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Clinical Experience with Early Enteral Feeding in Very-Low-Birth-Weight Infants

極低體重早產兒早期經腸道喂食的臨床經驗

摘要


本篇研究最主要的目地在評估對無全靜養的極度體重早產兒,給予早期經腸道餵食的安全性及益處。并記錄體重增加、餵食耐受不良、院內感染比例及出生後的生長曲線。 1995年9月1日至1997年2月28日,共收集61個住進馬偕紀念醫院新生兒加護病房體重小於1250公克的極低體重早產兒,其中9個早產兒未能完成研究,另外3個則因嚴重慢性肺疾病而被排除.進入研究的49個早產兒,依出生體重區分A組1001-1250gm(平均出生體重1153±64gm,平均出生週數29.0±2.2週)以及B組出生體重小於或等於1000gm(平均出生體重911±82gm,平均出生週數27.1±1.5週)。他們接受母奶或早產兒奶水,以利用間歇性或連績性鼻胃管餵食,并追蹤其出生後30天的生長情形。我們發現,A組經腸道餵食達到每天每公斤100大卡的平均天數為也生後17天,B組為20天。A組及B組分別為218.2±143.1gm及95.38±1.5gm。沒有壞死性腸炎的發生。2個個案發生大腸桿菌幾血症,1個個案發生克雷白桿菌(Klebs)幾血症。我們認為早期經腸道餵食對極低體重早產兒是有益的,并無增加壞死性腸炎的產生。同時顯示了極度度體重早產兒單純經由腸道喂食,其體重增加情形有雙相生長曲線的表現。但在餵食耐受不良的極低體重早產兒在到達足量餵食前靜脈營養是必須的。

並列摘要


The primary objective of this study was to evaluate the safety and benefit of early enteral feeding in very-low-birth-weight (VLBW) infants without parenteral nutrition. Weight gain, feeding intolerance, nosocomial infection rate and a postnatal growth curve were recorded for 61 VLBW premature infants who were admitted to the Neonatal Intensive Care Unit of Mackay Memorial Hospital from September 1, 1995 to February 28, 1997. Nine infants were unable to complete the study and three were excluded because of severe bronchopulmonary dysplasia; therefore only 49 infants could be evaluated. They were divided into two groups based on birth weight: 1001 gm to 1250 gm (Group A, mean birth weight 1153 ±64 gm, mean gestational age 29.0 ±2.2 weeks), and less than or equal to 1000 gm (Group B, mean birth weight 911 ±82 gm, mean gestational age 27.1 ±1.5 weeks). They received breast milk or premature formula by intermittent naso gastric or continuous naso gastric feeding. Growth was followed over the first 30 postnatal days. Group A reached 100 kcal/kg/day of enteral feeding at a mean age of 17 days as compared with a mean age of 20 days for group B. Infants regained their birth weight at 20 and 25 days in Groups A and B, respectively. By the 30” postnatal day, weight gain exceeded birth weight by 218.2±143.1 gm and 95.3 ±81.5 gm in groups A and B respectively. No definite episodes of necrotizing enterocolitis (NEC) developed. Two cases of Escherichia coli sepsis and one of Klebsiella sepsis occurred. The conclusion was that early enteral feeding in very-low-birth-weight infants does not increase the risk of NEC. It was also demonstrated that enteral feeding alone can produce biphasic postnatal growth curves in very-low-birth-weight infants. Although early enteral feeding was well tolerated in the study infants, the occurrence of feeding intolerance in some (36%) would suggest that additional parenteral nutrition may benefit some infants until full enteral feeding can be achieved.

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