背景：与早期肠内喂养相比，应用延迟的缓慢肠内喂养来减少极低出生体重（ELBW）婴儿坏死性小肠结肠炎（NEC）发生的研究并不多。

目的：研究标准化缓慢肠内喂养（SSEF）方案在ELBW婴儿中应用的效应。

方法：将遵从SSEF方案的ELBW婴儿（2009年9月～2012年12月）与相似的历史对照组（2003年1月～2009年7月）进行对比。将两组的短期预后通过倾向评分分析进行比较。

结果：SSEF组125名婴儿与294名历史对照组的婴儿进行了比较。与对照组相比，SSEF组的喂养起始时间，完全依赖肠内喂养的时间，肠外营养（PN）时间，以及依赖中央静脉时间均较长。SSEF组和对照组整体发生NEC（5.6%比11.2%，P=0.10）或需要手术的NEC（1.6%比4.8%，P=0.17）的差异没有统计学意义。然而，与对照组相比，出生体重＜750g的婴儿，NEC（2.1%比16.2%，P＜0.01）或并发NEC/死亡（12.8%比29.5%，P=0.03）的人数明显较少。活着出院后的婴儿中，两组的出院体重和PS校正后的的住院时间无差别。

结论：SSEF方案显著降低了出生体重＜750g的婴儿NEC的发生率以及并发NEC/死亡的发生率。尽管在这套方案中需要更长时间获得充足肠内喂养，但事实证明存活的ELBW婴儿在没有延长住院时间而出院后体重增加与对照组相似。

JPEN J Parenter Enteral Nutr. 2015;39(6):644-54.

Standardized Slow Enteral Feeding Protocol and the Incidence of Necrotizing Enterocolitis in Extremely Low Birth Weight Infants.

Viswanathan S, McNelis K, Super D, Einstadter D, Groh-Wargo S, Collin M.

Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.

MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.

BACKGROUND: Compared with early enteral feeds, the delayed introduction and slow advancement of enteral feedings to reduce the incidence of necrotizing enterocolitis (NEC) are not well studied in extremely low birth weight (ELBW) infants.

OBJECTIVE: To study the effects of a standardized slow enteral feeding (SSEF) protocol in ELBW infants.

METHODS: ELBW infants who followed an SSEF protocol (September 2009 to December 2012) were compared with a similar group of historical controls (January 2003 to July 2009). Short-term outcomes between the 2 groups were compared by propensity score (PS) analysis.

RESULTS: One hundred twenty-five infants in the SSEF group were compared with 294 historical controls. Compared with the controls, feeding initiation day, full enteral feeding day, parenteral nutrition (PN) days, and total central line days were longer in the SSEF group. There was no significant difference in overall NEC (5.6% vs 11.2%, respectively; P = .10) or surgical NEC (1.6% vs 4.8%, respectively; P = .17) between the SSEF group and controls. However, in infants with birth weight <750 g, NEC (2.1% vs 16.2%, respectively; P < .01) or combined NEC/death (12.8% vs 29.5%, respectively; P = .03) was significantly less in the SSEF group compared with controls. In infants who survived to discharge, there was no significant difference in the discharge weight or length of stay in PS-adjusted analysis.

CONCLUSIONS: An SSEF protocol significantly reduces the incidence of NEC and combined NEC/death in infants with birth weight <750 g. Despite taking longer to achieve full enteral feeding on this protocol, surviving ELBW infants demonstrated comparable weight gain at discharge without prolonging their hospital stay.

KEYWORDS: extremely low birth weight infants; feeding protocol; necrotizing enterocolitis; preterm infants

PMID: 25316681

DOI: 10.1177/0148607114552848