Meta-analysis of the Impact of Early Enteral Nutrition on the Clinical Outcomes of Very Low Birth Weight Premature Infants
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摘要:
目的 系统评价早期肠道内营养对极低出生体重早产儿临床结局的影响。 方法 通过计算机检索有关极低出生体重早产儿应用早期肠道内营养后临床结局指标相关的文献，检索时间为建库起至2023年12月31日；数据提取后用RevMan5.4软件进行Meta分析。 结果 共筛选出323篇文献，最终纳入8篇，总样本量为 3451 例，Meta分析的结果显示，早期肠道内营养对极低出生体重早产儿住院时长[MD = -17.26，95%CI （-35.41，0.89），P = 0.06]、NEC发病率[RR = 0.98，95%CI （0.75，1.27），P = 0.85]等无影响；但早期肠道内营养可以减少极低出生体重早产儿达全肠道内喂养时间[MD = -3.44，95%CI（-4.15，-2.73），P <0.00001 ]、静脉营养时间[MD = -5.90，95%CI （-10.42，-1.38），P = 0.01]、喂养不耐受发生率[RR = 0.70，95%CI （0.63，0.77），P <0.00001 ]，感染发生率[RR = 0.57，95%CI （0.42，0.76），P =0.0001 ]。结论 早期肠道内营养能减少极低出生体重早产儿达全肠道营养时间、静脉营养时间、喂养不耐受发生率、感染发生率。 Abstract:Objective To evaluate the effect of early enteral nutrition on the clinical outcomes of very low birth weight preterm infants. Methods The literature on the use of early enteral nutrition and clinical outcome measures in VLBW premature infants was searched by computer until 31 December 2023. The data were extracted for Meta-analysis with RevMan5.4 software. Results A total of 323 articles were selected, and 8 articles were selected, with a total sample size of 3451 cases, the results of the Meta-analysis showed that early enteral nutrition for hospitalization of very low birth weight preterm infants [MD = -17.26, 95%CI （-35.41, 0.89）, P = 0.06], incidence of NEC [RR = 0.98, 95%CI （0.75, 1.27）, P = 0.85] has no effect. But early enteral nutrition can reduce the duration of full enteral feeding in very low birth weight premature infants [MD = -3.44, 95%CI （-4.15, -2.73）, P <0.00001 ], reducing the time of parenteral nutrition [MD = -5.90, 95%CI （-10.42, -1.38）, P = 0.01], incidence of feeding intolerance [RR = 0.70, 95%CI （0.63, 0.77）, P <0.00001 ], Reduced incidence of infection [RR = 0.57, 95%CI （0.42, 0.76）, P =0.0001 ].Conclusion Early enteral nutrition can reduce the total duration of enteral nutrition, parenteral nutrition, incidence of feeding intolerance and infection. -
Key words:
- Premature infants /
- Very low birth weight /
- Enteral nutrition /
- Clinical outcomes /
- Meta-analysis
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表 1 文献基本特征
Table 1. Basic characteristics of literature
纳入研究 国家 研究对象 样本量 干预措施 结局指标 试验组 对照组 试验组 试验组 Gao 2023 中国 极低出生体重儿 1539 1017 ≤24 h >24 h ②③④ Salas 2018 英国 极低出生体重儿 30 30 ≤24 h >96 h ③④⑤⑥ Leaf 2012 沙特 极低出生体重儿 45 49 24 h-48 h 120-144 h ③④ 王琳2023 中国 极低出生体重儿 152 160 ≤24 h >24 h ③④ 于新颖2014 中国 极低出生体重儿 116 26 ≤72 h >168 h ②④ 陈潮青2014 中国 极低出生体重儿 45 45 ≤24 h >72 h ①②③④⑤ 何蓉2013 中国 极低出生体重儿 56 40 ≤24 h >48 h ①②③④⑤⑥ 张悦2011 中国 极低出生体重儿 48 53 ≤24 h >96 h ①②④⑤⑥ 注：①住院时间，②喂养不耐受，③新生儿坏死性小肠结肠炎，④院内感染，⑤达全肠内营养时间，⑥肠外营养时间。 
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表 2 文献质量评价结果
Table 2. Results of literature quality evaluation
纳入研究 随机分配 分配隐藏 盲法 结局资料 选择性报告 其他偏倚 证据等级 Gao 2023 高 低 低 低 低 低 B Salas 2018 低 低 低 低 低 低 A Leaf 2012 低 低 低 低 低 低 A 王琳2023 高 低 低 低 低 低 B 于新颖2014 高 低 低 低 低 低 B 陈潮青2014 低 低 低 低 低 低 A 何蓉2013 高 低 低 低 低 低 B 张悦2011 低 低 低 低 低 低 A
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[1] 邵肖梅,叶鸿瑁,邱小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版,2019: 64. [2] 王琳,赵小朋,刘辉娟,等. 基于循证的标准化喂养方案可以帮助极早产儿/极低出生体重儿尽早达到全肠道喂养[J]. 中国当代儿科杂志,2022,24(6):648-653. doi: 10.7499/j.issn.1008-8830.2202121 [3] 李娜,刘丽红. 早产儿临床流行病学研究现状[J]. 