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Feeding intolerance is a common cause of enteral nutrition interruption, which has a high incidence in the pediatric intensive care unit.It seriously affects the nutritional management of critically ill children, affects the treatment effect of critically ill children, and can lead to serious complications and even death.There is a lack of standardized and unified standards for the assessment of feeding intolerance in clinical practice, and there is an urgent need for objective and standard assessment tools.Ultrasound is a non-invasive, simple and non-radiation clinical technique, which can be used to measure gastric residual volume at the bedside in critically ill children, and evaluate feeding intolerance.
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【Objective】 To investigate the influencing factors of red blood cell transfusion volume for premature neonatal pneumonia and its predictive value for feeding intolerance. 【Methods】 272 infants of premature neonatal pneumonia treated with red blood cell transfusion were collected as the research objects. Red blood cell transfusion volume was investigated and its influencing factors were analyzed by multiple linear regression. Receiver operating curve (ROC) was used to analyze the predictive value of red blood cell transfusion volume on feeding intolerance in infants with premature neonatal pneumonia. 【Results】 The average red blood cell transfusion volume in infants with premature neonatal pneumonia was (76.19±26.03) mL. Multiple linear regression analysis showed that gestational age, birth weight, volume of blood collection and hemoglobin level before blood transfusion were influencing factors of red blood cell transfusion volume in infants with premature neonatal pneumonia (B=-1.930, -6.215, 1.041, -0.249, P<0.05). The incidence of feeding intolerance in infants with premature neonatal pneumonia was 19.5%. The transfusion volume of feeding intolerance group was significantly higher than that of the non-feeding intolerance group(P<0.05). ROC analysis showed that the area under curve (AUC) of red blood cell transfusion volume for predicting feeding intolerance was 0.755. 【Conclusion】 Gestational age, birth weight, volume of blood collection and hemoglobin level before blood transfusion are influencing factors of red blood cell transfusion volume in infants with premature neonatal pneumonia. The incidence of feeding intolerance in premature neonatal pneumonia is high. The red blood cell infusion volume is of good predictive value for the occurrence of feeding intolerance. Latrogenic blood loss and red blood cell transfusion volume should be minimized clinically.
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Objective:To study the changes and influencing factors of splanchnic regional saturation before and after feeding in preterm infants with feeding intolerance (FI).Methods:From December 2018 to August 2019, preterm infants with FI admitted to the neonatal intensive care unit of our hospital within 24 hours after birth were prospectively enrolled in this same-patient before-after study. Splanchnic regional saturation (rSsO 2) and cerebral regional oxygenation (rSc0 2) 5 minutes before feeding and 1 hour after feeding were monitored using near-infrared spectroscopy (NIRS). The average values of rScO 2, rSsO 2 and splanchnic-cerebral oxygenation ratio (SCOR) before and after feeding were calculated. The clinical data including postnatal age, corrected gestational age and feeding methods (breastfeeding or formula feeding) were collected. Single-factor correlation analysis and multiple linear regression were used to analyze the influencing factors of rSsO 2 before and after feeding. Results:A total of 41 preterm infants were included. No significant differences existed in rSsO 2, rScO 2 and SCOR before and after feeding ( P>0.05). The feeding methods showed relative prominent influences on the changes of rSsO 2 and SCOR before and after feeding. The breastfeeding infants had smaller changes of rSsO 2 and SCOR before and after feeding compared with formula feeding infants, the regression equations were Y=5.538-4.065X (model complex correlation coefficient was 0.414 determination coefficient R2=0.171, F=8.050, P<0.01) and Y=0.109-0.075X (model complex correlation coefficient was 0.405 determination coefficient R=0.1642, F=7.655, P<0.01). Conclusions:Proper feeding will not increase rSsO 2 in preterm infants with FI. Comparing with formula feeding infants, breastfeeding infants has more stable post-feeding rSsO 2.Breastfeeding should be the first choice for preterm infants with FI.
