极低出生体重儿住院期间体重增长状况及影响因素

目的了解极低出生体重儿住院期间体重增长情况,探讨影响体重增长速度的相关因素。方法回顾性调查深圳市妇幼保健院2011年1月1日—2012年12月31日期间住院的147例极低出生体重儿的临床资料,采用单因素和logistic多因素分析体重增长速度的影响因素。结果 147例极低出生体重儿中,体重增长速度中位数为12.77 g/(kg·d),宫外生长迟缓率为62.6%,适宜体重和高体重增长组的住院天数(P_(50)分别为48 d、36 d)小于低体重增长组P_(50)=56 d),高体重增长组宫外生长迟缓率(34.80%)小于适宜(65.30%)和低体重增长组(75.90%)(均P0.05);多分类logistic回归分析显示,出生体重、体重恢复时间和达到全肠内营养时间与体重增长速度有关。结论大多数极低出生体重儿在住院期间体重增长缓慢,影响其体重增长速度的因素有出生体重、体重恢复时间和达到全肠内营养时间。     

喂养不耐受对极低出生体重儿影响的分析

[目的]探讨喂养不耐受对极低出生体重儿体重增长的影响. [方法]对2006年9月～2007年9月生后24 h内陕西省妇幼保健院NICU孕周<34周、出生体重≤1 500 g,无消化系统畸形的54例极低出生体重儿的资料进行回顾性分析,入选病例根据喂养情况分为喂养耐受组与不耐受组. [结果]喂养耐受组和喂养不耐受组间出生3周内热卡、蛋白摄入及体重增长差异有显着性.两组间开奶日龄、足量喂养日龄、体重开始增长日龄、恢复出生体重日龄、静脉营养时间、住院日数差异有显着性,胎龄、出生体重差异无显着性. [结论]对极低出生体重儿应早期喂养,减少喂养不耐受性,肠道内营养能提供更足够的能量以满足极低出生体重儿的体重增长,同时需要肠外营养作为肠内营养的补充.     

个性化免疫强化对早产致低出生体重儿营养支持的影响

目的了解免疫强化对因早产所致低出生体重儿营养支持的临床疗效,为新生儿营养保健提供理论依据。方法选取2015年1月-2016年9月在该院出生并住院治疗的172例早产所致低出生体重儿进行临床对照试验,根据性别、体重进行匹配分为对照组和试验组,每组各86例。对照组采取肠内营养加静脉支持的营养方式,实验组采取同样的肠内营养,结合个性化的免疫强化进行营养支持。比较两组新生儿出生后第1周和第2周体重、体重增长速率、总热能摄入量、前白蛋白(PA)、白蛋白(ALB)、尿素氮(Urea)的差异,并比较两组新生儿住院期间营养相关并发症发生率的差异。结果两组早产儿出生后体重、体重增长速率、总热能摄入量、PA、ALB、Urea进行重复测量方差分析发现,3项指标前后比较差异均有统计学意义(均P<0.05);分析该差异的具体来源,均由组间差异、时间因素、组间和时间相互作用构成;两组早产儿出生后第1周、第2周体重、体重增长速率、总热能摄入量、PA含量、ALB含量、Urea含量比较差异均有统计学意义(均P<0.05);两组早产儿住院期间低血糖症和贫血发生率显著均高于对照组(均P<0.05)。结论因早产所致低出生体重儿在临床营养支持过程中,除常规肠内营养和静脉营养支持外,根据新生儿营养状况给予个性化的免疫强化有助于新生儿基础能量摄入的增加和体重的恢复,降低营养相关并发症的发生率。     

低出生体重儿液体配方奶对极低/超低出生体重儿生后早期生长发育的影响

目的:研究低出生体重儿液体配方奶对极低/超低出生体重早产儿生后早期生长发育的影响,进而评估其临床应用效果。方法:选择胎龄≤32周住院的极低/超低出生体重儿,分为观察组和对照组,分别给予低出生体重儿液体配方奶和普通早产儿配方奶粉喂养,观察喂养后体格发育指标、喂养相关指标、合并疾病等方面的差异,进行统计学分析。结果:应用低出生体重儿液体配方奶喂养的极低和超低出生体重早产儿体重增长速率高于对照组;体重增长所需热量、恢复至出生体重所需时间、喂养耐受时间、静脉营养应用时间均低于对照组;感染、贫血和高间接胆红素血症的发生率低于对照组,差异具有统计学意义(P<0.05)。结论:低出生体重儿液体配方奶由于可提供高热量,有效利用度高,肠道负荷小,且应用方便、能保证极低和超低出生体重儿生后早期良好的生长发育,同时可减少其并发症的发生。     

