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Impact of introducing a standardized nutrition protocol on very premature infants' growth and morbidity.

引入标准化营养方案对极早产儿生长和发病率的影响。

  • 影响因子:3.02
  • DOI:10.1371/journal.pone.0232659
  • 作者列表:"Wittwer A","Hascoët JM
  • 发表时间:2020-05-21
Abstract

BACKGROUND:Inappropriate nutritional intake in premature infants may be responsible for postnatal growth restriction (PGR) and adverse long-term outcomes. OBJECTIVE:We evaluated the impact of an updated nutrition protocol on very premature infants' longitudinal growth and morbidity, and secondly the compliance to this new protocol. DESIGN:All infants born between 26-32 weeks gestation (GA) were studied retrospectively during two 6-month periods before (group 1) and after (group 2) the introduction of an optimized nutrition protocol, in a longitudinal comparative analysis. RESULTS:158 infants were included; 72 before and 86 after the introduction of the protocol (Group 1: (mean±SD) birthweight (BW) 1154±276 g, GA 29.0±1.4 weeks; Group 2: BW 1215±332 g, GA 28.9±1.7 weeks). We observed growth improvement in Group 2 more pronounced in males (weight z-score) at D42 (-1.688±0.758 vs. -1.370±0.762, p = 0.045), D49 (-1.696±0.776 vs. -1.370±0.718, p = 0.051), D56 (-1.748±0.855 vs. -1.392±0.737, p = 0.072), D63 (-1.885±0.832 vs. -1.336±0.779 p = 0.016), and D70 (-2.001±0.747 vs. -1.228±0.765 p = 0.004). There was no difference in females or in morbidities between the groups. We observed low compliance to the protocol in both groups: similar energy intake but higher lipid intake in Group 1 and higher protein intake in Group 2. CONCLUSION:The quality of nutritional care with a strictly-defined protocol may significantly improve weight gain for very preterm infants. As compliance remained low, an educational reinforcement is needed to prevent PGR. CLINICAL TRIAL REGISTRATION:This retrospective study was registered by ClinicalTrials.gov under number NCT03217045, and by the CNIL (Commission Nationale de l'Informatique et des Libertés) under study number R2015-1 for the Maternity of the CHRU of Nancy.

摘要

背景: 早产儿营养摄入不当可能是出生后生长受限 (PGR) 和不良长期结局的原因。 目的: 我们评估了更新的营养方案对极早产儿纵向生长和发病率的影响,其次评估了对这一新方案的依从性。 设计: 在纵向比较分析中,在引入优化营养方案之前 (组1) 和之后 (组2) 的两个6个月期间,对出生在26-32周妊娠 (GA) 之间的所有婴儿进行回顾性研究。 结果: 共纳入158名婴儿; 方案引入前72名,引入后86名 (组1 :( 平均 ± SD) 出生体重 (BW) 1154 ± 276g,GA 29.0 ± 1.4周; 组2: BW 1215 ± 332g,GA 28.9 ± 1.7周)。我们观察到第2组的生长改善在男性中更明显 (体重z评分),在第42天 (-1.688 ± 0.758 vs. -1.370 ± 0.762,p = 0.045),D49 (-1.696 ± 0.776 vs. -1.370 ± 0.718,p = 0.051),D56 (-1.748 ± 0.855 vs. -1.392 ± 0.737,p = 0.072),D63 (-1.885 ± 0.832 vs. -1.336 ± 0.779 p = 0.016),而D70(-2.001 ± 0.747对-1.228 ± 0.765 p = 0.004)。两组之间的女性或发病率没有差异。我们观察到两组对方案的依从性低: 第1组能量摄入相似,但脂质摄入较高,第2组蛋白质摄入较高。 结论: 严格定义的营养护理方案的质量可以显著改善极早产儿的体重增加。由于依从性仍然很低,需要加强教育以防止PGR。 临床试验注册: 这项回顾性研究由ClinicalTrials.gov注册,编号为NCT03217045,由CNIL (national ale de l 'informatique et des libert é s委员会) 注册,编号为R2015-1,研究编号为Nancy CHRU的产妇。

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METHODS::Objective: This study used near-infrared spectroscopy (NIRS) to detect the pulmonary regional oxygen saturation (rSO2) of premature infants. The oxygenation state of the lung tissue was also evaluated, which provided preliminary evidence regarding the application of NIRS in oxygen therapy for premature infants.Methods: NIRS was used to measure the pulmonary rSO2 of 26 premature infants (gestational age <32 weeks). The correlations between pulmonary rSO2 and the arterial partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), and pulse oxygen saturation (SpO2) were analyzed. The diagnostic value of NIRS was evaluated via both Pearson's correlation and receiver operating characteristic (ROC) curve analyses.Results: Pulmonary rSO2 was positively correlated with both PO2 and SaO2; the linear correlation coefficients (r) were 0.544 (p = .004) and 0.515 (p = .007), respectively. No significant correlation was found between rSO2 and SpO2 (p = .098). SpO2 was positively correlated with PO2 (r = 0.402, p = .042) and SaO2 (r = 0.625, p = .001). NIRS could be used to predict hypoxemia (area under the curve [AUC] = 0.843; Youden's index =0.654) when the pulmonary rSO2 was 62.39%, the sensitivity was 88.9%, and the specificity was 23.5% (p = .005) as well as predict hyperoxemia (AUC = 0.775; Youden's index = 0.65) when the pulmonary rSO2 was 61.99%, the sensitivity was 100%, and the specificity was 35% (p = .045). SpO2 predicted hypoxemia (AUC = 0.784, p = .019) but not hyperoxemia (AUC = 0.7, p = .144).Conclusion: NIRS objectively reflects the changes in oxygenation in the lung tissue. This study provides evidence for the clinical application of NIRS.

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新生儿/早产方向

新生儿指的是胎儿娩出母体并自脐带结扎起,至出生后满28天这一段时间的婴儿;早产儿是指胎龄在37足周以前出生的活产婴儿称为早产儿或未成熟儿。

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