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Objective:To explore the effects of probiotics on feeding intolerance and early growth and development of preterm and very low birth weight infants (VLBWI).Methods:A total of 446 patients with VLBWI were enrolled in Henan Children′s Hospital from March 20, 2019 to March 20, 2022. They were divided into breast milk group (119 cases), breast milk+probiotic group (108 cases), formula group (115 cases) and formula+probiotic group (104 cases) according to the feeding mode and whether they received early probiotic supplement or not. The feeding programs of each group were carried out according to the “2013 Clinical Application Guide of nutritional support for newborn infants” and “the feeding guidelines for VLBWI”. On this basis, the probiotic supplement group was treated with Clostridium butyricum powder at a dose of 0.25 g/twice a day for 2 weeks, nasal feeding or bottle administration. The incidence of feeding intolerance, the time of recovery of birth weight, the time of reaching total gastrointestinal feeding, and the time of hospitalization in each group were observed, and the average increment of body mass, head circumference and body length in each group at 28 days after birth were compared.Results:In breast milk group, the incidence of feeding intolerance, total gastrointestinal feeding time, and hospital stay were significantly lower than those in the formula group [40.3% vs 47.8%, (13.2±2.4) vs (14.9±1.9) d, (26.5±7.5) vs (29.8±9.6) d], besides, the average increments of early growth and developmental indexes such as body mass, head circumference, and body length at 28 days of birth were significantly lower than those in the formula group [(15.4±2.7) vs (17.7±3.7) g/d, (5.8±1.0) vs (6.2±1.0) mm/week, (6.8±0.7) vs (7.3±0.8) mm/week], however, the recovery time of birth weight in the breast milk group was significantly higher than that in the formula group [(6.2±1.2) vs (5.3±1.4) d] (all P<0.05). The incidence of feeding intolerance, the recovery time of birth weight, the total gastrointestinal feeding time and the hospital stay in the breast milk+probiotics group were significantly lower than those in the breast milk group [34.3% vs 40.3%, (5.4±1.2) vs (6.2±1.2) d, (10.4±1.9) vs (13.2±2.4) d, (22.9±5.6) vs (26.5±7.5) d], besides, the average increments of body mass, head circumference and body length at 28 days of birth was significantly higher than that in the breast milk group [(17.2±3.5) vs (15.4±2.7) g/d, (6.2±1.0) vs (5.8±1.0) mm/week, (7.2±0.8) vs (6.8±0.7) mm/week] (all P<0.05). The incidence of feeding intolerance, total gastrointestinal feeding time and hospital stay in breast milk+probiotics group were significantly lower than those in formula+probiotics group [34.3% vs 47.1%, (10.4±1.9) vs (15.3±2.0) d, (22.9±5.6) vs (30.4±8.2) d] (all P<0.05), besides, there was no significant difference in the average increments of early growth and developmental indexes between the breast milk+probiotics group and the formula+probiotics group (all P>0.05). There were no significant difference in the above indexes between the formula+probiotics group and the formula group (all P>0.05). Conclusion:Probiotics can improve the clinical outcome of feeding intolerance and promote early growth and development of breast feeding VLBWI.
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OBJECTIVES@#To systematically evaluate the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical development in preterm infants.@*METHODS@#A computerized search was performed in the databases including China National Knowledge Infrastructure, Wanfang Data, Weipu, PubMed, Embase, and the Cochrane Library to identify randomized controlled trials of the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical growth in preterm infants. RevMan 5.3 software was used to perform a Meta analysis for the included studies.@*RESULTS@#A total of 7 randomized controlled studies were included. The results of Meta analysis showed that compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula could reduce the risk of neonatal necrotizing enterocolitis (RR=0.40, P=0.04) and feeding intolerance (RR=0.40, P=0.005), and had no significant effect on the growth of weight, length and head circumference (P>0.05).@*CONCLUSIONS@#Compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula in preterm infants may reduce the occurrence of necrotizing enterocolitis and feeding intolerance, and can meet the nutrient requirement of physical development. However, the evidence is limited, and the results of this study cannot support the routine prophylactic use of hydrolyzed protein formula in preterm infants.
