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Objective:To explore the value of ultrasound measuring gastric sinus cross-sectional area (CSA) to guide early individualized enteral nutrition implementation strategies in sepsis patients.Methods:Thirty septic patients admitted to the EICU and comprehensive ICU of The Second Affiliated Hospital of Nanjing University of Chinese Medicine between January 2021 and December 2022 each were included. EICU patients used bedside ultrasound for gastric sinus CSA to guide the implementation of early enteral nutrition in septic patients, and a routine nutritional support strategy was adopted in the integrated ICU. The correlation of CSA and feeding intolerance in patients with septic gastrointestinal dysfunction, the ROC curve and other relevant indicators of gastrointestinal dysfunction gastrointestinal dysfunction score, SOFA score, APACHEⅡ score, intra-abdominal pressure (IAP), serum protein (PA), [albumin (Alb)]. By comparing the indicators related to inflammation, nutritional status and days of ICU stay after different strategies of the two groups, the advantages of different strategies were analyzed.Results:The baseline data of the two groups were balanced and comparable; the incidence of feeding intolerance was significantly higher (36.67%) than the conventional group (10.00%), with aggressive and early individualized treatment, the incidence rate on the third day was only 10.00%, significantly lower than that in the conventional treatment group (40.00%). Treatment up to the 5th day, the related function scores (gastrointestinal dysfunction score, APACHEⅡ score, SOFA score, IAP), nutritional status indicators (5 d hot card reaching the standard rate, PA, Alb) and inflammation indicators (WBC, PCT, hs-CRP) were significantly improved compared with admission, and is better than the conventional treatment group. In addition, the ICU hospital days and the incidence of aspiration were lower in the ultrasound treatment group ( P <0.05). CSA showed favorable correlation with gastrointestinal dysfunction score, APACHEⅡ score, SOFA score, IAP, PA and Alb, correlation coefficients were 0.79、0.60、0.66、0.71、-0.6 and -0.64( P <0.05). The ROC curve for predicting feeding intolerance by CSA showed the AUC was 0.828, 95% CI was 0.737-0.919, its optimal cutoff value for predicted feeding intolerance was 7.835 cm 2, the sensitivity and specificity were 88.20% and 71.80%. Conclusions:Ultrasound measuring CSA can early and effectively found the feeding intolerance in the patients with sepsis , via giving individualized enteral nutrition implementation strategy, significantly improve the organ function score, nutritional status and inflammation index, reduce the ICU hospital days and aspiration, and correlate with the conventional evaluation index, and sensitivity and specificity are high, worthy of the clinical further promotion.
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Objective:The prediction model of feeding intolerance in preterm infants was established and validated to provide guidance for clinical practice.Methods:This was a case-control study. A retrospective analysis was conducted on 210 premature infants with gestational age less than 34 weeks from September 2022 to May 2023. They were divided into training and validation sets in a 1∶1 ratio. The univariate and multivariate binary Logistic regression analysis were performed on training set samples, first identified the risk factors for feeding intolerance occurrence, and established a premature feeding intolerance risk prediction model based on these risk factors. Visualized the model using a column chart. The performance of the model was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and clinical decision curves in the training and validation sets, respectively. The ROC curve was used to evaluate the differentiation ability of the model, the calibration curve was used to evaluate the consistency of the model, and clinical decision-making was used to evaluate the net benefit status of patients when the model guides clinical interventions.Results:Among them, there were 84 cases in the feeding tolerance and 126 cases in the feeding intolerance. There were 53 males and 31 females with feeding tolerance aged (32.38 ± 1.37) weeks and 73 males and 53 females with feeding intolerance aged (30.01 ± 2.14) weeks. Through univariate Logistic regression analysis of 12 related variables, there were significant differences between the feeding tolerance premature infants and the feeding intolerance premature infants in 8 variables of premature birth weight, birth asphyxia, caffeine use, delayed defecation, gestational age, lactation time, non-invasive ventilation time, and invasive ventilation time ( OR values were 0.032-18.706, all P<0.05). Multiple Logistic regression ultimately screened out three variables, namely premature infant body mass, delayed defecation, and non-invasive ventilation time ( OR = 0.073, 4.926, 1.244, all P<0.05). The area under the ROC curve of the training and validation sets were 0.906 and 0.876, respectively. The calibration curves of the training and validation sets indicated that the model had high consistency. The Hosmer-Lemeshow goodness of fit test showed that χ2 = 7.92, P = 0.442. Conclusions:The prediction model established in this study has high discrimination, calibration, and clinical practical value, and can accurately predict the risk of feeding intolerance in premature infants, providing reference basis for timely nursing and clinical intervention.
