深度水解蛋白配方奶对极低出生体质量儿喂养的影响

目的 探讨深度水解蛋白配方奶(HPF)开奶与标准早产儿配方奶(SPF)相比,是否能减少极低出生体质量儿(VLBWI)喂养不耐受,使VLBWI更早达到全肠道喂养,促进VLBWI的生长发育.方法 随机将2009年1-6月本院NICU收治的VLBWI 30例分为HPF组及 SPF组,2组均以20 mL·kg-1·d-1开奶,并在能耐受的情况下按此速度加奶.HPF组在日龄14 d结束HPF喂养,换等量的SPF喂养;SPF组持续以SPF喂养.观察2组患儿开奶前7 d胃潴留总次数、第7天餐前胃残留奶量(包括最大胃残留量、全天胃残留总量/全天预计喂奶量)、体质量增长速度、达完全肠道喂养时间、28 d时体格发育情况及是否合并坏死性小肠结肠炎(NEC).结果 与SPF组相比,HPF组开奶前7 d胃残留总次数(15.5±2.9)次 vs(17.1±4.5次)]、第7天最大胃残留量(0.9±1.0) mL vs (1.8±1.3) mL]、第7天全天胃残留量/全天预计奶量(3.1±4.8)% vs (8.7±6.9)%]降低,胃排空改善,胃潴留量减少,达完全肠内喂养时间缩短(12.7±4.2) d vs (16.6±4.8) d],平均每日体质量增长加快(15.37±4.08) g·d-1 vs (11.02±3.49) g·d-1],差异均有统计学意义(Pa<0.05).2组患儿28 d时头围(30.01±1.11) cm vs (29.05±1.20) cm]、身长(42.85±1.62) cm vs (41.55±1.51) cm]、体质量(1.792±0.213) kg vs (1.617±0.187) kg]比较,差异均有统计学意义(Pa<0.05).2组患儿NEC发病率有明显差异.结论 HPF能够促进胃排空,改善VLBWI的喂养不耐受,并使其更早达到完全肠道内喂养,从而促进VLBWI的生长发育,可将HPF用于VLBWI的开奶.

Effect of Extensively Hydrolyzed Protein Formula on Feeding of Very Low Birth Weight Infants

Objective To investigate whether extensively hydrolyzed protein formula(HPF),compared with standard preterm infant formula(SPF),can accelerate gastric emptying,and improve early feeding tolerance,enable a more rapid establishment of full enteral feeding and promote the development of very low birth weight infants(VLBWI).Methods Thirty VLBWI who admitted in NICU of Hubei Maternity and Child Health Hospital from Jan.2009 to Jun.2009 were randomly divided into HPF group(n=16) and SPF group(n=14).Bolus feeding every 2 to 3 hours were started and accelerated at a speed of 20 mL·kg-1·d-1 if tolerance.HPF group received HPF feeding for 14 days,then change to SPF feeding for the other 14 days.SPF group received SPF feeding for the entire 28 days.Gastric residuals,rate of weigh gain,full enteral feeding time and the incidence of necrotizing enterocolitis(NEC) were compared.The weight,body length and head circumference at 28 day were recorded.Results Compared with SPF group,gastric emptying in HPF group was significantly improved,gastric residual was much less.The total gastric residual number of the first 7 days (15.5±2.9) times vs(17.1±4.5) times],maximum residual on the 7th day(0.9±1.0) mL vs(1.8±1.3) mL],maximum residual as a percentage of total feed volume on the 7th day(3.1±4.8)% vs(8.7±6.9)%] were decreased.Less time was required to achieve full enteral feeding(12.7±4.2) d vs(16.6±4.8) d] in HPF group compared with SPF group,and the rate of weight gain was increased (15.37±4.08) g·d-1 vs(11.02±3.49) g·d-1].There was also statistically significant difference with regard to growth measured by head circumference(30.01±1.11) cm vs(29.05±1.20) cm],and length (42.85±1.62) cm vs(41.55±1.51) cm],weight(1.792±0.213) kg vs(1.617±0.187) kg] on the 28th day.There were statistically significant difference in NEC morbidity between 2 groups.Conclusions HPF can improve gastric emptying and feeding tolerance,and enable a more rapid establishment of full enteral feeding in VLBWI compared with SPF,so it can be used as starter formula.