我国NICU早产儿营养状况的多中心研究
摘要
目的：了解我国不同地区NICU中早产儿住院期间的营养状况,分析影响早产儿生长发育的高危因素。
方法：采用回顾性调查的方法,收集2005年1月1日至2006年6月30日我国十所医院早产儿的临床资料,包括住院期间的喂养方式、营养状况、并发症及治疗,对影响早产儿生长发育的危险因素进行分析。
结果：入选对象1000例,收集合格调查表974份。平均胎龄32.8±2.0周,平均出生体重1794.9±449.5克。其中胎龄<32周378例、体重<1500克285例。开始喂养时间平均第2.84±2.13天。早产配方奶喂养占77.0%,母乳十早产配方奶喂养占13.6%。肠外营养应用氨基酸占87.3%,开始应用时间3.1±2.1天；应用脂肪乳剂占56.9%,开始应用时间4.3±3.2天。住院期间总热卡达120kcal/kg. d者占74.1%,达标日龄平均为16.3±9.4天；口服热卡达100kcal/kg. d者占84.1%,达标日龄平均为17.0±9.4天。胎龄越小,达标日龄越晚,且各医院之间有差异。早产儿平均生理性体重下降幅度为出生体重的7.54±4.7%,恢复体重日龄10.92±5.1天。住院期间平均体重增长速度13.4±6.0g/kg.d,平均住院时间26.4±12.9天。在696例单胎早产儿中以体重、身高和头围作为生长参数,在出院时以纠正胎龄的相应百分位数进行评价,分别有60%、58.9%、29.5%的早产儿其体重、身高和头围低于第10百分位,较出生时分别提高了32.7、30.9和10.2个百分点。
结论：我国早产儿住院期间的营养状况不容乐观,各医院对早产儿的营养支持策略差异显著；出生体重小于第十百分位、开始喂养时间晚和体重增长速度慢是导致早产儿出生后生长迟缓的危险因素；而开始喂养时间晚、体重下降幅度大、恢复体重日龄及总热卡达标日龄延迟是影响早产儿住院期间体重增长速度的主要原因。因此积极的营养支持策略对改善我国早产儿的营养状况及远期预后有重要意义。
Objective:To study the nutritional status of premature infants who were in early stage of life at the different areas in China and the effects of high risk factors on their growth.
Methods:Data of premature infants of10hospitals were retrospectively collected, including their complications and treatment, nutrition support, growth velocity, from Jan1,2005to Jun30,2006.The risk factors which resulted in growth retardation of premature infants were identified.
Results:A total of1000premature infants were enrolled in our study and finally the data of974premature infants was eligible. Of974premature infants mean gestational age was32.8±2.0weeks and mean birth weight was1794.9±449.5g at birth.378premature infants<32weeks of gestational age and285premature infants were<1500g of birth weight. Mean time of initial enteral feeding was2.84±2.13day of life,77%of premature infants were fed with the formulas for low birth weight and13.6%of premature infants were fed by human milk mixed with the formulas for low birth weight. For parenteral nutrition amino acid solutions were administered in87.3percent of premature infants and Mean time to begin was3.1±2.1day of life, lipid emulsions were supplied in56.9%of premature infants and Mean time to begin was4.3±3.2day of life. During hospitalization there were74.1%of premature infants whose total energy intake reached recommendations of120kcal/kg/d and mean time to reach recommendations was16.3±9.4day of life,84.1%of premature infants whose energy intake of enteral feeding reached100kcal/kg/d and mean time to achieve was17.0±9.4day of life. Lower was gestational age of premature infants longer the time achieving these goals was and the differences were obvious among10hospitals. Mean loss of weight was7.54±4.7%of birth weight in the first days of life and the day of life when infants regain to birth weight was10.92±5.1days. Mean growth velocity after regaining to birth weight during hospitalization was13.4±6. Og/kg. d and mean Length of hospital stay was26.4±12.9days. The growth parameters of infants were evaluated with their adjusted gestational age on discharge. There were60%,58.9%,29.5%of infants for weight, length and head circumference respectively, who had values<10th percentile and the percentages were heighten by32.7,30.9and10.2respectively compared with those at birth.