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Humans , Infant , Infant, Newborn , Enterocolitis, Necrotizing/prevention & control , Gastrointestinal Diseases/prevention & control , Infant Formula/chemistry , Infant, Low Birth Weight , Infant, Premature , Randomized Controlled Trials as TopicABSTRACT
Objective:To explore the effects of Zusanli acupoint massage combined with abdominal touching on feeding intolerance (FI) of premature infants. Methods:A total of 100 premature infants meeting the inclusion criteria in neonatal ward of the hospital from January 2018 to June 2020 were divided into control group (50 cases) and observation group (50 cases) by random number table method. The control group was given routine treatment and feeding, while observation group was given Zusanli acupoint massage and abdominal touching on the basis of control group. The feeding observation indexes, three immunoglobulin indexes, FI and complications were compared between the two groups. Results:The feeding transition time (8.57 ± 2.35 d vs. 11.60 ± 4.38 d, t=4.310) and the time of returning to birth weight (9.11 ± 1.79 d vs. 10.48 ± 2.34 d, t=3.289) in observation group were significantly shorter than those in control group ( P<0.05), and feeding efficiency (9.48 ± 2.07 ml/min vs. 7.16 ± 2.30 ml/min, t=5.302) was significantly higher than that of control group ( P<0.05). The incidence rates of FI [14.0% (7/50) vs. 42.0% (21/50); χ2=9.722, P<0.01] and apnea [12.0% (6/50) vs. 32.0% (16/51); χ2=5.828, P<0.01]. Conclusion:Zusanli acupoint massage combined with abdominal touching is beneficial to improve feeding performance of premature infants, recover birth weight as soon as possible, achieve total intestinal feeding and improve early feeding tolerance.
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Objective To compare the effects of two different types of enteral nutrition on postpyloric feeding critical ill patients.Methods A prospective study was conducted to continuously collect 60 critical ill patients with indications ofpost-pyloric feeding in ICU and NICU wards of our hospital from January 2016 to December 2018.They were randomly (random number) divided into the peptide-based enteral nutrition (PBEN) group and intact protein enteral nutrition (IPEN) group with 30 patients in each group.Enteral nutrition was started immediately within 24 h after the nasointestinal tube was placed,and the PBEN group was treated with peptide-based enteral nutrition,while the IPEN group was treated with intact protein enteral nutrition.The nutritional metabolism index,intestinal barrier index on the 7th and 14th days after enteral nutrition treatment were observed and compared.The enteral feeding complications,incidence of feeding intolerance,gastrointestinal adaptability and 7-day enteral nutrition compliance rate of the two groups during the enteral nutrition were also observed and compared.Chi-square test was used for counting data and t test was used for measuring data.Results On the 7th and 14th days after enteral nutrition therapy,there was no statistical difference in nutritional metabolism indexes between the two groups (P＞0.05).In comparison of intestinal barrier indexes,diamine oxidase (DAO) level in the PBEN group was lower than that in the IPEN group at the same time,and the difference was statistically significant [7th day:(6.1±2.9) U/mL vs (7.8±2.7) U/mL,t=-2.354,P=0.019;14th day:(4.7±1.6) U/mL vs (6.9±2.0) U/mL,t=-3.285,P=0.004].During enteral nutrition,the diarrhea rate of patients in the PBEN group was slightly higher than that in the IPEN group (6.6％ vs 3.3％),while the abdominal distension rate in the IPEN group was slightly higher (3.3％ vs 10.0％),but there was no statistical difference between the two groups (P＞0.05).The gastrointestinal adaptation time of patients in the PBEN group was significantly shorter than that in the IPEN group [(7.8±1.3) h vs (9.1±2.0) h,t=-2.334,P=0.027].The 7-day enteral nutrition compliance rate showed no significant difference between the two groups(P＞0.05).Conclusions Diarrhea was the main complication in the PBEN group and abdominal distension was the main complication in the IPEN group for post-pyloric feeding critical ill patients.Peptide-based enteral nutrition could repair the intestinal barrier function of post-pyloric feeding critical ill patients and increase the adaptability of gastrointestinal tract in the initial stage of enteral nutrition.
