不同胎龄超低出生体重儿肠内喂养状况比较

柯若; 陈思思; 周瑞茜; 胡莹莹

doi:10.16766/j.cnki.issn.1674-4152.002595

不同胎龄超低出生体重儿肠内喂养状况比较

doi: 10.16766/j.cnki.issn.1674-4152.002595

温州医科大学附属第二医院新生儿科，浙江温州 325000

基金项目:

浙江省基础公益研究计划项目 LQ20H040002

详细信息

通讯作者:
胡莹莹，E-mail：gongcailanpo@163.com

中图分类号: R722.19 R459.3
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出版历程
- 收稿日期: 2021-11-02

Comparison of enteral feeding status of extremely low birth weight infant of different gestational ages

Department of Neonatology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨和比较不同胎龄超低出生体重儿(ELBWI)肠内喂养状况间的差异。方法选取2019年1月—2020年12月温州医科大学附属第二医院新生儿重症监护病房(NICU)收治的ELBWI共120例为研究对象, 根据胎龄将患儿分为胎龄＜28周组68例和胎龄≥28周组52例。比较2组肠内喂养状况及肠内营养不耐受(FI)情况。结果胎龄＜28周组生后前3周奶量明显少于胎龄≥28周组(t=-2.208、-13.148、-27.781，均P < 0.05)；胎龄＜28周组首次达到足量肠内喂养时间、总住院时间均明显高于胎龄≥28周组(t=8.459、22.654，P < 0.05)；而恢复出生体重后体重增长速率、出院时体重均明显低于胎龄≥28周组(t=-10.034、-12.042，均P < 0.05)。住院期间胎龄＜28周组支气管肺发育不良(BPD)发生率、坏死性小肠结肠炎(NEC)发生率、有创机械通气比例、2周内应用布洛芬比例、抗生素应用时间＞2周比例均明显高于胎龄≥28周组(χ²=7.169、6.114、4.544、4.834、4.488，均P < 0.05)；而FI持续时间、生后2周内FI发生率及FI复发率明显高于胎龄≥28周组(均P < 0.05)。结论不同胎龄ELBWI的肠内喂养状况差异较大，与胎龄≥28周ELBWI相比较，胎龄＜28周ELBWI的FI复发率更高，喂养耐受性差，生长发育缓慢。
- 超低出生体重儿 /
- 胎龄 /
- 肠内喂养
Abstract: Objective To investigate and compare the differences in enteral feeding status amongst extremely low birth weight infants (ELBWI) of different gestational ages. Methods A total of 120 ELBWI patients admitted to the neonatal intensive care unit (NICU) of the Second Affiliated Hospital of Wenzhou Medical University from January 2019 to December 2020 were selected as the research subjects. According to the gestational age, the children were divided into the gestational age < 28 weeks group (n=68) and the gestational age ≥28 weeks group (n=52). Enteral feeding status and enteral nutritional intolerance (FI) were compared between the two groups. Results The amount of milk in the first 3 weeks after birth in the gestational age < 28 weeks group was significantly lower than that in the gestational age ≥28 weeks group (t=-2.208, -13.148, -27.781, all P < 0.05). The time to reach sufficient enteral feeding for the first time and the total length of hospital stay in the gestational age < 28 weeks group were significantly higher than those in the gestational age ≥28 weeks group (t=8.459, 22.654, all P < 0.05). The rate of weight gain after birth weight recovery and weight at discharge were significantly lower than those in the gestational age ≥28 weeks group (t=-10.034, -12.042, all P < 0.05). During hospitalisation, the incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, invasive mechanical ventilation, ibuprofen use within 2 weeks and antibiotic use >2 weeks in gestational age < 28 weeks were significantly higher than those in gestational age≥28 weeks (χ²=7.169, 6.114, 4.544, 4.834, 4.488, all P < 0.05). The duration of FI, the incidence of FI within 2 weeks after birth and the recurrence rate of FI in gestational age < 28 weeks were significantly higher than those of gestational age ≥28 weeks (all P < 0.05). Conclusion The enteral feeding status of ELBWI at different gestational ages varies greatly. Compared with ELBWI of ≥28 weeks of gestational age, ELBWI of < 28 weeks of gestational age have higher FI recurrence rate, poor feeding tolerance and slow growth and development.
- Extremely low birth weight infant /
- Gestational age /
- Enteral feeding
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表 1 2组ELBWI一般资料比较

