大剂量红霉素治疗早产儿喂养不耐受的疗效观察

目的：探讨大剂量红霉素治疗早产儿喂养不耐受的疗效。方法选取2013年1月—2014年1月于贵港市妇幼保健院就诊的喂养不耐受早产儿54例,随机分为观察组与对照组,各27例。对照组予以常规治疗,观察组在对照组基础上加用大剂量红霉素治疗。观察两组肠内热卡达标（即达到50kcal·kg -1·d -1）时间、住院时间、全胃肠外营养（TPN）时间及并发症发生情况。结果观察组肠内热卡达标时间、住院时间及 TPN 时间短于对照组,差异均有统计学意义（P ＜0.05）;两组并发症发生率比较,差异无统计学意义（P ＞0.05）。结论大剂量红霉素治疗早产儿喂养不耐受的疗效显著,能改善早产儿胃肠动力,缩短住院时间,且并发症少。     

减重代谢术后患者饮食体验的系统评价

目的 系统评价肥胖症患者减重代谢术后的饮食体验的研究,全面了解其存在的饮食问题与管理需求,为更好地开展临床医疗工作提供依据。 方法 计算机检索Cochrane Library、乔安娜布里格斯研究所循证卫生保健中心数据库、PubMed、Embase、Web of Science、CINAHL、PsycINFO、中国知网、万方数据库、中国生物医学文献数据库。搜集有关肥胖症患者减重代谢术后饮食体验的质性研究,检索年限为建库至2021年1月。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心质性研究质量评价标准评价文献质量,采用汇集性整合的方法进行结果整合。 结果 共纳入18项研究,提炼39个结果,归纳为7个类别,综合为4个整合结果。①减重代谢术后患者进食状态的变化:饮食方式的变化、饮食管理阶段的变化;②减重代谢术后积极的进食策略;③减重代谢术后消极的进食体验和不良饮食行为:消极的进食体验、不良饮食行为及原因;④减重代谢术后患者寻求多方面的饮食管理支持:医护人员的饮食管理支持、家人和朋友的饮食管理支持、社会组织的饮食管理支持。 结论 医护人员应重视患者在减重代谢术后已出现的或可能会出现的饮食问题,根据相关原因,有针对性的提供支持与帮助以应对术后饮食挑战,指导患者建立正确的饮食行为,实现并维持最佳的减重效果,提高生活质量。     

Effect of abdominal massage on feeding intolerance among premature baby with mechanical ventilation in neonatal intensive care unit in indonesia

BackgroundFeeding intolerance in premature infants is due to the immaturity of the gastrointestinal system which is aggravated by the installation of mechanical ventilation. The impact of premature babies is delaying enteral nutrition, NEC, the risk due to parenteral nutrition and the high cost of care. Abdominal massage is one of the recommended actions to prevent it.ObjectiveThe study aimed to determine the effect of abdominal massage on feeding intolerance in premature infants with mechanical ventilation in the NICU.MethodsThis study was conducted using quasi-experimental with nonequivalent control group pretest and posttest design in the neonatal intensive care unit (NICU). The study was conducted on 34 premature infants, 17 groups who did abdominal massage and 17 as a control group. Feeding intolerance is determined by the presence of one or more symptoms such as increased gastric residue, abdominal distension and frequency of vomiting observed on the first (pre) and fifth (post) days. Abdominal massage is carried out twice a day for 15 min in a 5 day period. Data can be seen the difference on the first day and the last day.ResultsThe results showed a decrease in average gastric residue difference of 0.65 cc and abdominal distension of 0.59 cm in the intervention group (p < 0.05). Whereas in the control group gastric residue increased 3.59 cc and abdominal distension 1.88 cm (p < 0.05). The mean difference in vomiting frequency decreased in both groups, a decrease of 0.118 in the intervention group and 0.18 in the control group (p = 0.63). There was a significant difference in the occurrence of feeding intolerance between groups after the intervention (p = 0.05), where the incidence of feeding intolerance did not increase (0%) in the intervention group, while the control group increased by 9 (52.9%) respondents. There was a significant contribution to the confounding factor of the type of mechanical ventilation in the amount of gastric residue after the intervention (p = 0.02).ConclusionThere is an effect of abdominal massage on the incidence of feeding inolerance in premature infants with mechanical ventilation, so researchers recommend SPO abdominal massage to be considered as a treatment for intolerance feeding in premature infants with mechanical ventilation in the NICU.     

Dysphagia in cerebral palsy: A comparative study of the exeter dysphagia assesment technique and a multidisciplinary assessment

Eighteen children with cerebral palsy in a special school, most of whom had feeding difficulties, were studied to compare the diagnostic value of the Exeter Dysphagia Assessment Technique (EDAT) with an exhaustive clinical assessment undertaken by a multidisciplinary team experienced in the diagnosis and treatment of dysphagia of neurological origin. Four feeding skills were assessed by each method independently, viz. anticipation, intraoral sensory perception, oral-motor efficiency, and pharyngeal triggering. Comparison of the two sets of results showed agreement in at least 78% of the assessed skills. The possible reasons for the few discrepancies are discussed. The noninvasive EDAT equipment was easy to use with the children, who had a range of type and severity of cerebral palsy. The test was undertaken in their familiar surroundings and took 15 to 20 min per child. Interpretation of the results showed that EDAT provided a rapid, reliable diagnostic aid which assisted in the assessment of the degree of feeding impairment within each of the four feeding skills tested. The authors are very grateful for the financial support for this project which was provided partially by Action Research and partially by the Northcott Devon Medical Foundation     

