| Objective: A retrospective analysis of clinical practice in very immatureinfants-the gestational age≤32weeks or birth weight≤1500g that have been admittedto our hospital in the past5years. We have observed the enteral nutrition intake, weightgain, feeding intolerance, extrauterine growth restriction, and nutrition-relatedcomplications incidents; and investigated the risk factors of feeding intolerance inpreterm infants, so as to further improve and provide clinical reference to theestablishment of enteral nutrition in very immature preterm infants.Method:130preterm infants among gestational age≤32weeks or birth weight≤1500g were divided into three subgroups, according to gestational age: GA≤30weeks(group GA1),30weeks <GA≤32weeks(group GA2); GA>32weeks (group GA3); Thestudy subjects were divided into three subgroups according to birth weight: BW≤1000g (group BW1),1000g <BW≤1500g (group BW2), BW>1500g (group BW3).The subjects were divided into three subgroups according to comparison between birthweight and average weight of same gestational age: SGA group, AGA group and LGAgroup.The subjects were divided into feeding tolerance group (FT group) and feedingintolerance (FI group) according to the existence of feeding intolerance. Summarizingthe following indicators in overall, comparing and analysing the following indicatorsamong groups: the process of establishment of enteral feeding, the incidence andduration, as well as clinical presentation of feeding intolerance, nutrition-relatedcomplications, time of enteral nutrition which is respectively up to50kcal/(kg.d),85kcal/(kg.d),100kcal/(kg.d),150kcal/(kg.d), the average daily milk of the first twoweeks, duration of hospitalization, the day with the lowest weight after birth, thepercentage of lowest weight accounted for the BW, weight gain, the days of recovery toBW, days when weight is up to2kg, the incidence of the extrauterine growth restriction.We have analyzed the risk factors of feeding intolerance by using the χ2test, singlefactor and multifactor Logistic regression. Data were assessed by SPSS16.0.Results:○1The time for initial enteral feeding in all cases was6.20±5.23h postnatal. The time for initial enteral feeding in group GA1was later than groupGA2(Z=-2.773，P=0.006)；The time for initial enteral feeding in group BW2was laterthan group BW3(Z=6.549，P=0.010)；The time for initial enteral feeding in group FTwas earlier than group FI(t=-2.682，P=0.008)；The application of PS has certain effecton the time for initial enteral feeding(t=-4.464，P=0.000).○2Overall feeding averagebegan at2.27±2.10ml every time, and advanced6.00±3.23ml/(kg.d); feeding intervalsconverted to q3h from q2h when the average milk volume was19.19±8.19ml/2h; whenoral feeding, the average milk volume was128.50±67.33ml/(kg.d), the body weightwas1.69±0.20kg, it happened at22.15±15.65d postnatal, and the corrected GA was34.21±1.82weeks.○3The incidence of feeding intolerance was60.8percent in allcases, the incidence of feeding intolerance was67.7percent in the very low birthweight infants, the duration of feeding intolerance was3.78±4.28days.○4The singlefactor analysis showed that the birth weight, asphyxia, electrolyte disturbances,intracranial hemorrhage, anemia, RDS, the application of PS and the time for initialenteral feeding may be the risk factors of feeding intolerance. Further multifactorlogistic regression analysis showed, electrolyte disturbances, intracranial hemorrhageand anemia were the risk factors of feeding intolerance.○5The incidence of nutritionrelated complications was low:130premature infants, without NEC, the incidence ofsepsis was2.3%, the incidence of PNAC was0.8%, the incidence of electrolytedisturbances was41.5%, and the incidence of glucose abnormalities was17.7%.○6Thetime of reaching50kcal/(kg.d),85kcal/(kg.d),100kcal/(kg.d) and150kcal/(kg.d) byenteral feeding were8.01±4.78d,13.05±7.60d,15.85±8.72d,26.2±12.83d postnatal.The lower BW, the longer time to target calories. The time to every target calories ofGroup FT was shorter than group FI.○7The establishment of enteral nutrition in thefirst two weeks after birth: the milk volume was10ml/(kg.d) in the first day, advancedabout10ml/(kg.d) per day. The calorie of enteral nutrition was average50kcal/(kg.d) at6thday postnatal, and average100kcal/(kg.d) at14thday postnatal.○8The hospitalizeddays was average36.7±16.13d in all cases, number of days for weight loss to theminimum was6.08±2.83d, the body weight decreased8.16±5.01%compared with birthweight, the body weight regained to birth weight at13.12±6.35d after birth, the growthvelocity from minimum weight to regain to birth weight was16.36±9.20g/(kg.d), thegrowth velocity from regained to birth weight to2kg was19.83±5.89g/(kg.d), the growth velocity from minimum weight to2kg was19.60±6.13g/(kg.d), the bodyweight reached to2kg at34.29±13.30d postnatal. The incidence of EUGR was51.5%.Conclusion:○1The establishment scheme of enteral nutrition in premature infantsamong GA≤32weeks or BW≤1500g could be carried out as follows: the prematureinfants BW≤1000g, feeding begins at0.5~1ml per time, advanced4~6ml/(kg.d),feeding interval is2h, and converted to q3h from q2h when the milk volume reach to20ml/2h, oral feeding could be attempted when the corrected gestational age reached to36~37weeks or the milk volume reached to190ml/(kg.d); the premature infants1000g＜BW≤1500g, feeding begins at1~2ml per time, advanced5~6ml/(kg.d), feeding q2hwhen the beginning milk volume less than2ml per time, feeding q3h when thebeginning milk volume is2ml per time, and converted to q3h from q2h when the milkvolume reach to20ml/2h, oral feeding could be attempted when the correctedgestational age reached to34~35weeks or the milk volume reached to150ml/(kg.d); thepremature infants BW＞1000g, feeding begins at2~4ml per time, advanced6~7ml/(kg.d), feeding interval is3h, oral feeding could be attempted when thecorrected gestational age reached to32~33weeks or the milk volume reached to80ml/(kg.d).○2Electrolyte disturbances, intracranial hemorrhage and anemia were therisk factors of feeding intolerance in preterm infants. Birth weight, asphyxia,maternal-feto transfusion or feto-fetal transfusion, pneumorrhagia, may be the riskfactors of feeding intolerance, but still need more study on large sample to confirm.○3The time of reaching50kcal/(kg.d),85kcal/(kg.d),100kcal/(kg.d) and150kcal/(kg.d)by enteral feeding in the preterm infants GA≤32weeks or BW≤1500g were8.01±4.78d,13.05±7.60d,15.85±8.72d,26.2±12.83d postnatal.○4Early enteral feeding,begining at a small amount of milk, slowly increasing the feeding volume in prematureinfants-GA≤32weeks or BW≤1500g is feasible, it did not increase the incidence offeeding intolerance, but lower the nutrition related complications. |
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