影响极低出生体重儿体重增长的多因素分析

目的探讨影响极低出生体重儿(VLBW)体重增长的相关因素。方法对1998年7月—2004年3月重庆医科大学儿童医院新生儿病房收治的51例VLBW进行回顾性分析。结果单因素分析发现,早开奶、热卡摄入量和蛋白质摄入量对体重增长有显著性影响(P<0·05)。多元逐步回归分析结果示,热卡摄入量和蛋白质摄入量是影响体重增长的显著因素,回归方程为Y(体重增长)=-6·426+0·120X1(热卡摄入量)+3·737X2(蛋白质摄入量)(P<0·01)。达到体重增长目标对象中单纯胃肠内营养组和部分胃肠外营养组热卡摄入量分别为(520·62±21·59)kJ/(kg·d)(124·43±5·16)kcal/(kg·d)]、(451·49±68·41)kJ/(kg·d)(107·98±16·35)kcal/(kg·d)],差异有统计学意义(P<0·05)。早开奶组出生体重恢复时间、住院时间和胃肠外营养液体量占总液量比例>75%时间平均秩分别为18·58、20·24、20·11,晚开奶组分别为33·00、32·48、31·83,差异有统计学意义(P<0·05)。结论VLBW在生后应保证足量热卡和蛋白质的供给,对于小于胎龄儿和有严重并发症的患儿更应该加强营养的补充,对VLBW应尽早喂养,同时需要胃肠外营养作为肠内营养的补充。

Multiple-factor analysis of weight gain in very low birth weight infants

OBJECTIVE: To investigate the correlative factors of weight gain in very low birth weight infants (VLBW). METHODS: Fifty-one cases of VLBW from July 1998 to March 2004 were analyzed retrospectively. RESULTS: Twenty two cases were small for gestational age (SGA) and 29 cases were appropriate for gestational age (AGA). The age of first feeding was (2.35 +/- 2.29) d. Caloric intake was (377.61 +/- 121.50) kJ/(kg.d) (90.25 +/- 29.04) kcal/(kg.d)] and protein intake was (2.18 +/- 0.83) g/(kg.d). The age of birth weight regained was (7.41 +/- 3.57) d and the velocity of weight gain was (16.38 +/- 9.29) g/d or (12.63 +/- 7.15) g/(kg.d). Single factor analysis found that early feeding and caloric supply and protein supply had significant influence on weight gain (P < 0.05). The result of multivariate linear analysis showed that the significant risk factors were associated with supply of calorie and protein. The equation was Y (weight gain) = -6.426 + 0.120X(1) (caloric supply) + 3.737X(2) (protein supply) (P < 0.01). The caloric supply of the cases that achieved the nutritional goal was (468.19 +/- 67.11) kJ/(kg.d), (111.90 +/- 16.04) kcal/(kg.d)], and that with enteral nutrition and partial parenteral nutrition was (520.62 +/- 21.59) kJ/(kg.d)], (124.43 +/- 5.16) kcal/(kg.d), (451.49 +/- 68.41) kJ/(kg.d)], (107.98 +/- 16.35) kcal/(kg.d)] respectively. There was significant difference between the two groups (P < 0.05). The mean rank of time of birth weight regaining, the time in hospital stay and duration of parenteral nutrition providing at least 75% of the total daily fluid volume was 18.58, 20.24 and 20.11 in the group of early feeding, and it was 33.00, 32.48 and 31.83 in the group of late feeding, respectively. There were significant differences between the two groups (P < 0.05). CONCLUSION: Sufficient supply of calorie and protein should be ensured in VLBW infants, especially in SGA and severely ill infants. It was very important to feed VLBW infants as early as possible, which could improve feeding tolerance and gastrointestinal maturation. VLBW infants should receive parenteral nutrition as supplements to enteral feeding.