极低体重儿肠外营养临床分析

目的总结极低出生体重儿肠外营养临床资料,提高治疗水平.方法总结我科2004年1月～12月162例肠外营养资料,以同期住院非肠外营养80例极低出生体重儿作为对照.结果162例肠外静脉营养患儿体重增长较对照组差异有显著意义,两组并发症比较差异无统计学意义.结论正确应用肠外营养可使极底体重儿体重增长良好.     

非营养性吸吮联合腹部抚触对极低出生体重儿体重增长的影响研究

目的探讨非营养性吸吮联合腹部按摩对极低出生体重儿体重增长的影响。方法将舟山市妇幼保健院NICU收治的48例需经鼻胃管喂养的极低出生体重儿随机分成两组。对照组（24例）给予单纯经鼻胃管喂养,实验组（24例）在经鼻胃管喂养的基础上辅以非营养性吸吮加腹部抚触,两组均给予同一种早产儿特殊配方乳喂养。观察记录两组胃内残留发生率、鼻胃管留置时间、达到完全肠道营养时间、胎粪完全排尽时间、恢复出生体重时间、体重增长速度、睡眠时间。结果与对照组比较,实验组鼻胃管留置时间较短,达到完全肠道营养时间短,胎粪完全排尽时间短,胃内残留奶量少,恢复出生体重时间及体重增长速度快,睡眠时间相对延长。结论极低出生体重儿在鼻胃管喂养期间辅以非营养吸吮伴腹部抚触的方法,能有效促进胃排空,对其胃肠功能发育及体重增长有促进作用。     

长期住院极低出生体重儿营养状况及体重增长影响因素分析

[目的]调查长期住院极低出生体重儿(very low birth weight infants,VLBWI)的营养状况,分析影响体重增长的危险因素,为制定合理的营养方案提供参考.[方法]对两年间住院28 d及以上的80例VLBWI进行回顾调查,了解其喂养、热卡、蛋白质摄入、体重增长、出生时小于胎龄儿(small for gestation age,SGA)及生后宫外发育迟缓(extrauterine growth retard,EUGR)发生率等情况,并分析影响体重增长的危险因素.[结果]在恢复出生体重后,随摄入热卡增加体重也增加,蛋白质变化不明显,但可达3 g/(kg·d);出生时SGA发生率为28.8%,EUGR发生率生后渐增,6周时达72.5%;达足量热卡供应的时间是[21.21±13.56(6～65)d],达足量肠道喂养的时间为[27.87±11.12(12～57)d];体重增长速率平均为15.76(8.72～24.69)g/(kg·d),影响体重增长最重要的危险因素是开奶时间晚.[结论]长期住院VLBWI存在多种营养问题包括热卡摄入相对不足,EUGR的发生率随着日龄而增高.建议对VLBWI尽早建立肠道喂养,及时补充静脉营养.     

极低、超低出生体重儿84例营养状况分析

目的 通过三种不同的营养评价方法对极低与超低出生体重儿进行营养评估,探讨早产儿理想的营养评价方法。方法 84例极低出生体重儿(包括超低出生体重儿)按照肠外营养(parentaral nutrition,PN)应用的时间分为两组,记录两组出生体重及住院期间的体重变化,将患儿体重生长指标进行统计,应用三种方法,即Mounla 营养评价法、以宫内生长速度为标准的判断方法、日均体重增长曲线与Christensen 体重生长曲线对比的方法,来评估不同营养方式患儿的营养状况。结果 根据Mounla 营养评价方法,两组营养状况组成差异无统计学意义;根据宫内生长速度为标准进行评估,两组住院期间平均体重增长均>15 g/(kg·d),两组比较差异有统计学意义(t=3.731,P<0.05);将两组日均体重增长曲线与Christensen 体重生长曲线对比,发现四项体重生长指标落后于Christensen 曲线数值,PN时间较长的组2指标明显落后。 结论 应用三种营养评价方法评估不同营养方式的患儿的营养状况,得出不同的结论。推测评估极低、超低出生体重儿的营养状况,以宫内生长速度为标准的判断方法过于简单,Mounla营养评价方法可能不够全面,而Christensen体重生长曲线是否适合中国儿童尚不确定,更合理的营养评估方法有待进一步扩大样本量进行深入研究。     