国际儿科学杂志,2016,43(7):576-580. doi: 10.3760/cma.j.issn.1673-4408.2016.07.016 [4] Hay W W. Aggressive nutrition of the preterm infant[J]. Current pediatrics reports (Philadelphia,PA),2013,1:229-239. [5] Ramaswamy V V,Bandyopadhyay T,Ahmed J,et al. Enteral feeding strategies in preterm neonates≤32 weeks gestational age: A systematic review and network meta-analysis[J]. Ann Nutr Metab,2021,77(4):204-220. doi: 10.1159/000516640 [6] Xu J H,Coo H,Fucile S,et al. A national survey of the enteral feeding practices in Canadian neonatal intensive care units[J]. Paediatr Child Health,2020,25(8):529-533. doi: 10.1093/pch/pxz112 [7] Saenz D P M,Closa R,Gormaz M,et al. Nutritional practices in very low birth weight infants: A national survey[J]. Nutr Hosp,2017,34(5):1067-1072. [8] Gao L,Shen W,Wu F,et al. Effect of early initiation of enteral nutrition on short-term clinical outcomes of very premature infants: A national multicenter cohort study in China[J]. Nutrition,2023,107:111912. doi: 10.1016/j.nut.2022.111912 [9] Salas A A,Li P,Parks K,et al. Early progressive feeding in extremely preterm infants: a randomized trial[J]. Am J Clin Nutr,2018,107(3):365-370. doi: 10.1093/ajcn/nqy012 [10] Leaf A,Dorling J,Kempley S,et al. Early or delayed enteral feeding for preterm growth-restricted infants: A randomized trial[J]. Pediatrics,2012,129(5):e1260-e1268. doi: 10.1542/peds.2011-2379 [11] 于新颖,范玲. 肠内营养开始时间对极低出生体重儿消化功能及生长速度的影响[J]. 中国当代儿科杂志,2014,16(8):814-819. doi: 10.7499/j.issn.1008-8830.2014.08.009 [12] 陈潮青,罗学虹,陈宜升. 早期微量肠内喂养对极低出生体质量儿预后的影响[J]. 河南医学研究,2014,23(7):86-88. [13] 何蓉,严洁,肖志辉. 早期微量喂养对极低出生体重早产儿营养状况和并发症的影响[J]. 中华临床医师杂志(电子版),2013,7(7):3155-3157. [14] 张悦,袁福宁. 早期微量喂养对极低出生体质量儿宫外生长与预后的影响[J]. 福建医药杂志,2011,33(3):15-17. doi: 10.3969/j.issn.1002-2600.2011.03.007 [15] 胡小慧. 早期微量喂养联合静脉营养方式对危重早产儿的疗效分析[J]. 中外医学研究,2013,11(5):41. doi: 10.3969/j.issn.1674-6805.2013.05.029 [16] 李丽玲,王丽,于玲,等. 非营养性乳房吸吮对极低出生体重早产儿经口喂养能力的影响[J]. 中华护理杂志,2023,58(12):1422-1427. doi: 10.3761/j.issn.0254-1769.2023.12.002 [17] Walsh V,Brown J,Copperthwaite B R,et al. Early full enteral feeding for preterm or low birth weight infants[J]. Cochrane Database Syst Rev,2020,12(12):CD13542. [18] Dutta S,Singh B,Chessell L,et al. Guidelines for feeding very low birth weight infants[J]. Nutrients,2015,7(1):423-442. doi: 10.3390/nu7010423 [19] 丁国芳. 极低出生体重儿尽早达到足量肠内营养喂养策略—《极低出生体重儿喂养指南》解读[J]. 中国实用儿科杂志,2016,31(2):85-89. [20] Hanson C,Thoene M,Wagner J,et al. Parenteral nutrition additive shortages: the short-term,long-term and potential epigenetic implications in premature and hospitalized infants[J]. Nutrients,2012,4(12):1977-1988. doi: 10.3390/nu4121977 [21] Bozkurt O,Alyamac D E,Bidev D,et al. Prolonged minimal enteral nutrition versus early feeding advancements in preterm infants with birth weight≤1250 g: A prospective randomized trial[J]. J Matern Fetal Neonatal Med,2022,35(2):341-347. doi: 10.1080/14767058.2020.1716723 [22] 李斯,洪雅华,梅宛平. 低热量肠内营养对危重症患者临床结局影响的Meta分析[J]. 护理实践与研究,2022,19(21):3281-3287. [23] 熊伟,邱其周,陈虹余,等. 不同肠内营养时间对极低出生体重儿营养摄入及生长发育的影响[J]. 中国中西医结合儿科学,2016,8(3):283-286. doi: 10.3969/j.issn.1674-3865.2016.03.011 [24] Park S,Moon S,Pai H,et al. Appropriate duration of peripherally inserted central catheter maintenance to prevent central line-associated bloodstream infection[J]. PLoS One,2020,15(6):e234966. [25] Nangia S,Vadivel V,Thukral A,et al. Early total enteral feeding versus conventional enteral feeding in stable very-low-birth-weight infants: A randomised controlled Trial[J]. Neonatology (Basel,Switzerland),2019,115(3):256-262. doi: 10.1159/000496015 [26] 刘巍巍,焦颖,邹丽颖. 母乳喂养对极低出生体重早产儿血浆蛋白、血脂及并发症发生情况的影响[J]. 中国临床医生杂志,2019,47(7):856-858. doi: 10.3969/j.issn.2095-8552.2019.07.035 [27] 陈宁,才海燕,高彩云,等. 捐赠母乳对极低出生体质量早产儿的应用效果[J]. 中国妇幼健康研究,2022,33(2):106-110. [28] Kumar N,Oredein I,Al-Nahar M,et al. Impact of feeding volumes in the first 24 h of life on neonatal feeding intolerance[J]. Frontiers in Pediatrics,2023,11(3):1245947. -
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