基于循证的标准化喂养方案可以帮助极早产儿/极低出生体重儿尽早达到全肠道喂养

Evidence-based standardized nutrition protocol can shorten the time to full enteral feeding in very preterm/very low birth weight infants

摘要:

目的 探讨实施基于循证的标准化喂养方案能否促进极早产儿/极低出生体重儿全胃肠道营养建立及其对早期临床结局的影响。 方法 回顾性纳入胎龄≤32周或出生体重<1 500 g的早产儿312例为研究对象。根据2020年5月实施早产儿标准化喂养方案前后1年时间将患儿分为对照组（2019年5月1日至2020年4月30日，n=160）和试验组（2020年6月1日至2021年5月31日，n=152），比较两组患儿达到全肠道喂养时间、开始肠内喂养时间、静脉营养持续时间、恢复至出生体重时间、中心静脉留置时间的差异及相关早产儿常见合并症发生率。 结果 试验组达到全肠道喂养时间、肠内喂养开始时间、静脉营养持续时间和中心静脉留置时间均较对照组明显缩短，中心导管相关性血流感染率较对照组明显降低（P<0.05），但Ⅱ~Ⅲ期新生儿坏死性小肠结肠炎等早产儿常见合并症的发生率及病死率在两组间比较差异无统计学意义（P>0.05）。 结论 实施早产儿标准化喂养方案可以帮助极早产儿/极低出生体重儿更快建立全肠道喂养，减少静脉营养使用，降低中心导管相关性血流感染，而不增加新生儿坏死性小肠结肠炎风险。

Abstract:

Objective To investigate whether evidence-based standardized nutrition protocol can facilitate the establishment of full enteral nutrition and its effect on short-term clinical outcomes in very preterm/very low birth weight infants. Methods A retrospective analysis was performed on the medical data of 312 preterm infants with a gestational age of ≤32 weeks or a birth weight of <1 500 g. The standardized nutrition protocol for preterm infants was implemented in May 2020; 160 infants who were treated from May 1, 2019 to April 30, 2020 were enrolled as the control group, and 152 infants who were treated from June 1, 2020 to May 31, 2021 were enrolled as the test group. The two groups were compared in terms of the time to full enteral feeding, the time to the start of enteral feeding, duration of parenteral nutrition, the time to recovery to birth weight, the duration of central venous catheterization, and the incidence rates of common complications in preterm infants. Results Compared with the control group, the test group had significantly shorter time to full enteral feeding, time to the start of enteral feeding, duration of parenteral nutrition, and duration of central venous catheterization and a significantly lower incidence rate of catheter-related bloodstream infection (P<0.05). There were no significant differences between the two groups in the mortality rate and the incidence rate of common complications in preterm infants including grade II-III necrotizing enterocolitis (P>0.05). Conclusions Implementation of the standardized nutrition protocol can facilitate the establishment of full enteral feeding, shorten the duration of parenteral nutrition, and reduce catheter-related bloodstream infection in very preterm/very low birth weight infants, without increasing the risk of necrotizing enterocolitis.