| Background Along with the elevation of survival rate of very low birth weight infants (VLBWI), the enteral feeding of VLBWI has become one of the most important factors, which influence the length of stay, near and far prognosis.Object To analyze the correlation factors about enteral feeding in very low birth weight infants (VLBWI). Discuss how to evaluate various influence factors objectively, and enact safe and effective clinical protocols of VLBWI enteral feeding.Methods Retrospective study was carried in VLBWI to analyze the correlation between the time achieving full enteral feeding and multiple factors influencing the VLBWI enteral feeding. According to different correlative degree of correlation factors, assign different score, inact score system. Evaluate the safety and efficiency of the score system.Results One hundred and forty-seven VLBWI were analyzed, gestational age (31.0±2.0) weeks, birth weight(1246±185)g, and the time achieving full enteral feeding was (24.4±10.5) days. T-test and one-factor analysis of variance showed that there is significant correlation between the time achieving full enteral feeding and birth weight, gestational age, newborn respiratory distress syndrome, mechanical ventilation, umbilical catheterization, aminophylline, phototherapy, sepsis, the time begin to enteral feeding and mile volume on the seventh day. Multiple linear regression analysis showed the time achieving full enteral feeding was significantly correlated with birth weight, mechanical ventilation duration, sepsis, phototherapy, the time begin to enteral feeding and milk volume on the seventh day. According to different correlative degree of correlation factors, assign different score, calculate the total score of the first, third, seventh day of the 147 VLBWI. The total scores were correlative to the time achieving full enteral feeding significantly. Score system can be used to guide the VLBWI enteral feeding. At the same time we enact the monitoring standard of enteral feeding, and use the score system and monitoring standard in VLBWI. Forty-eight VLBWI in group A didn't use score system, gestational age (30.0±2.1) weeks, birth weight (1173±170)g; 48 VLBWI in group B were guided with the score system, gestational age (30.3±1.7) weeks, birth weight (1133±238)g, there was no difference between two groups. The incidence of newborn respiratory distress syndrome of B group was significant higher than A group(P=0.016).The time of umbilical catheterization of B group was longer than A group. There was no significant difference of the incidence of other complications between two groups. The beginning milk volume, milk volume on the third, seventh, fourteenth, twenty-fist, twenty-eighth day of B group were significant larger than that of Agroup(P=0.008,P=000,P=0.000,P=0.020, P=0.005, P=0.011). The time achieving full enteral feeding of B group was shorter than that of A group(P=0.007). The incidence of necrotizing enterocolitis in group B was lower than that of A group(P=0.041). There was no significant difference of the total amino acid dosage between two groups. The total dosage fatty emulsion was less, and the duration of parenteral nutrition was shorter in B group than A group(P=0.000, P=0.016). There was no significant difference of length of stay between two groups. VLBWI of B group began to gain weight earlier, regained birth weight earlier, and got more weight in the second week (P=0.028, P=0.001, P=0.020).Conclusion The enteral feeding of VLBW1 was not only influenced by gestational age and birth weight, but also by other parenteral correlation factors. Evaluate the influencing factors objectively, and the score system enacted according to the different correlative degree of influencing factors was significantly correlated with enteral feeding. VLBWI guided with the score system achieved full enteral feeding faster, and shorten the duration of parenteral nutrition without increasing the incidence of necrotizing enterocolitis.. Background The neonate esophageal function is immature, but we have few accurate and objective test method. Recent years, esophagus high resolution manometry (HRM) has been used in the diagnosis of adult esophagus disease from research. But there was no research about neonate HRM result.Object To detect neonate esophagus function with HRM, and provide initial data for the research of neonate esophagus.Methods Proceed esophageal HRM in neonates, whose respiratory, metabolic and circulatory function was stable, gestational age more than 32weeks, birth weight more than 1200g. Evoke subjects to suck and swallow using a nipple, and record at least 10 complete esophageal peristalsis of every subject. Analyze the data of HRM. and summary the characteristic of neonate esophageal function. Compare the data of neonate with adult data reported in the literatures, and compare the data of full term infants with preterm infants.Results Esophageal HRM was detected in 11 neonates. Five full term neonates, gestational age (39.5±0.7) (38+3～40+1)weeks, birth weight (3553±260) (3170～3800) g; and 6 preterm neonates, gestational age (33.9±1.2) (32+3～36+1) weeks, birth weight (2059±612) (1285～2850) g. A total of 126 complete esophageal peristalsis were recorded, the data were analyzed using Mano View analysis software. Neonate esophageal peristalsis varied, we recorded pharyngeal swallow with no coordinate relaxation of upper esophageal sphincter, low pressure esophageal peristalsis, the whole esophageal contraction after swallow and with low esophageal sphincter moving proximally, low upper esophageal sphincter pressure, low low esophageal sphincter pressure, multiple inefficient swallows without esophageal peristalsis, and complete esophageal peristalsis with obvious pressure enhancement. The distance from nose to upper esophageal sphincter of neonates was shorter (10.6 vs 16.9cm,p=0.000), the upper esophageal sphincter pressure of neonates was lower (23.2 vs 66mmHg, p=0.000), the low esophageal sphincter length of neonates was shorter(1.6 vs 3.7cm, p=0.000) than that of healthy adults. But basal low esophageal sphincter pressure and relaxation pressure of neonates were higher than adults (23.5 vs 15.8mmHg,p=0.038,10.9 vs 3.9mmHg, p=0.000). There were no significant differences between term and preterm neonates about the distance from nose to upper esophageal sphincter, basal upper esophageal sphincter pressure and relaxation pressure, and the pressure changing time of upper esophageal sphincter. The esophagus length of preterm neonates were shorter than that of term neonates (8.4 vs 9.8cm,p=0.028). There were no significant differences between term and preterm neonates about the distance from nose to low esophageal sphincter, low esophageal sphincter length, basal pressure and relaxation pressure.Conclusions HRM can be used to detect neonates esophageal function, it's safe for neonates whose gestational age is larger than 32 weeks, and birth weight is more than 1200 g. The neonate esophageal function is immature. There is many individual differences, and the style of esophageal peristalsis is varied. A large sample research is needed to analyze the normal and abnormal status of neonate esophageal function. |