Conclusions:The nutritional status of premature infants in China during hospitalization is series.Difference of nutrition support strategy between hospitals is obvious. Less than10th percentile in birth weight, later introduction of enteral feedings and slower growth velocity during hospitalization were risk factors for postnatal growth retardation of premature infants. The aggressive nutrition support strategy will be important for improving the nutritional status and development of premature infants in China.
方法：采用回顾性调查的方法,收集2005年1月1日至2006年6月30日我国十所医院早产儿的临床资料,包括住院期间的喂养方式、营养状况、并发症及治疗,对影响早产儿生长发育的危险因素进行分析。
结果：入选对象1000例,收集合格调查表974份。平均胎龄32.8±2.0周,平均出生体重1794.9±449.5克。其中胎龄<32周378例、体重<1500克285例。开始喂养时间平均第2.84±2.13天。早产配方奶喂养占77.0%,母乳十早产配方奶喂养占13.6%。肠外营养应用氨基酸占87.3%,开始应用时间3.1±2.1天；应用脂肪乳剂占56.9%,开始应用时间4.3±3.2天。住院期间总热卡达120kcal/kg. d者占74.1%,达标日龄平均为16.3±9.4天；口服热卡达100kcal/kg. d者占84.1%,达标日龄平均为17.0±9.4天。胎龄越小,达标日龄越晚,且各医院之间有差异。早产儿平均生理性体重下降幅度为出生体重的7.54±4.7%,恢复体重日龄10.92±5.1天。住院期间平均体重增长速度13.4±6.0g/kg.d,平均住院时间26.4±12.9天。在696例单胎早产儿中以体重、身高和头围作为生长参数,在出院时以纠正胎龄的相应百分位数进行评价,分别有60%、58.9%、29.5%的早产儿其体重、身高和头围低于第10百分位,较出生时分别提高了32.7、30.9和10.2个百分点。
结论：我国早产儿住院期间的营养状况不容乐观,各医院对早产儿的营养支持策略差异显著；出生体重小于第十百分位、开始喂养时间晚和体重增长速度慢是导致早产儿出生后生长迟缓的危险因素；而开始喂养时间晚、体重下降幅度大、恢复体重日龄及总热卡达标日龄延迟是影响早产儿住院期间体重增长速度的主要原因。因此积极的营养支持策略对改善我国早产儿的营养状况及远期预后有重要意义。
Objective:To study the nutritional status of premature infants who were in early stage of life at the different areas in China and the effects of high risk factors on their growth.
Methods:Data of premature infants of10hospitals were retrospectively collected, including their complications and treatment, nutrition support, growth velocity, from Jan1,2005to Jun30,2006.The risk factors which resulted in growth retardation of premature infants were identified.
Results:A total of1000premature infants were enrolled in our study and finally the data of974premature infants was eligible. Of974premature infants mean gestational age was32.8±2.0weeks and mean birth weight was1794.9±449.5g at birth.378premature infants<32weeks of gestational age and285premature infants were<1500g of birth weight. Mean time of initial enteral feeding was2.84±2.13day of life,77%of premature infants were fed with the formulas for low birth weight and13.6%of premature infants were fed by human milk mixed with the formulas for low birth weight. For parenteral nutrition amino acid solutions were administered in87.3percent of premature infants and Mean time to begin was3.1±2.1day of life, lipid emulsions were supplied in56.9%of premature infants and Mean time to begin was4.3±3.2day of life. During hospitalization there were74.1%of premature infants whose total energy intake reached recommendations of120kcal/kg/d and mean time to reach recommendations was16.3±9.4day of life,84.1%of premature infants whose energy intake of enteral feeding reached100kcal/kg/d and mean time to achieve was17.0±9.4day of life. Lower was gestational age of premature infants longer the time achieving these goals was and the differences were obvious among10hospitals. Mean loss of weight was7.54±4.7%of birth weight in the first days of life and the day of life when infants regain to birth weight was10.92±5.1days. Mean growth velocity after regaining to birth weight during hospitalization was13.4±6. Og/kg. d and mean Length of hospital stay was26.4±12.9days. The growth parameters of infants were evaluated with their adjusted gestational age on discharge. There were60%,58.9%,29.5%of infants for weight, length and head circumference respectively, who had values<10th percentile and the percentages were heighten by32.7,30.9and10.2respectively compared with those at birth.
