極低出生體重早產兒追趕成長營養照護個案報告

Catch Up Growth Nutrition Care of Extremely Low Birth Weight Premature Infants: A Case Report

毛舒茵(Shu-Yin Mao) ； 王麟玉(Lin-Yu Wang)

《臺灣膳食營養學雜誌》 10卷2期 (2018/12) Pp. 41-53

https://doi.org/10.6709/TJD.201812_10(2).0005

摘要

早產兒是指低於孕期37週前所出生的新生兒，極低體重早產兒是指出生體重低於1000 g，極低體重兒出生後將面臨許多早產併發症的處置（呼吸窘迫、壞死性腸炎缺血、開放性動脈導管及早產兒視網膜症）。此個案是由一位懷孕24週過5天初次懷孕與生產產婦所產下早產兒，預產期為2015年7月6日，因早期破水，2015年3月21日以手術方式生出680 g男嬰。出生時阿普伽新生兒評分1分鐘為4分，出生後5分鐘為6分，出生後施打表面張力素使肺泡成熟，因呼吸窘迫出生後轉入小兒加護病房照護，營養支持採用全靜脈營養與腸道餵食。在照護的過程中早產併發症均一一發生。2015年3月31日做開放性動脈導管手術，2015年4月14日因壞死性腸炎做小腸切除術與小腸造口，2015年6月23日將小腸造口關閉。在整個照護過程中，主要營養問題熱量蛋白質不足，營養處置是以全靜脈營養為主與少量腸道營養支持（母奶或早產奶水），且給與益生菌來增進腸胃道功能，腸胃道功能完善後漸進增加腸道餵食量，藉由全靜脈營養加腸道營養達到估算熱量與蛋白質需求。在腸胃道功能異常的營養問題為，個案小腸造口術後，造口引流量多，主要營養處置是以全靜脈營養為主，在術後數天開始以0.7 cal/ml早產奶水或母奶做為腸道營養支持。待術後適應期腸胃道症狀改善，漸進增加早產奶水營養密度與餵食量，母奶餵食量達50～70 ml/day即添加母乳添加劑以達到估算熱量蛋白質與維生素礦物質需求。個案住院期間雙親學習早產照護各項技能以利返家照護，個案出生後在院住了5個多月狀況穩定後返家照護。這位極低體重早產兒個案，返家後須定期回門診追蹤相關併發症發展狀況與成長追趕狀況。2016年12月矯正年齡1歲5個月，身高74 cm、體重7.5 kg，體重追趕狀況持續進步，但仍未達到標準。極低體重早產兒照護需要許多醫療人員的協助，主要目的是提高早產兒存活率與促進健康成長，存活率與促進健康成長，對其雙親在身心面臨極大的挑戰，早產團隊在照護早產兒的同時也須給予雙親支持與協助。

關鍵字

極低出生體重 ； 早產兒 ； 壞死性腸炎

並列摘要

Extremely-low-birth-weight premature babies (ELBWPB: below 1000 g) born before 37-week pregnancy had many complications including respiratory distress, necrotizing enterocolitis, patent ductus arteriosus, and prematurity retinopathy). Our case weighed 680 g by Cesarean section due to the premature membrane rupture on March 21, 2015, and was delivered by the week 24 and day 5 pregnancy (gravida 1 para 1) woman who expected to deliver the baby on July 6, 2015. The 1- and 5-min Apgar scores were 4 and 5, respectively. Injection of the pulmonary surfactant matured the alveoli. Due to occurrence of the respiratory distress, he was transferred to the pediatric intensive care unit, received total parenteral nutrition (TPN) and enteral nutrition (EN). Several complications then occurred. The patent ductus arteriosus operation was performed on March 31, 2015 necrotizing enteritis-demanded enterectomy and enterostomy on April 14 and closed enterostomy on June 23. The first nutrition problem was found to be inadequate calorie and protein intake. This patient was treated by prescribing TPN which attained the quested calories and protein, and a small amount of EN-requested breast milk or premature milk along with probiotics administration. Touching the EN-pertinent problem, it was the enterostomy-induced much drainage treated with EN (by 0.7 kcal/ml breast milk or premature milk) a few days postoperatively. During postoperative adaptation period, the enteral symptoms were gradually improved, nutrient density as well as amounts of premature milk administered also gradually increased, breast milk fortifier powder was added to 50-70 mL breast milk/ day in order to meet the energy requirement as well as protein, vitamins and minerals needed. During hospitalization for 5 months, parents has learned skills of home care for this ELBWPB and this case was discharged. This case has received regular follow up for the complication and growth in outpatient clinics. The adjusted age was 1 year and 5 months, body height as 74 cm, body weight as 7.5 kg (＜ 3%) in December 2016, the overall catchup growth status gradually made progress, but still had not reach normal level. Thus, care of ELBWPB demands much more on medical personnel assistances aiming to improve survival and better growth catch up, and to provide assistance and support to ELBWPB families.

並列關鍵字

extremely-low-birth-weight ； premature babies ； necrotizing enterocolitis