中国新生儿协作网重症监护病房出生胎龄<32周早产儿达全肠喂养时间分析  

A survey on the time to reach full enteral feeding for preterm infants with gestational age<32 weeks in neonatal intensive care unit of Chinese Neonatal Network

作　　者：付芬芬[1] 王瑾 李文丽[1] 杨洁 曹云 袁琳 周文俊 徐发林[1] Fu Fenfen;Wang Jin;Li Wenli;Yang Jie;Cao Yun;Yuan Lin;Zhou Wenjun;Xu Falin(Department of Neonatology,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Neonatology,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China;National Health Commission(NHC)Key Laboratory of Neonatal Diseases,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China;Department of Neonatology,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China)

机构地区：[1]郑州大学第三附属医院新生儿科,郑州450052 [2]国家儿童医学中心、复旦大学附属儿科医院新生儿科,上海201102 [3]国家儿童医学中心、复旦大学附属儿科医院国家卫生健康委员会新生儿疾病重点实验室,上海201102 [4]江西省妇幼保健院新生儿科,南昌330006

出　　处：《中华儿科杂志》2025年第4期379-386,共8页Chinese Journal of Pediatrics

基　　金：加拿大卫生研究院基金(CTP87518);河南省医学科技攻关计划联合共建项目(LHGJ20240358)。

摘　　要：目的分析中国新生儿协作网(CHNN)新生儿重症监护病房(NICU)出生胎龄<32周早产儿生后达全肠喂养时间(TFEF)。方法对CHNN前瞻性多中心队列数据的回顾性分析。研究对象为CHNN 89家参研单位2019年1月1日至2022年12月31日出生胎龄<32周且出生体重<1500 g、生后24 h内收治入NICU、住院时间≥7 d且出院前达全肠喂养的16155例早产儿。按照出生体重分为超低出生体重儿组和极低出生体重儿组,描述不同出生胎龄、入院危重程度、达全肠喂养前NICU治疗措施以及相关早产儿并发症情况下TFEF的分布特征。组间比较采用Mann-WhitneyU检验或Kruskal-WallisH检验。结果16155例早产儿中男8505例(52.6%)。超低出生体重儿组3374例早产儿TFEF为32(22,46)d,其中351例(10.4%)为≤2周、1050例(31.1%)为>2~4周、964例(28.6%)为>4~6周、1009例(29.9%)为>6周;极低出生体重儿组12781例早产儿TFEF为22(15,32)d,其中439例(3.4%)为≤1周、2565例(20.1%)为>1~2周、5526例(43.2%)为>2~4周、4251例(33.3%)为>4周。625例出生胎龄≤25周早产儿TFEF为36(23,52)d,2606例出生胎龄31周早产儿TFEF为20(13,28)d。超低出生体重儿及极低出生体重儿两组参研单位本院出生者较外院出生转入者、母乳喂养较配方及混合喂养者TFEF均更短(均P<0.001);开奶时间越早,TFEF均更短(均P<0.001);全肠喂养前留置外周中心静脉导管及输血和血制品者较未应用者,TFEF均更长(均P<0.001);并发有血流动力学异常动脉导管未闭、坏死性小肠结肠炎、晚发型败血症、严重早产儿视网膜病及支气管肺发育不良者较无相应并发症者,TFEF均更长(均P<0.001)。结论极低出生体重儿及超低出生体重儿TFEF分布均存在较大差异,早产儿出生胎龄、治疗措施、并发症情况不同TFEF也不同。应进一步质量改进以缩短TFEF。Objective To analyze the time to reach full enteral feedings(TFEF)among preterm infants with gestational age(GA)<32 weeks admitted to the neonatal intensive care unit(NICU)of Chinese Neonatal Network(CHNN).Methods This was a retrospective analysis based on the database from the CHNN 89 participating centers between January 1 st,2019 and December 31 st,2022.All 16155 preterm infants with a GA<32 weeks and a birth weight<1500 g,admitted to the NICU within 24 h after birth,hospitalization for at least 7 d and achieved full enteral feedings before discharge were included.According to the birth weight,these infants were divided into extremely low birth weight(ELBW)group and very low birth weight(VLBW)group.The practice characteristics of TFEF across different GA,the severity of neonatal admission,the NICU interventions before reaching full enteral feeding,and relevant neonatal diseases were described.Mann-Whitney U tests or Kruskal-Wallis H tests was used for comparison between groups.Results Among the 16155 preterm infants with a GA<32 weeks,8505 case(52.6%)were male.The TFEF in 3374 cases of ELBW groups was 32(22,46)d,351 cases(10.4%)with TFEF≤2 weeks,1050 cases(31.1%)with TFEF>2-4 weeks,964 cases(28.6%)with TFEF>4-6 weeks,and 1009 cases(29.9%)with TFEF>6 weeks.The TFEF in 12781 cases of VLBW group was 22(15,32)d,439 cases(3.4%)with TFEF≤1 week,2565 cases(20.1%)with TFEF>1-2 weeks,5526 cases(43.2%)with TFEF>2-4 weeks,and 4251 cases(33.3%)with TFEF>4 weeks.The TFEF was 36(23,52)d of 625 preterm infants at a GA≤25 weeks and 20(13,28)d of 2606 preterm infants at a GA 31 weeks.Inborn infants had a shorter TFEF than those outborn infants and the infants with breast-fed achieved shorter than formula and mixed feeding both in ELBW and VLBW groups(all P<0.001).The earlier enteral feeding started,the shorter TFEF will be both in ELBW and VLBW groups(both P<0.001).The TFEF of preterm infants who were treated before full enteral feeding like peripherally inserted central catheters,and blood transfusions and blood product

关 键 词：婴儿 早产 肠内营养 达全肠喂养时间 

分 类 号：R722.6[医药卫生—儿科]