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【Objective】 To analyze the effect of extensively hydrolyzed formula(eHF) in the treatment of feeding intolerance in preterm infants and the effect on hospital infection, in order to provide reference for the clinical treatment of feeding intolerance in preterm infants. 【Methods】 A total of 208 cases of preterm infants with feeding intolerance diagnosed and treated in Shandong Heze Municipal Hospital from April 2017 to February 2020 were selected into the clinical trial for eligibility assessment, then were randomly assigned into study group(n=100) and control group(n=100) after screening and exclusion. Children in the control group were fed with standard preterm formula, while children in the study group were fed with eHF. Feeding tolerance indicators, including daily milk intake, time to meconium evacuation, time to full gastrointestinal nutrition, total gastric residual counts(GRV1) in the 7-d period after resumption of breastfeeding, ratio of all-day gastric residual counts/all-day estimated milk intake after resumption of breastfeeding(GRV2) were compared between the two groups, and growth indicators(body weight growth rate, head dimension growth rate), complication incidence [necrotizing enterocolitis(NEC), pathological jaundice, positive fecal occult blood or blood in stool] and incidence of hospital-acquired infections. 【Results】 The daily milk intake(t=5.037) of the study group was higher than that of the control group, and the time of foetal excretion(t=9.217), the time to reach full gastrointestinal nutrition(t=15.833), GRV1(t=6.737), GRV2(t=9.956) were lower than those of the control group, and the differences were all statistically significant(P<0.05). The rate of weight gain(t=2.454) and head dimension growth(t=5.469) in the study group was significantly higher than those of the control group(P<0.05). The incidence of the three complications of NEC, pathological jaundice and positive fecal occult blood or blood in stool(χ2=4.310) and the incidence of hospital infections(χ2=4.688) were significantly lower in the study group than in the control group(P<0.05). 【Conclusions】 Compared with the standard formula milk for preterm infants, eHF can significantly improve the feeding intolerance of preterm infants, promote growth and development, and reduce the occurrence of hospital-acquired infections. Therefore, eHF can be widely used in clinic for preterm infants with feeding intolerance.
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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 prognosis and influencing factors in critically ill surgical patients of different feeding intolerance trajectories.Methods:The retrospective cohort study was conducted. The clinical data of 354 critically ill surgical patients who were admitted to 69 medical centers in the Chinese Critical Care Nutrition Trials Group -NEED database from March 2018 to July 2019 were selected. There were 247 males and 107 females, aged 58(46,68)years. According to the trajectory model of feeding intolerance change, 354 patients were divided into 3 categories as feeding intolerance, decreased feeding intolerance, continuous feeding intolerance, including 164, 49, 141 cases respectively. Observation indicators: (1) general situations of patients of different feeding intolerance trajectories; (2) treatment of patients of different feeding intolerance trajectories; (3) survival of patients of different feeding intolerance trajectories; (4) analysis of pro-gnostic factors in critically ill surgical patients. Measurement data of normal distribution were expressed as Mean± SD, and one-way analysis of variance was used for comparison between groups. Measurement data of skewed distribution were expressed as M( Q1, Q3), and Kruskal-Wallis rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Ordinal data were compared using the Kruskal-Wallis rank sum test. Bonferroni correction was used for pairwise comparison. Group-based trajectory model was constructed according to Traj plug-in in Stata17.0 statistical software, and the optimal trajectory model was evaluated by Bayesian information criterion and average posterior probability parameter. The Kaplan-Meier method was used to draw the survival curve and calculate the survival rate, and Log-Rank test was used for survival analyses. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. Results:(1) General situations of patients of different feeding intolerance trajectories. Of 354 critically ill surgical patients, 257 cases underwent enteral nutrition and 97 cases underwent enteral plus parenteral nutrition. The acute physiological and chronic health score (APACHEII) was 17(13,21), and the sequential organ failure score (SOFA) was 6(5,8). The modified Critical Illness Nutritional risk score (mNUTRIC) was 4 (2,5), the number of complications was 2(1,3). There were 293, 55 and 6 patients with grade Ⅰ, grade Ⅱ and grade Ⅲ acute gastrointestinal injury (AGI), and there were 224, 17 and 61 patients who were treated with mechanical ventilation, continuous renal replacement therapy and vasoactive drugs, respectively. The incidence of feeding intolerance in 354 patients increased first and then decreased, reaching a peak of 25.42%(90/354) on the third day and 53.67%(190/354) within 7 days. Of 354 critically ill