Conclusions:The nutritional status of premature infants in China during hospitalization is series.Difference of nutrition support strategy between hospitals is obvious. Less than10th percentile in birth weight, later introduction of enteral feedings and slower growth velocity during hospitalization were risk factors for postnatal growth retardation of premature infants. The aggressive nutrition support strategy will be important for improving the nutritional status and development of premature infants in China.
引文
1. Yu VY, Karen Simmer. Enteral nutrition:practical aspects, strategy and management In:Tsang RC, Uauy R, Koletzko B, Zlotkin SH, editors. Nutrition of the Preterm Infant.2nd Ed. Digital Educational publishing, Inc. Cincinnati, Ohio,2005.311-332.
2. Premji SS. Standardised feeding regimens:Hope for reducing the risk of necrotising enterocolitis [J]. Arch Dis Child Fetal Neonatal Ed,2005,90 (3):192-193.
3. Lau C. Oral feeding in the preterm infant. NeoReviews.2006;7:e19-27.
4. O'Reilly BK, Duenas ML, Greecher C, et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition. Pediatrics,2003,111:e461-470.
5. Schanler RJ, Atkinson SA. Human milk. In:Tsang RC, Uauy R, Koletzko B, Zlotkin SH, editors. Nutrition of the Preterm Infant.2nd Ed. Digital Educational publishing,Inc. Cincinnati:Ohio,2005.333-356.
6. Patel AL, Meier PP, Engstrom JL. The evidence for use of human milk in very low-birthweight preterm infants. NeoReviews,2007,8:e459-e466.
7. te Bmake FW, van den Akker CH, Wattlmena DJ, et al. Anino acid administration to prematureinfants directly after bilth[J]. J Pedintr,2005,147(4).457-461.
8. Lehner F, demmemair H, Roschinger W, et al. Metbolic effects of intravenous LCT or MCT/LCT lipid emulsions in preterm infants[J]. J Lipid Res,2006, 47(2):404-411.
9.中华医学会肠外肠内营养学分会儿科协作组,中华医学会儿科学分会新生儿学组,中华医学会小儿外科学分会新生儿学组.中国新生儿营养支持临床应用指南.临床儿科杂志,2006,24：692-695。
10. Committee on Nutrition, American Academy of Pediatrics. Pediattic Nutrition Handbook[M].4th edition. Elk Grove Village, Ill. American Academy of Pediatrics.1998:305-312.
11. Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation:a universal problem in preterm infants. Arch Dis Child Fetal Neonatal Ed,2004,89:F428-430.
12. Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics,2003,111: 986-990.
13. Radmacher PG, Looney SW, Rafail ST, et al. Prediction of Extrauterine Growth Retardation in VVLBW Infants. J Perinatol,2003,23:392-395.
14.孙秀静万伟琳董梅等.极或超低出生体重儿41例追赶生长情况的临床研究.中国新生儿科杂志,2008。
15. Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation:an inevitable consequence of current recommendations in preterm infants? Pediatrics,2001,107:270-273.
16. Yu VY. Extrauterine growth restriction in preterm infants:importance of optimizing nutrition in neonatal intensive care units. Croat Med J, 2005,46:737-743.