Table 1. General data of ELBWI were compared between the two groups

组别	例数	性别[例(%)]		分娩方式[例(%)]		出生体重 (x±s，g)	出生时身长 (x±s，cm)
组别	例数	男	女	剖宫产	顺产	出生体重 (x±s，g)	出生时身长 (x±s，cm)
胎龄＜28周组	68	37(54.41)	31(45.59)	23(33.82)	45(66.18)	802.78±12.79	43.82±2.63
胎龄≥28周组	52	27(51.92)	25(48.07)	21(36.21)	31(59.62)	865.83±15.92	44.15±2.78
统计量		0.073^a		0.546^a		-24.056^b	-0.664^b
P值		0.787		0.460		＜0.001	0.505
注：^a为χ²值，^b为t值。

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表 2 2组ELBWI肠内喂养情况比较[x±s，mL/(kg·d)]

Table 2. Comparison of enteral feeding of ELBWI between the two groups [x±s, mL/(kg·d)]

组别	例数	开奶量	生后第1周奶量	生后第2周奶量	生后第3周奶量	生后第4周奶量	出院时奶量	F值	P值
胎龄＜28周组	68	13.50±1.87	26.52±3.75	58.73±5.72^a	87.36±4.71^ab	122.76±7.92^abc	157.24±11.48^abcd	3 422.032	＜0.001
胎龄≥28周组	52	12.97±1.78	27.91±3.68	72.69±5.82^a	113.75±5.69^abc	124.85±8.74^abc	159.73±13.86^abcd	1 926.672	＜0.001
t值		0.533	-2.208	-13.148	-27.781	-1.369	-1.076
P值		0.595	0.045	＜0.001	＜0.001	0.174	0.284
注：与同组生后第1周比较，^aP＜0.05；与同组生后第2周比较，^bP＜0.05；与同组生后第3周比较，^cP＜0.05；与同组生后第4周比较，^dP＜0.05。

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表 3 2组ELBWI生长指标及住院时间比较(x±s)

Table 3. ELBWI growth index and hospitalization time were compared between the two groups(x±s)

组别	例数	首次达到足量肠内喂养时间(d)	恢复出生体重后体重增长速率(%)	出院时体重(g)	住院时间(d)
胎龄＜28周组	68	32.57±2.46	14.62±1.72	2 175.84±135.63	68.82±2.42
胎龄≥28周组	52	28.62±2.63	18.47±2.48	2 483.71±142.81	57.79±2.91
t值		8.459	-10.034	-12.042	22.654
P值		＜0.001	＜0.001	＜0.001	＜0.001

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表 4 2组ELBWI住院期间主要疾病和治疗措施比较[例(%)]

Table 4. Comparison of main diseases and treatment measures during hospitalization between two groups of ELBWI[cases (%)]

组别	例数	BPD	NEC	有创机械通气	2周内应用布洛芬	抗生素应用＞2周
胎龄＜28周组	68	49(72.06)	17(25.00)	13(19.12)	45(66.18)	59(86.76)
胎龄≥28周组	52	25(48.08)	4(7.69)	3(5.77)	24(46.16)	37(71.15)
χ²值		7.169	6.114	4.544	4.834	4.488
P值		0.007	0.013	0.033	0.028	0.034

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表 5 2组ELBWI的FI发生情况比较

Table 5. The incidence of FI in ELBWI was compared between the two groups

组别	例数	FI总发生[例(%)]	FI持续时间(x±s，d)	生后2周内FI发生率[例(%)]	FI复发[例(%)]
胎龄＜28周组	68	56(82.35)	51.72±1.48	53(77.94)	32(47.06)
胎龄≥28周组	52	38(73.08)	46.78±1.87	31(59.62)	15(28.85)
统计量		1.494^a	16.156^b	4.172^a	4.102^a
P值		0.222	＜0.001	0.030	0.043
注：^a为χ²值，^b为t值。

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