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Objective To investigate the effect of comprehensive feeding intervention on feeding quality and weight gain of premature infants. Methods Eighty-one premature infants admitted to the neonatal intensive care unit (NICU) of our hospital from September 2016 to December 2018 were selected and randomly divided into the intervention group (n=41) and the control group (n=40). Infants in the control group received routine nursing and infants in the intervention group were given comprehensive feeding intervention on the basis of routine nursing includingimproved Y type gastric tube, gravity tube feeding in prone position, oral movement intervention, colostrum oral immunotherapy and kangaroo nursing. The changes of feeding process were compared between the two groups and the occurrence of feeding intolerance in the two groups was observed. Results The duration of tube feeding and hospital stay were lower in the intervention group than in the control group (P<0.05). No statistically significant difference was found in birth weight and body weight at discharge between the two groups (P>0.05), but the average daily weight growth rate [g/ (kg·d) ] after 1 week and the milk volume [ml/ (kg·d) ] at 1 week were higher in the intervention group than in the control group (P<0.05). The incidence of gastric retention, abdominal distension and vomiting in the intervention group was lower than that in the control group, but only the difference in the incidence of gastric retention (24.4％ vs 47.5％) was statistically significant (P<0.05). The incidence of feeding intolerance was significantly lower in the intervention group than in the control group (24.39％ vs 47.50％, P<0.05). Conclusion Comprehensive nursing intervention can shorten the tube feeding time of premature infants, promote the weight growth of premature infants, improve the feeding quality, reduce the incidence of feeding intolerance, and reduce the hospital stay of premature infants, so as to reduce the hospitalization cost, improve the quality of life of premature infants, and increase the satisfaction of parents.
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Very low birth weight infants (VLBW) and extremely low birth weight infants (ELBW) are prone to complications such as feeding intolerance and infectious diseases such as necrotizing enterocolitis due to the prematurity of the immunological and gastrointestinal system.In recent years,probiotics are being widely used in preterm infants to improve gut microbiota and enhance the resistance to foreign substance.in this way,probiotics plays a role in lessening the incidence of feeding intolerance,reducing the mortality and morbidity of severe NEC and shortening of hospital stay.
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PURPOSE: The routine evaluation of gastric residuals (RGR) is considered standard care for premature infants. This study evaluated the usefulness of RGR in premature infants.METHODS: The study retrospectively investigated 208 premature infants (gestational aged under 34 weeks) who underwent gavage feeding in a neonatal intensive care unit at a tertiary hospital. The patients were divided into two groups: RGR (n=104) and no-RGR (n=104). Those in the no-RGR group had their gastric residuals checked only if signs of feeding intolerance were present. Clinical outcomes, including the time to reach full enteral feeding (FEF) and the incidences of gastrointestinal disorders such as feeding intolerance (FI) and necrotizing enterocolitis (NEC), were compared. Data were analyzed with SPSS ver. 21, using a Mann-Whitney U test, chi-squared test, and Fisher's exact test.RESULTS: There was no statistically significant difference for the time to FEF (z=−0.61, p =.541), incidence of FI (χ²=0.38, p =.540), and NEC (χ²=1.42, p =.234) between the two groups.CONCLUSION: No-RGR did not increase the risk for FI or NEC. These results suggest that RGR evaluation may not improve nutritional outcomes in premature infants. Recommendations for further research and practice guidelines will be provided.
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Humans , Infant, Newborn , Enteral Nutrition , Enterocolitis , Enterocolitis, Necrotizing , Incidence , Infant, Premature , Intensive Care, Neonatal , Premature Birth , Retrospective Studies , Tertiary Care CentersABSTRACT
Very low birth weight infants (VLBW) and extremely low birth weight infants (ELBW) are prone to complications such as feeding intolerance and infectious diseases such as necrotizing enterocolitis due to the prematurity of the immunological and gastrointestinal system.In recent years, probiotics are being widely used in preterm infants to improve gut microbiota and enhance the resistance to foreign substance.In this way, probiotics plays a role in lessening the incidence of feeding intolerance, reducing the mortality and morbidity of severe NEC and shortening of hospital stay.