surgical patients, cases with no feeding intolerance, decreased feeding intolerance, continuous feeding intolerance had the APACHE Ⅱ as 16(12,20), 17(14,25), 18(13,22), mNUTRIC as 3(2,5), 4(3,6), 4(3,5), the number of complications as 2(1,2), 2(2,3), 2(2,3). There were 152, 27, 114 cases with grade Ⅰ AGI, 12, 22, 27 cases with grade Ⅱ-Ⅲ AGI, 95, 39, 90 cases with mechanical ventilation. There were significant differences in the above indicators among the three groups ( H=6.14, 13.11, 28.05, χ2=37.96, 7.65, P< 0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance and continuous feeding intolerance had the higher number of complications and grade of AGI ( Z=60.32, 54.69, χ2=39.72, 9.52, P<0.05), patients with decreased feeding intolerance had the higher mNUTRIC scores and ratio of mechanical ventilation ( Z=53.41, χ2=7.59, P<0.05). (2) Treatment of patients of different feeding intolerance trajectories. Cases with prokinetic drugs use and post-pyloric feeding were 36, 13 of patients with no feeding intolerance, 25 and 10 of patients with decreased feeding intolerance, 46 and 19 of patients with continuous feeding intolerance, respectively, showing significant differences in the above indicators among the three groups ( χ2=15.76, 6.20, P<0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance had higher ratio of prokinetic drugs use and ratio of post-pyloric feeding ( χ2=15.60, 6.10, P<0.05). (3) Survival of patients of different feeding intolerance trajectories. The 28-day overall survival rates of patients with no feeding intolerance, decreased feeding intolerance, and continued feeding intolerance were 96.96%, 95.92%, and 87.94%, respectively, showing a significant difference ( χ2=10.39, P<0.05). Further analysis showed a significant difference between patents with no feeding intolerance and patients with continuous feeding intolerance ( χ2=9.19, P<0.05). (4) Analysis of prognostic factors in critically ill surgical patients. Multivariate analysis showed that continuous feeding intolerance was an independent risk factor for 28-day death in critically ill surgical patients ( hazard ratio=3.92, 95% confidence interval as 1.43-10.79, P<0.05). Conclusion:For surgical critically ill patients, patients with continuous feeding intolerance have a higher 28-day mortality than patients with no feeding intolerance, and the continuous feeding intolerance is an independent risk factor for 28-day death in critically ill surgical patients.
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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 reveal the research hotspos and the dynamic frontier in feeding intolerance in critically ill patients.Method:We took feeding intolerance and critical illness as the theme, the CNKI and WOS core database as the research object, and used CiteSpace software as research tool, to conduct a visual atlas analysis on the research status and hotspos evolution at home and abroad. Results:There were totally 2 426 feeding intolerance related papers published, and quantity of publications increased year by year. Australia and some European and American countries are in a leading position. The institutions in the lead regarding scientific research level were Royal Adelaide Hospital, Adelaide University, Louisville University, Repatriation General Hospital and Queens University. The researches mainly focused on the investigation of mechanism, symptom evaluation, and management of feeding intolerance .Conclusion:The feeding of critically ill patients has attracted more and more attention. In the future, we should further carry out high-quality and large-scale empirical research, explore new technologies and big data, and develop evidence-based prevention and management strategies for feeding intolerance.
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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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Humanos , Lactante , Recién Nacido , Enterocolitis Necrotizante/prevención & control , Enfermedades Gastrointestinales/prevención & control , Fórmulas Infantiles/química , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
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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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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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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Humanos , Recién Nacido , Peso al Nacer , Diarrea , Enterocolitis Necrotizante , Edad Gestacional , Recien Nacido Prematuro , Limosilactobacillus reuteri , Lactobacillus , Tiempo de Internación , Mortalidad , Nutrición Parenteral , Prevalencia , Probióticos , SepsisRESUMEN
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: 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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Humanos , Recién Nacido , Nutrición Enteral , Enterocolitis , Enterocolitis Necrotizante , Incidencia , Recien Nacido Prematuro , Cuidado Intensivo Neonatal , Nacimiento Prematuro , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
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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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 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.