极低出生体重儿早期静脉营养的疗效观察

目的探讨极低出生体重儿早期静脉营养的耐受性和疗效。方法按入院先后将60例极低出生体重儿随机配对分为早期静脉营养组(早期组)和晚期静脉营养组(晚期组)。早期组于出生后24h内即给予静脉营养供给,晚期组于出生后3d开始静脉营养供给,两组均应用6%小儿氨基酸和20%脂肪乳,用量均从1.5g/(kg·d)开始,每日递增0.5g/(kg·d)直至3.0g/(kg·d)。同时,均根据病情尽早经口微量喂养。于入院后72h内和1周后检测肝功能、总胆红素、三酰甘油、总胆固醇和尿素氮,每日监测体质量、微量血糖,比较两组患儿恢复出生体质量的时间、体质量下降幅度、第3天热量、第7天热量、静脉营养时间、住院天数、过渡到全肠道营养的时间以及并发症发生例数。将资料输入SPSS软件进行统计分析。结果早期组患儿恢复至出生体质量时间较晚期组短(P0.01),第3天热量、第7天热量较晚期组高(P0.01),体质量下降幅度,两组差异有统计学意义(P0.05)。结论极低出生体重儿早期积极、规范和足量的肠外静脉营养是安全有效的。     

极低体重儿营养相关性胆汁淤积危险因素分析

目的 探讨极低出生体重儿胃肠外营养相关性胆汁淤积症的危险因素.方法 以2013年1月至2015年1月入住盐城市妇幼保健院重症监护病房,使用胃肠外营养(PN)时间＞2周的极低出生体重儿223例为研究对象.将发生胃肠外营养相关性胆汁淤积症(PNAC)的54例为观察组,其余169例为对照组,比较两组患儿在出生情况、胃肠外营养相关因素以及住院期间相关并发症情况.结果 通过多因素Logistic回归分析结果提示出生体重越低、禁食时间越长、开始喂养时间越迟、胃肠外营养持续时间越长,以及合并窒息、颅内出血、败血症等并发症均为PNAC发生的相关危险因素(x2值分别为4.259、5.423、10.227、27.371、3.862、4.110、6.001,均P＜0.05).结论 极低出生体重儿在胃肠外营养过程中,为减少PNAC的发生,应关注如下危险因素出生体重低、禁食时间长、开始喂养时间迟、PN持续时间长,以及合并窒息、颅内出血、败血症等并发症.     

不同喂养方式对极低出生体质量儿胃肠功能影响的比较

目的:探讨经幽门喂养(TP)和经胃管喂养(IG)对极低出生体质量儿胃肠功能的影响,以制订合理的早期肠内营养(EEN)方案。方法:将60例极低出生体质量儿随机分为TP组和IG组,每组各30例。观察两组病儿呼吸暂停发生频率、体质量增长速度、达出生体质量时间、喂养不耐受时间、达TEN时间、宫外发育迟缓(EUGR)发生率以及胃动素、胃泌素、住院时间、喂养相关并发症、坏死性小肠结肠炎和肠穿孔等指标。结果:TP组病儿喂养不耐受时间和达TEN时间均明显低于IG组(P0.05),呼吸暂停发生频率明显低于IG组(P0.01)。两组病儿的体质量增长速度、出院时EUGR发生率、并发症坏死性小肠结肠炎和住院时间均无显著性差异(P0.05)。两组病儿胃动素和胃泌素水平出生后第8天与喂养前比较有显著性差异(P0.01),且胃动素水平TP组明显高于IG组,差异有显著性统计学意义(P0.01)。结论:TP可用于胃管喂养耐受性差或反复出现呼吸暂停的极低出生体质量儿,在进行喂养时应针对不同情况制订个体化方案。     