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Objective@#To investigate the effect of comprehensive feeding intervention on feeding quality and weight gain of premature infants.@*Methods@#Eighty-one premature infants admitted to the neonatal intensive care unit (NICU) of our hospital from September 2016 to December 2018 were selected and randomly divided into the intervention group (n=41) and the control group (n=40). Infants in the control group received routine nursing and infants in the intervention group were given comprehensive feeding intervention on the basis of routine nursing includingimproved Y type gastric tube, gravity tube feeding in prone position, oral movement intervention, colostrum oral immunotherapy and kangaroo nursing. The changes of feeding process were compared between the two groups and the occurrence of feeding intolerance in the two groups was observed.@*Results@#The duration of tube feeding and hospital stay were lower in the intervention group than in the control group (P<0.05). No statistically significant difference was found in birth weight and body weight at discharge between the two groups (P>0.05), but the average daily weight growth rate [g/(kg·d) ] after 1 week and the milk volume [ml/(kg·d)] at 1 week were higher in the intervention group than in the control group(P<0.05). The incidence of gastric retention, abdominal distension and vomiting in the intervention group was lower than that in the control group, but only the difference in the incidence of gastric retention (24.4% vs 47.5%) was statistically significant (P<0.05). The incidence of feeding intolerance was significantly lower in the intervention group than in the control group (24.39% vs 47.50%, P<0.05).@*Conclusion@#Comprehensive nursing intervention can shorten the tube feeding time of premature infants, promote the weight growth of premature infants, improve the feeding quality, reduce the incidence of feeding intolerance, and reduce the hospital stay of premature infants, so as to reduce the hospitalization cost, improve the quality of life of premature infants, and increase the satisfaction of parents.
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PURPOSE: Feeding tolerance is extremely important in preterm infants. This study aimed to evaluate whether preterm infants receiving Lactobacillus reuteri DSM 17938 would develop fewer symptoms of feeding intolerance. Secondary outcomes were duration of parenteral nutrition, time to reach full feeding, length of hospital stay, sepsis, necrotizing enterocolitis (NEC), diarrhea, and mortality. METHODS: This double-blind randomized controlled trial of L. reuteri DSM 17938 versus placebo included 94 neonates with a gestational age of 28–34 weeks and birth weight of 1,000–1,800 g. RESULTS: Feeding intolerance (vomiting and/or distension) was less common in the probiotic group than in the placebo group (8.5% vs. 25.5%; relative risk, 0.33; 95% confidence interval, 0.12–0.96; p=0.03). No significant intergroup differences were found in proven sepsis, time to reach full feeding, length of hospital stay, or diarrhea. The prevalence of NEC (stages 2 and 3) was 6.4% in the placebo group vs. 0% in the probiotic group (relative risk, 1.07; 95% confidence interval, 0.99–1.15; p=0.24). Mortality rates were 2.1% in the probiotic group and 8.5% in the placebo group, p=0.36). CONCLUSION: The administration of L. reuteri DSM 17938 to preterm infants was safe and significantly reduced feeding intolerance. No significant differences were found in any other secondary outcomes.
