical energy intakes were provided. Weight z score decreased during first 3 days in average with initial weight loss, and then, the z score increased during the first 6 weeks of life in the majority (75%) of infants. Cumulative protein deficit during the first week of life was the major determinant of the postnatal growth during the first 6 weeks of life. Conclusion: Cumulative nutritional deficit may be drastically reduced in both EPT and VPT infants after optimizing nutritional policy during the first weeks of life, and the postnatal growth restriction could even be prevented.     

重症患儿营养支持的风险和对策

营养支持,包括肠外营养和肠内营养,已成为危重患儿治疗的重要组成部分,营养支持的风险也越来越受到关注.营养支持的并发症包括与营养支持通路相关的机械性损伤、导管相关性血流感染、肠内营养不耐受和代谢性并发症.这些并发症大部分可以预防,评估和控制风险因素是最有效的预防方法,预防和治疗并发症是保证成功进行营养支持、改善患儿预后的关键.     

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??Nutrition support is an essential management of critically ill patients??and enteral nutrition conforms to the physiological state of the body??which can maintain the integrity of intestinal mucosal structure and function??thus ensure the enough intake of calories and protein and preventing the risk of intestinal bacterial translocation effectively. Endoscope-guided placement of feeding tubes is a kind of simple??direct and accurate method to establish enteral nutrition in clinic. The method has high success rate??relatively simple operation. Thus??it is a safe and effective treatment for enteral nutrition, which is worthy of clinical application.