Objective To evaluate the nutritional status of extremely low birth weight (ELBW) infants and the effects of nutritional support strategy alterations on their growth during hospitalization.Method From 2005 to 2014,clinical data of ELBW infants admitted to the neonatal intensive care unit (NICU) in our hospital were retrospectively analyzed.The clinical data included their general status,enteral and parental nutritional support strategy and complications during hospitalization The patients were assigned into pre5 group and late5 group.Those who survived and discharged from 2005 to 2009 were the pre5 group,and those who survived and discharged fromn 2010 to 2014 were the late5 group.The independent t test and chi square test were used for statistical analysis.Result A total of 58 ELBW infants were enrolled in the study,including 18 patients in the pre5 group and 40 in the late5 group.No statistically significant differences existed between the two groups on gestational age,birth weight,Z score (weight for length and gender),birth length,head circumference and main complications during hospitalization (P ＞0.05).Pre5 group had higher incidence of small for gestational age (SGA) than late5 group (16/18 vs.25/40,P =0.037),while the EUGR ratio at discharge (14/18 vs.21/40,P =0.061) was similar.When compared with pre5 group,late5 group had larger amount of initial enteral feeding volume [4.4 ml/(kg · d) vs.2.4 ml/(kg · d),P =0.014] and feeding volume at the end of the first week [(19.8 ± 16.0) ml/(kg · d) vs.(12.2 ±9.5) ml/(kg · d),P =0.036].Similarly,the starting dose of amino acids in parenteral nutrition [2.0g/(kg· d) vs.1.0 g/(kg· d),P＜0.001],maximum dose of amino acids [4.0g/(kg.d) vs.3.5 g/(kg · d),P ＜ 0.001],total calories at the end of the first week [(82.6 ± 12.6) kcal/(kg · d) vs.(71.1±15.2) kcal/(kg· d),P=0.004] and the second week [(103.7 ±19.8) kcal/(kg· d) vs.(92.3 ± 17.9) kcal/(kg · d),P =0.041],the weight gain velocity from birth to discharge [(18.7 ± 2.9) g/(kg.d) vs.(16.9±2.8) g/(kg· d),P=0.031] and change of Z scores (AZ) [-0.6 (-1.0,-0.4) vs.-1.2 (-1.6,-0.8),P =0.004] showed significantl differences between the two groups,with better outcomes in late5 group.However,the duration of parenteral nutrition,the total amount of amino acids,the time reaching total enteral feeding,the length of hospital stay were similar between the two groups.Ten cases(61.1％)of infants in pre5 group were breastfed,and four of them used human milk fortifier (HMF) (fortified rate was 22％).32 cases (80％) in late5 group were breastfed and 23 cases used HMF (fortified rate was 57.5％).The time to initiate HMF in the late5 group was at (30.2 ± 13.2) days,and human milk amount was (89.9 ± 34.5) ml/kg,fortified duration was (32.8 ± 15.7) days.Conclusion The enteral feeding strategy were more vigorous in the last 5 years than before,the initial feeding volume,the increasing rate,the initial dosage of amino acid,and maximum dosage of amino acid had been increased.Human milk and HMF of preterm infants were preferred.The vigorous nutritional support strategy were effective for the weight gain of ELBW infants without obvious side effects during hospitalization.%目的 探讨超低出生体重(ELBW)早产儿早期营养状况及近年营养支持策略变化对其住院期间生长情况的影响.方法 回顾性分析2005-2014年我院新生儿重症监护病房收治的ELBW早产儿一般情况及住院期间肠内、肠外营养和并发症相关数据,2005-2009年存活出院者为前5年组,2010-2014年存活出院者为后5年组,分别采用两独立样本t检验和x2检验对两组资料进行比较.结果 纳入的ELBW早产儿中,前5年组18例,后5年组40例.前5年组与后5年组胎龄、出生体重、出生时年龄别体重Z评分、出生身长、出生头围及住院期间主要并发症发生率比较,差异均无统计学意义(P＞0.05).前5年组小于胎龄儿比例高于后5年组(16/18比25/40),差异有统计学意义(P＜0.05),两组出院时宫外生长迟缓比例(14/18比21/40)差异无统计学意义(P＞0.05).营养支持策略方面,后5年组开奶量[4.4 ml/(kg·d)比2.4 ml/(kg·d)]、第7大奶量[(19.8±16.0)ml/(kg·d)比(12.2±9.5) ml/(kg·d)]、氨基酸起始量[2.0g/(kg·d)比1.0 g/(kg·d)]、氨基酸最大量[4.0g/(kg·d)比3.5 g/(kg·d)]、第1周末总热卡[(82.6±12.6) kcal/(kg·d)比(71.1± 15.2) kcal/(kg·d)]、第2周末总热卡[(103.7±19.8) kcal/(kg·d)比(92.3±17.9) kcal/(kg· d)]、住院期间体重增长速度[(18.7±2.9) g/(kg·d)比(16.9±2.8)g/(kg·d)]、住院期间年龄别体重Z评分变化值[-0.6(-1.0,-0.4)比-1.2(-1.6,-0.8)]均明显优于前5年组,差异有统计学意义(P＜0.05).两组肠外营养时间、氨基酸总量、达足量肠内营养时间、总住院时间比较,差异均无统计学意义(P＞0.05).前5年组母乳喂养10例(10/18),后5年组母乳喂养32例(32/40).后5年组开始母乳强化时间(30.2±13.2)d,开始母乳强化时奶量(89.9±34.5)ml/kg,住院期间母乳强化剂使用时间(32.8±15.7)d.结论 近5年ELBW早产儿的肠内外营养策略更加积极,开奶量和早期奶量增加速度、氨基酸起始量及最大量均较前增加,同时强调母乳喂养及母乳强化治疗.积极的营养支持策略有助于ELBW早产儿住院期间的优化生长,未带来不良影响.
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