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Humans , Infant, Newborn , Birth Weight , Diarrhea , Enterocolitis, Necrotizing , Gestational Age , Infant, Premature , Limosilactobacillus reuteri , Lactobacillus , Length of Stay , Mortality , Parenteral Nutrition , Prevalence , Probiotics , SepsisABSTRACT
Objective To study the clinical efficacy and safety of Simo Decoction for the treatment of feeding intolerance of near term infants; To explore the value of increase of time averaged mean velocity (TAMV) in the superior mesenteric artery. Methods Totally 85 patients were randomly divided into control group (41 cases) and observation group (44 cases). Both two group were given comprehensive treatment and feeding regulation, lasted for 7 d. The observation group was given Simo Decoction on the basis of the control group, 1 mL/kg each time, 3 times a day, orally or nasal feeding, lasted for 2 days. After the treatment, no gastric retention time, vomiting ceased time, total enteral nutrition time, and hospitalization time were compared, and the total TCM syndrome scores and TAMV increase were observed. Clinical efficacy was evaluated and safety indexes were monitored. Results No gastric retention time, vomiting ceased time, total enteral nutrition time and hospitalization time in the observation group were shorter than the control group (P<0.05). Compared with before treatment, the total TCM syndrome scores in the two groups decreased after treatment (P<0.05); After treatment, the total TCM syndrome scores in the observation group were lower than those in the control group (P<0.05). The total effective rate was 86.36% (38/44) in the observation group and 68.29% (28/41) in the control group. The observation group was significantly better than the control group (P<0.05); After treatment, the TAMV increase in the observation group was higher than that in the control group (P<0.05). No adverse reactions occurred in both groups. Conclusion Simo Decoction can improve the symptoms and shorten the time of hospitalization in the treatment of feeding intolerance of near term infants, with confirmed efficacy and no obvious adverse reactions, which can be prejudged and monitored by monitoring TAMV increase.
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Objective To explore the occurrence of enteral feeding intolerance and its influencing factors in patients with severe acute pancreatitis. Methods A retrospective analysis of severe acute pancreatitis patients undergoing enteral nutrition therapy admitted to a tertiary hospital from October 2012 to October 2015 was performed. The occurrence of enteral feeding intolerance was analyzed,and its influencing factors were evaluated by single factor analysis and multivariate logistic regression analysis. Results There were 54 patients suffered from enteral feeding intolerance among 92 patients. The results of single factor analysis and multivariate regression analysis showed that higher APACHE II score,intra-abdominal pressure and central venous pressure were independent risk factors of feeding intolerance,while adding dietary fiber was a protective factor. Conclusion Severe acute pancreatitis patients with higher APACHE II score,intra-abdominal pressure and central venous pressure can aggravate the risk of feeding intolerance,while adding dietary fiber is beneficial for reducing the incidence.
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Objective To analyse the status quo,hotspots and trends of researches on feeding intolerance in preterm infants from 2012 to 2016 in China by co-word analysis,in order to propose directions for future researches.Methods Related studies pub lished from November 2012 to November 2016 were obtained through searching in databases,including CNKI,Wanfang,VIP andCBM,with the keywords "preterm infant","low birth weight infant" and "feeding intolerance".Studies were selected in strict accordance with the inclusion and exclusion criteria.The co-occurrence matrix of high frequency keywords was established via Microsoft Office Excel2007,and the visual network was drawn by Ucinet6.0 and Netdraw.Results A total of 536 studies were included,and 35 high-frequency keywords were extracted.The subjects of these studies mainly were very low birth weight infants,and there were few researches on extremely low birth weight infants.The reasons and treatments for feeding intolerance,clinical efficacy,clinical manifestations,growth and development,enteral/parenteral nutrition and necrotizing enterocolitis were the focus of attention of clinicians.Conclusion There have been in-depth researches on clinical features,diagnosis standard,prevention and treatment measurement of feeding intolerance in China,further researches are needed to investigate the etiology,exact pathogenesis and biological indicators.
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Objective To analyse the status quo,hotspots and trends of researches on feeding intolerance in preterm infants from 2012 to 2016 in China by co-word analysis,in order to propose directions for future researches.Methods Related studies pub lished from November 2012 to November 2016 were obtained through searching in databases,including CNKI,Wanfang,VIP andCBM,with the keywords "preterm infant","low birth weight infant" and "feeding intolerance".Studies were selected in strict accordance with the inclusion and exclusion criteria.The co-occurrence matrix of high frequency keywords was established via Microsoft Office Excel2007,and the visual network was drawn by Ucinet6.0 and Netdraw.Results A total of 536 studies were included,and 35 high-frequency keywords were extracted.The subjects of these studies mainly were very low birth weight infants,and there were few researches on extremely low birth weight infants.The reasons and treatments for feeding intolerance,clinical efficacy,clinical manifestations,growth and development,enteral/parenteral nutrition and necrotizing enterocolitis were the focus of attention of clinicians.Conclusion There have been in-depth researches on clinical features,diagnosis standard,prevention and treatment measurement of feeding intolerance in China,further researches are needed to investigate the etiology,exact pathogenesis and biological indicators.