Length of Nutritional Transition Associates Negatively with Postnatal Growth in Very Low Birthweight Infants

Very low birthweight (VLBW, <1500 g) infants may be predisposed to undernutrition during the nutritional transition phase from parenteral to enteral nutrition. We studied the associations among the length of the transition phase, postnatal macronutrient intake, and growth from birth to term equivalent age in VLBW infants. This retrospective cohort study included 248 VLBW infants born before 32 weeks of gestation and admitted to the Children’s Hospital, Helsinki, Finland during 2005–2013. Daily nutrient intakes were obtained from computerized medication administration records. The length of the transition phase correlated negatively with cumulative energy, protein, fat, and carbohydrate intake at 28 days of age. It also associated negatively with weight and head circumference growth from birth to term equivalent age. For infants with a long transition phase (over 12 d), the estimates (95% CI) for weight and head circumference z-score change from birth to term equivalent age were −0.3 (−0.56, −0.04) and −0.44 (−0.81, −0.07), respectively, in comparison to those with a short transition phase (ad 7 d). For VLBW infants, rapid transition to full enteral feeding might be beneficial. However, if enteral nutrition cannot be advanced, well-planned parenteral nutrition during the transition phase is necessary to promote adequate growth.     

Glutamine-enriched enteral nutrition in very-low-birth-weight infants and effects on feeding tolerance and infectious morbidity: a randomized controlled trial

BACKGROUND: Glutamine depletion has negative effects on the functional integrity of the gut and leads to immunosuppression. Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion because nutrition is limited in the first weeks of life. OBJECTIVE: The objective was to determine the effect of glutamine-enriched enteral nutrition on feeding tolerance, infectious morbidity, and short-term outcome in VLBW infants. DESIGN: In a double-blind randomized controlled trial, VLBW infants (gestational age <32 wk or birth weight <1500 g) were allocated to receive enteral glutamine supplementation (0.3 g . kg(-1) . d(-1)) or isonitrogenous control supplementation (alanine) between days 3 and 30 of life. The supplementations were added to breast milk or to preterm formula. The primary endpoint for the study was time to full enteral feeding. Secondary endpoints were other variables of feeding tolerance, infectious morbidity, and short-term outcome. RESULTS: Baseline patient and nutritional characteristics were not significantly different in the glutamine-supplemented (n = 52) and the control (n = 50) groups. The median time to full enteral feeding was 13 d (range: 7-31 d) in the glutamine-supplemented group and 13 d (range: 6-35 d) in the control group (hazard ratio: 1.19; 95% CI: 0.79, 1.79; P = 0.40). In the glutamine-supplemented group, 26 of 52 infants (50%) had >/=1 serious infection compared with 38 of 50 (76%) in the control group (odds ratio: 0.32; 95% CI: 0.14, 0.74; P = 0.008). Other variables of feeding tolerance and short-term outcome were not significantly different between groups. CONCLUSIONS: Glutamine-enriched enteral nutrition did not improve feeding tolerance or short-term outcome in VLBW infants. However, infectious morbidity was significantly lowered in infants who received glutamine-enriched enteral nutrition.     

极低出生体重儿不同喂养方式的临床分析

目的 探讨不同喂养方式对极低出生体重儿的喂养耐受性及喂养效果的优劣性.方法 将45例极低出生体重儿随机分为两组,A组:23例,间歇经口管饲+非营养性吸吮,B组:22例,经口喂养;两组起始奶量均从10～20mL·kg-1·d-1、从每3小时喂1次开始,每次持续时间为10～15分钟,每天增加20mL/kg.所有的极低出生体重儿均同时进行部分静脉营养,直至达到完全肠道内营养.比较两组极低出生体重儿的喂养耐受、胃食道返流、乳汁吸入性肺炎的发生率以及达到完全肠道喂养的时间.结果 A组胃食道返流、乳汁吸入性肺炎发生率较B组低(χ2=3.74,P=0.04;χ2=5.14,P=0.02),达到完全肠道营养时间短(t=6.41,P=0.00).喂养不耐受的发生率两组间比较无显著性差异(χ2=0.25,P=0.40).结论 极低出生体重儿采用间歇经口管饲+非营养性吸吮有利于其生长发育和胃肠功能的完善.     

