新生兒加護病房早產兒體重與營養攝取之關係

The association of weight and nutrient intakes with preterm infants in neonatal intensive care unit

林柔懷(Jou-Huai Lin)

指導教授 ： 黃詩茜

中山醫學大學/健康管理學院/營養學系碩士班/碩士(2016年)

摘要

台灣地區新生兒加護病房早產兒缺乏本土生長曲線作為生長參考指標，在美國大多利用intrauterine growth curves作為早產兒生長的參考依據，但該曲線是否適合作為台灣早產兒生長參考則有待商確。而早產兒的營養攝取足夠與否不僅與生長情形有關，甚至會影響日後智力發展或心血管代謝，2010 年歐洲小兒腸胃肝膽營養學會修正了早產兒腸道營養之準則，以改善早產兒營養不良與生長遲滯的問題。因此本研究目的為：(1) 利用新生兒加護病房之早產兒數據繪製胎齡-體重之生長曲線並與美國 intrauterine growth curves 相較；(2) 探討早產兒熱量與蛋白質實際攝取量是否達到建議攝取量；(3) 比較 2010 年前後早產兒營養攝取狀況及體重的差異；(4) 探討早產兒體重與營養素攝取量的相關性。本研究為回溯性研究，收集 2005 年 12 月至 2013 年 12 月彰化基督教醫院新生兒加護病房 594 位早產兒資料。紀錄早產兒基本資料、體位資料、進入新生兒加護病房 24 小時內之疾病嚴重程度及早產兒營養攝取情形。結果顯示出生胎齡小於 30 週的男女生出生體重曲線近似 intrauterine growth curves，但出生胎齡 30 週後的男女生，出生體重卻低於 intrauterine growth curves。進一步追蹤早產兒體重直至 37 週時，發現出生胎齡 24-29 週早產兒平均體重顯著高於出生胎齡 30-35 週。再依早產兒體重分組，早產兒熱量實際攝取量已達到建議攝取量 78.6-82.4 %，蛋白質亦達到 82.4-93.8 %。再將資料以早產兒出生年份 2010 年為界分為兩組，發現 2010-2013 年出生的早產兒，在出生第一、二及四週的脂肪與熱量攝取量都顯著高於 2005-2009 年，雖期間體重無顯著增加，但當追蹤至胎齡 37 週時，其體重顯著高於 2005-2009 年出生的早產兒。營養素攝取與體重相關性部分，無論男女生，出生年份為 2010-2013年，出生胎齡介於 24-29 週的早產兒，在出生第一及二週的三大營養素及熱量攝取量與體重呈正相關，當早產兒出生至第四週時，僅脂肪及熱量攝取量與體重呈顯著正相關。本研究結果顯示近年來，早產兒營養攝取已積極提升，生長狀況也明顯改善，在不危及早產兒腎臟發育情況下，針對出生胎齡介於 24-29 週的早產兒，可在出生第一及二週時積極給予三大營養素與熱量攝取量，至第四週時，可提高脂肪攝取量以促進早產兒生長。

關鍵字

早產兒 ； 新生兒加護病房 ； 生長曲線 ； 營養素攝取

並列摘要

Intrauterine growth curves are the standard for assessing the growth of preterm infants and are widely used in the neonatal intensive care unit setting in United States; however, we do not have our own reference growth curves in Taiwan. Therefore, due to different racial and growth environment, it is doubt that if the intrauterine growth curves in United States is applicable to Taiwanese. The nutritional intakes of preterm infants is related to growth, and influence on the intellectual development and cardiovascular metabolism. As a result, the purposes of this study were: 1) to compare the growth pattern data and draw weight-age growth curve from the neonatal intensive care unit in Taiwan to the intrauterine growth curves; 2) to evaluate if the calorie and protein intakes of preterm infants meet the recommended intakes; 3) to compare the nutrient intakes and weight of preterm infants before and after 2010 year; 4) to investigate the association between the nutritional situation and body weight of preterm infants. This is a retrospective study. The study duration was from December 2005 to December 2013 in Changhua Christian Hospital neonatal intensive care unit (n = 594). Data collected included individual baseline data, anthropometric data, and preterm neonatal disease severity within 24 hours when hospitalizing and nutrient intakes. The results showed that regardless gender, gestational age (GA) less than 30 weeks, and their birth weight curves were closed to the intrauterine growth curves; however, GA more than 30 weeks, their birth weight curves were lower than intrauterine growth curves. When following the preterm infants' body weight until GA 37 weeks, the average body weight of GA 24-29 weeks was significantly higher than GA 30-35 weeks. When dividing group based on preterm infants’ body weight, the actual calorie intakes has reached to 78.6-82.4 % of the recommended intakes and protein intakes has reached to 82.4-93.8 %. For actual calorie intakes, there is no significant difference among groups. When dividing group based on preterm infants’ birth year, the fat and calorie intakes in first, second, and fourth week among the group of birth, year within 2010-2013 were significantly higher than birth year within 2005-2009. When following to GA 37 weeks, the body weight among the group of birth year within 2010-2013 was significantly higher than birth year within 2005-2009. The macronutrients and calorie intakes were positive correlation with body weight among the group of birth year within 2005-2009, GA within 24-29 weeks in the first and second week after birth. The fat and calorie intakes were significant positive correlation with body weight after fourth week birthed. This study show recently the nutritional status and growth patterns are significant improved in preterm infants. In order to catch up the normal growth and safe to the kidney development of preterm infants, the macronutrients and calorie intakes should be increased in the first and second week after birth; the fat intakes should be increased in fourth week after birth.

並列關鍵字

preterm infants ； neonatal intensive care unit ； growth curves ； nutrient intakes

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