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So far,the unified definition and diagnostic criteria of feeding intolerance in preterm infants is still unavailable,although they have always been modified and improved.The curative effects of intervention strategies,including the feeding strategies,breast-feeding,medication,and so on,still need multiple clinical randomized studies in order to be verified and evaluated.Therefore,this article will summarize the progress in the definition of feeding intolerance,feeding strategies and medication.
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Objective To investigate the prevalence of feeding intolerance (FI),and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients.Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014,and all clinical,laboratory,and survival data were prospectively collected.The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms,feeding details and organ dysfunction within the first week of ICU stay.The intra-abdominal pressures (IAP) was measured using AbViser device.Results Of 550 patients enrolled,418 were assessed in GI symptoms and feeding details within 7 days of ICU stay.The mean age and SOFA score were (65.1 ± 18.3) years and (8.96 ±4.10),respectively.Of them,355 patients (84.9％) were under mechanical ventilation support,and 37 (8.85％) received renal replacement therapy.The mean length of time for enteral feeding was (30.8 ±26.2) h,and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2％ and 25.4％,respectively.Compared to those with FI within 7 days of ICU stay,the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3％ vs.5.7％,P =0.003) and higher rate of withdrawal of vasoactive medication (45.5％ vs.20.0％,P =0.037),as well as lower mortality rate of 28-day (24.4％ vs.38.7％,P =0.004) and 60-day (29.6％ vs.44.3％,P =0.005).In multivariate Cox regression model with adjustment for age,sex,participant center,serum creatinine and lactate,AGI grade on the first day of ICU stay,and comorbidities,the FI within 7 days of ICU stay (x2 ≥ 7.24,P ＜ 0.01) remained to be independent predictors for 60-day mortality.After further adjusted for SOFA score,the FI within 7 days of ICU stay (HR =1.71,95％ CI:1.18-2.49;P =0.006) and AGI grade on the first day of ICU stay (HR =1.33,95 ％ CI:1.07-1.65;P =0.009) could provide independent prognostic values of 60-day mortality.Conclusions There is high rate of FI occurred within 7 days of ICU stay,and is significantly associated with worse outcome.In addition,this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality.
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Objective To observe the changes of abdominal oxygen saturation in very low birth weight infants (VLBWI)with feeding intolerance (FI)within 1 4 days after birth monitored by near infrared spectroscopy (NIRS).Methods VLBWI fitting entry criteria were enrolled into this study.NIRS monitoring was carried out to detect cerebral oxygen saturation (ScO2 )and abdominal oxygen saturation (SsO2 ).Data were analyzed between FI infants and feeding tolerance (FT)infants.FI was defined as follows:gastric residual of more than 50% of the previous feeding volume;emesis or abdominal distention or both;decrease,delay or discontinuation of enteral feedings. Results 93 VLBWI were enrolled.52 cases(55.91 %)presented with FI,including 29 cases(31 .1 9%)of gastric residual increasing and 23 cases(24.73%)of emesis with or without abdominal distention within 1 4 days after birth. The levels of SsO2 and SsO2 /ScO2 showed no differences in infants with FT and with FI within 24h after birth (P >0.05).The change rates of the median of SsO2 and SsO2 /ScO2 in FT infants were similar during 1 4 days (P >0.05).While both the change rates of SsO2 and SsO2 /ScO2 were markedly decreased 1 day before and the day of FI (P <0.01 ).The decreasing degree of SsO2 was similar between infants with gastric residual increasing and infants with emesis with or without abdominal distention[(1 6.2 ±5.1 )vs (1 7.4 ±3.6)%,t =0.733,P =0.476]. Conclusion Abdominal oxygen saturation measured by NIRS may be a useful method for infants adjusting the feeding plan.