17.张宝林,冯泽康,张丽辉.中国15城市不同胎龄新生儿体格发育调查研究.中华儿科杂志,1988,26：206-208。
18. O'Reilly BK, Duenas ML, Greecher C, et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition. Pediatrics,2003,111:e461-470.
19. Blackwell MT, Eichenwald EC, McAlmon K, et al. Interneonatal intensive care unit variation in growth rates and feeding practices in healthy moderately premature infants. J Perinatol,2005,25:478-85.
20. Yu VY. Extrauterine growth restriction in preterm infants:importance of optimizing nutrition in neonatal intensive care units. Croat Med J, 2005,46:737-743
1. Cook R. Postnatal growth in preternal infants:Have we got it right? [J]. J Perinatol, 2005,25(suppl 2):S12-14.
2. Christensen RD, et al. Patten of daily weights among low birth weight neonates in the neonatal intensive care unit:data from a multihospital health-care system[J]. J perinatal,2006,26(1):34-43.
3. Lucas A. Long-term programming effects of early nutrition-implications for the preterm infants [J]. J prenatal,2005(suppl 2):S2-6.
4. Singhal, Lucas A. Early origins of cardiovascular disease. Is there a unifying hypothesis? [J]. Lancet,2004,363(9421):1642-1645.
5. Medoff CB, Ray W. Neonatal sucking behaviors [J]. J Nurs Res,1995,27:195-200.。
6. HafstromM, Lundquist C, Lindecrantz K, et al. Recording non-nutritive sucking in the neonates [J]. Acta Pediatr,1997,86:82-90.
7. Averous J, Bruhat A, Mordier S, et al. Recent advances in the understanding of amino acid regulation of gene expression [J]. J Nutr,2003,(suppl 6):S2040-S2045.
8.董梅,王丹华,丁国芳,等.极低出生体重儿胃肠喂养的临床观察[J].中华儿科杂志,2003,41(2)：87-90.
9. Lucas A. Programming by early nutrition:An experimental approach[J]. J Nutr,1998,128 (suppl 2):S401-S406.
10. Smith JR. Early enteral feeding for the very low birth weight infant:the development and impact of a research-based guidline[J]. Neonatal Netw, 2005,24(4); 9-19.
11. Teitelbawm DH, Tracy TF, et al. Use of cholecystokininoctapeptide for the prevention of parenteral nutrition -associated cholestasis[J]. Pediatrcs,2005,115(5):1332-1340.
12. Pande S, Brion LP, et al. Lack of effect of L-carnitine supplemention on weight gain in very preterm infants[J]. J Perinatal,2005(7):470-477.
2. Premji SS. Standardised feeding regimens:Hope for reducing the risk of necrotising enterocolitis [J]. Arch Dis Child Fetal Neonatal Ed,2005,90 (3):192-193.
3. Lau C. Oral feeding in the preterm infant. NeoReviews.2006;7:e19-27.
4. O'Reilly BK, Duenas ML, Greecher C, et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition. Pediatrics,2003,111:e461-470.
5. Schanler RJ, Atkinson SA. Human milk. In:Tsang RC, Uauy R, Koletzko B, Zlotkin SH, editors. Nutrition of the Preterm Infant.2nd Ed. Digital Educational publishing,Inc. Cincinnati:Ohio,2005.333-356.
6. Patel AL, Meier PP, Engstrom JL. The evidence for use of human milk in very low-birthweight preterm infants. NeoReviews,2007,8:e459-e466.
7. te Bmake FW, van den Akker CH, Wattlmena DJ, et al. Anino acid administration to prematureinfants directly after bilth[J]. J Pedintr,2005,147(4).457-461.
8. Lehner F, demmemair H, Roschinger W, et al. Metbolic effects of intravenous LCT or MCT/LCT lipid emulsions in preterm infants[J]. J Lipid Res,2006, 47(2):404-411.
