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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