极低体重儿的营养支持

随着极低体重婴儿存活率的增加，营养支持显得越来越重要。本文介绍了近年有关的进展，简单提及孕母与胎儿葡萄糖、氨基酸及脂肪的关系，主要总结了极低体重儿肠道营养的重要性及方法，以及静脉营养的重要性和各成份在极低体重儿应用的特点。     

不同肠道外营养方式对极低出生体重早产儿的应用效果对比

目的探讨不同肠道外营养方式对极低出生体重早产儿的应用效果。方法回顾性分析我院2010年6月至2013年6月95例极低出生体重早产儿的临床资料,依据肠道外营养方式不同将其分为观察组和对照组。观察组54例采用早期肠道外营养(ETPN)治疗,而对照组41例采用传统肠道外营养(TTPN)治疗。观察两组早产儿能量摄入量的差异,同时评价早产儿在并发症方面的情况。结果观察组能量摄入明显高于对照组(P<0.05),观察组恢复出生体重时间、达到追赶生长时间均明显短于对照组,比较具有统计学差异(P<0.05);而两组并发症的发生率无明显差异(P>0.05))。结论早期肠道外营养支持更有利于早产儿的能量摄入量,值得临床推广。     

The effect of glutamine-enriched enteral nutrition on intestinal permeability in very-low-birth-weight infants: a randomized controlled trial

BACKGROUND: Very-low-birth-weight (VLBW) infants are susceptible to glutamine depletion. Glutamine depletion has negative effects on intestinal integrity. The lower infection rate in VLBW infants receiving glutamine-enriched enteral nutrition may originate from improved intestinal integrity, as reflected by decreased intestinal permeability. The aim of our study was to investigate whether glutamine-enriched enteral nutrition in VLBW infants enhances the normal decrease in intestinal permeability, as measured by the sugar absorption test (SAT). METHODS: In a double-blind, randomized, placebo-controlled trial, VLBW infants (gestational age <32 weeks or birth weight <1,500 g) received enteral glutamine supplementation (0.3 g/kg/d) or an isonitrogenous placebo supplementation (alanine) between days 3 and 30 of life. Intestinal permeability, determined from the urinary lactulose/mannitol (L/M) ratio after an oral dose of lactulose and mannitol, was assessed at 4 time points: before the start of the study, and at days 7, 14, and 30 of life. RESULTS: At least 2 SATs were performed in 45/52 (86%) and 45/50 (90%) infants in the glutamine-supplemented and control groups, respectively. Baseline patient and nutrition characteristics were not different between the groups. There was no effect of glutamine-enriched enteral nutrition on the decrease of the L/M ratio between the start and end of the study (p = .78). In both treatment groups, median urinary lactulose concentrations decreased (p < .001), whereas median urinary mannitol concentrations increased (p = .003). CONCLUSIONS: Glutamine-enriched enteral nutrition does not enhance the postnatal decrease in intestinal permeability in VLBW infants. Any beneficial effect of glutamine may involve other aspects of intestinal integrity; for example, modulation of the intestinal inflammatory response.     

Urinary citrulline in very low birth weight preterm infants receiving intravenous nutrition

As gut immaturity precludes full enteral feeding, very low birth weight (VLBW) preterm infants receive parenteral nutrition (PN) during the first few weeks of life. Weaning VLBW infants off PN, however, is a top priority since PN is associated with a high risk of complications. The decision making is purely empirical, as there is currently no suitable index of gastrointestinal (GI) maturity. Plasma citrulline concentration is considered an index of GI function in conditions such as short-bowel syndrome and coeliac disease in adults. To identify the factors determining urinary citrulline excretion, and determine whether urinary citrulline excretion could be used as a non-invasive index of GI tolerance to enteral feeding, nutritional intake and urinary citrulline were monitored bi-weekly in forty-seven preterm infants?相似文献   