9.中华医学会肠外肠内营养学分会儿科协作组,中华医学会儿科学分会新生儿学组,中华医学会小儿外科学分会新生儿学组.中国新生儿营养支持临床应用指南.临床儿科杂志,2006,24：692-695。
10. Committee on Nutrition, American Academy of Pediatrics. Pediattic Nutrition Handbook[M].4th edition. Elk Grove Village, Ill. American Academy of Pediatrics.1998:305-312.
11. Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation:a universal problem in preterm infants. Arch Dis Child Fetal Neonatal Ed,2004,89:F428-430.
12. Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics,2003,111: 986-990.
13. Radmacher PG, Looney SW, Rafail ST, et al. Prediction of Extrauterine Growth Retardation in VVLBW Infants. J Perinatol,2003,23:392-395.
14.孙秀静万伟琳董梅等.极或超低出生体重儿41例追赶生长情况的临床研究.中国新生儿科杂志,2008。
15. Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation:an inevitable consequence of current recommendations in preterm infants? Pediatrics,2001,107:270-273.
16. Yu VY. Extrauterine growth restriction in preterm infants:importance of optimizing nutrition in neonatal intensive care units. Croat Med J, 2005,46:737-743.
17.张宝林,冯泽康,张丽辉.中国15城市不同胎龄新生儿体格发育调查研究.中华儿科杂志,1988,26：206-208。
18. O'Reilly BK, Duenas ML, Greecher C, et al. Evaluation, development, and implementation of potentially better practices in neonatal intensive care nutrition. Pediatrics,2003,111:e461-470.
19. Blackwell MT, Eichenwald EC, McAlmon K, et al. Interneonatal intensive care unit variation in growth rates and feeding practices in healthy moderately premature infants. J Perinatol,2005,25:478-85.
20. Yu VY. Extrauterine growth restriction in preterm infants:importance of optimizing nutrition in neonatal intensive care units. Croat Med J, 2005,46:737-743
1. Cook R. Postnatal growth in preternal infants:Have we got it right? [J]. J Perinatol, 2005,25(suppl 2):S12-14.
2. Christensen RD, et al. Patten of daily weights among low birth weight neonates in the neonatal intensive care unit:data from a multihospital health-care system[J]. J perinatal,2006,26(1):34-43.
3. Lucas A. Long-term programming effects of early nutrition-implications for the preterm infants [J]. J prenatal,2005(suppl 2):S2-6.
4. Singhal, Lucas A. Early origins of cardiovascular disease. Is there a unifying hypothesis? [J]. Lancet,2004,363(9421):1642-1645.
5. Medoff CB, Ray W. Neonatal sucking behaviors [J]. J Nurs Res,1995,27:195-200.。
6. HafstromM, Lundquist C, Lindecrantz K, et al. Recording non-nutritive sucking in the neonates [J]. Acta Pediatr,1997,86:82-90.
7. Averous J, Bruhat A, Mordier S, et al. Recent advances in the understanding of amino acid regulation of gene expression [J]. J Nutr,2003,(suppl 6):S2040-S2045.
8.董梅,王丹华,丁国芳,等.极低出生体重儿胃肠喂养的临床观察[J].中华儿科杂志,2003,41(2)：87-90.
9. Lucas A. Programming by early nutrition:An experimental approach[J]. J Nutr,1998,128 (suppl 2):S401-S406.
10. Smith JR. Early enteral feeding for the very low birth weight infant:the development and impact of a research-based guidline[J]. Neonatal Netw, 2005,24(4); 9-19.
11. Teitelbawm DH, Tracy TF, et al. Use of cholecystokininoctapeptide for the prevention of parenteral nutrition -associated cholestasis[J]. Pediatrcs,2005,115(5):1332-1340.
12. Pande S, Brion LP, et al. Lack of effect of L-carnitine supplemention on weight gain in very preterm infants[J]. J Perinatal,2005(7):470-477.