早期微量喂养联合非营养性吸吮治疗窒息后新生儿喂养不耐受效果分析

目的探讨早期微量喂养联合非营养性吸吮治疗窒息后新生儿喂养不耐受的临床疗效。方法将黄梅县人民医院儿科于2013年2~8月收治的90例窒息后新生儿喂养不耐受患儿按随机数字表法分为非营养性吸吮治疗组和联合治疗组,各45例。非营养性吸吮治疗组给予非营养性吸吮治疗,联合治疗组应用早期微量喂养联合非营养性吸吮治疗,比较两组患者恢复出生体质量时间及全量肠内营养时间,同时比较两组患者治疗前及治疗7 d后血清总胆红素及白蛋白改善水平,并观察两组患者治疗过程中的相关并发症发生率。结果联合治疗组恢复出生体质量时间及全量肠内营养时间显著短于非营养性吸吮治疗组[(9.7±1.5)d比(12.1±1.7)d、(9.9±0.9)d比(11.6±1.0)d],差异有统计学意义(P<0.01);联合治疗组治疗后7 d血清总胆红素显著低于非营养性吸吮治疗组[(98±6)μmol/L比(121±5)μmol/L,P<0.01],白蛋白水平显著高于非营养性吸吮治疗组[(41.2±0.7)μmol/L比(38.6±1.1)μmol/L,P<0.05];两组喂养相关并发症发生率比较差异无统计学意义(P>0.05)。结论早期微量喂养联合非营养性吸吮治疗可显著提高窒息后新生儿喂养不耐受患儿的治疗效果。     

Oesophageal atresia: The growth gap

Poor growth is an under-recognised yet significant long-term sequelae of oesophageal atresia(OA) repair. Few studies have specifically explored the reasons for growth impairment in this complex cohort. The association between poor growth with younger age and fundoplication appears to have the strongest supportive evidence, highlighting the need for early involvement of a dietitian and speech pathologist, and consideration of optimal medical reflux management prior to referring for anti-reflux surgery. However, it remains difficult to reach conclusions regarding other factors which may negatively influence growth, due to conflicting findings, inconsistent definitions and lack of validated tool utilisation. While swallowing and feeding difficulties are particularly frequent in younger children, their relationship with growth remains unclear. It is possible that these morbidities impact on the diet of children with OA, but detailed analysis of dietary composition and quality, and its relationship with these complications and growth, has not yet been conducted. Another potential area of research in OA is the role of the microbiota in growth and nutrition. While the microbiota has been linked to growth impairment in other paediatric conditions,it is yet to be investigated in OA. Further research is needed to identify the most,important contributory factors to poor growth, the role of the intestinal microbiota, and effective interventions to maximise growth and nutritional outcomes in this cohort.     

A review of postoperative feeding regimens in infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis is a condition well known to pediatric surgeons. Postoperative length of hospital stay is a financial concern and remains a potential target for reduction in hospital costs. Ultimately, these costs are directly affected by the ability to effectively advance postoperative enteral nutrition. This review will serve to: 1) identify clinically relevant postoperative feeding patterns following pyloromyotomy, 2) review the relevant literature to determine an optimal feeding pattern, and 3) identify possible preoperative predictors that may determine the success of postoperative feeding regiments.     

Food selectivity in children with and without an autism spectrum disorder: Investigation of diagnosis and age

Feeding problems are common in children with autism spectrum disorders (ASDs), with food selectivity being the most frequently reported. Selectivity based on type and/or texture of food is of concern in those with ASD. Variations in symptom presentation of food selectivity in children with different autism spectrum diagnoses across childhood have not often been investigated. Parent-report of food selectivity was examined in 525 children age 2–18 years diagnosed with autistic disorder, PDD-NOS, Asperger's disorder, atypical development, and typical development using information garnered from the Autism Spectrum Disorder-Comorbidity for Children (ASD-CC), a tool to assess emotional issues and comorbid psychopathology. Individuals with an ASD were reported to have significantly more food selectivity than both the atypically developing group and the typically developing group. In addition, the ASD groups, when looked at together, showed a decrease in food selectivity across childhood with significant decrease in the Asperger's disorder group.     

机械通气患儿能量代谢特点和喂养状态研究

目的：通过间接测热法测定机械通气患儿静息能量消耗,研究其能量代谢特点和喂养状态,为改进营养支持策略提供依据。方法以2013年2月至2013年11月入住PICU,符合间接测热条件的37例机械通气患儿为研究对象,自符合测定条件起第1、4、7、10、14和21天测定静息能量消耗( measurement of resting energy expenditure,MREE),运用Schofield-HTWT公式计算预测静息能量消耗值( predicted resting energy expenditure,PREE),并统计每日热量摄入值。按MREE/PREE比值评定代谢状态：低代谢(<90％)、正常代谢(90％~110％)和高代谢(>110％)。按热量摄入值/MREE 比值评定喂养状态：喂养不足(<90％)、喂养适当(90％~110％)和喂养过度(>110％)。结果37例危重症儿童机械通气第1天,15例(40.5％)为低代谢,9例(24.3％)为正常代谢,13例(35.1％)为高代谢;机械通气第7天,呈高代谢状态患儿比例增加至46.7％,但较第1天无统计学差异(χ2＝0.516,P＝0.972)。营养支持应用率为81.1％;实施营养支持者,累计实施间接测热82次,每日热量摄入值为(33.4±22.2)kcal/(kg?d),显著低于MREE水平[(53.7±17.4)kcal/(kg?d)](t＝6.505,P<0.01)。在实施营养支持过程中,机械通气患儿有62 d(75.6％)喂养不足,8 d(9.8％)喂养适当,12 d(14.6％)喂养过度。结论 PICU滞留期间机械通气患儿能量代谢状态不断变化,且PICU滞留期间有近90％的时间里患儿喂养不达标。