益生菌对早产极低出生体重儿早期胃肠功能及生长发育的影响

目的观察益生菌对早产极低出生体重儿早期胃肠功能及生长发育的影响。方法符合病例纳入标准的早产儿60例,随机分入治疗组与对照组各30例,2组均给予常规治疗,治疗组加用益生菌制剂(枯草杆菌肠球菌二联活菌多维颗粒剂),从生后第2天开始,0.33g/次,2次/天,疗程2周。观察两组早产儿出生后第1、3、7、14天血清胃泌素水平,观察呕吐、腹胀、胃潴留、排便不畅情况,观察体重、头围、恢复出生体重时间,达到完全肠内营养时间。结果出生后第1、3、7、14天胃泌素水平,治疗组分别为(39.50±8.22)、(39.90±9.20)、(45.80±13.23)、(53.63±15.48)pg/ml,对照组分别为(38.93±9.42)、(39.56±10.55)、(44.80±14.50)、(46.33±10.96)pg/ml,第14天的胃泌素浓度,治疗组高于对照组,差异有统计学意义(P<0.05);发生呕吐、腹胀、胃潴留、排便不畅的例数,治疗组分别为7、6、5、6例,对照组分别为15、14、12、14例,治疗组发生率均明显低于对照组,差异均有统计学意义(P<0.05);出生后第1、3、7、14天体重,治疗组分别为(1269±144)、(1239±146)、(1308±137)、(1426±150)g,对照组分别为(1281±146)、(1285±150)、(1290±149)、(1335±141)g,第14天的体重治疗组高于对照组,差异有统计学意义(P<0.05);出生后第1、3、7、14天头围,治疗组分别为(28.03±1.71)、(28.09±1.53)、(28.21±1.56)、(28.32±1.62)cm,对照组分别为(27.86±1.57)、(27.92±1.55)、(28.04±1.50)、(28.16±1.62)cm,两组比较,差异无统计学意义(P>0.05);恢复出生体重时间,治疗组为(6.87±1.33)d,对照组为(7.87±1.91)d,治疗组时间短于对照组,差异有统计学意义(P<0.05);达到完全肠内营养时间,治疗组为(11.43±2.21)d,对照组为(12.77±2.22)d,治疗组时间短于对照组,差异有统计学意义(P<0.05)。结论早期添加益生菌可促进早产极低出生体重儿胃泌素的分泌,促进胃肠功能的成熟;减少喂养不耐受的发生,促进体重增长,缩短达到完全肠内营养时间和恢复到出生体重所需时间。     

Glutamine-enriched enteral nutrition in very low birthweight infants and allergic and infectious diseases at 6 years of age

In a previous randomised controlled trial, we found that glutamine-enriched enteral nutrition in 102 very low birthweight (VLBW) infants decreased both the incidence of serious infections in the neonatal period and the risk of atopic dermatitis during the first year of life. We hypothesised that glutamine-enriched enteral nutrition in VLBW infants in the neonatal period influences the risk of allergic and infectious disease at 6 years of age. Eighty-eight of the 102 infants were eligible for the follow-up study (13 died, 1 chromosomal abnormality). Doctor-diagnosed allergic and infectious diseases were assessed by means of validated questionnaires. The association between glutamine-enriched enteral nutrition in the neonatal period and allergic and infectious diseases at 6 years of age was based on univariable and multivariable logistic regression analyses. Seventy-six of the 89 (85%) infants participated, 38 in the original glutamine-supplemented group and 38 in the control group. After adjustment, we found a decreased risk of atopic dermatitis in the glutamine-supplemented group: adjusted odds ratio (aOR) 0.23 [95% CI 0.06, 0.95]. No association between glutamine supplementation and hay fever, recurrent wheeze and asthma was found. A decreased risk of gastrointestinal tract infections was found in the glutamine-supplemented group (aOR) 0.10 [95% CI 0.01, 0.93], but there was no association with upper respiratory, lower respiratory or urinary tract infections. We concluded that glutamine-enriched enteral nutrition in the neonatal period in VLBW infants decreased the risk of atopic dermatitis and gastrointestinal tract infections at 6 years of age.