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早产儿两种加奶速度喂养的对照试验
Controlled Trial of Two Incremental Milk-Feeding Rates in Preterm Infants


Jon Dorling ... 妇产科和儿科 • 2019.10.10
相关阅读
• 早期早产儿的加奶速度与发育结局

摘要


背景

观察性数据已经表明,早产儿缓慢增加肠内喂养量与坏死性小肠结肠炎风险降低相关,但与迟发性脓毒症风险增加相关。然而,来自随机试验的数据有限。

 

方法

我们将早期早产儿或极低出生体重儿随机分组,分别采用每日增加30 mL/kg(较快加奶)或18 mL/kg(较慢加奶)的加奶速度,直至达到完全喂养量。主要结局是24月龄时无中度或重度神经发育障碍的生存。次要结局包括主要结局的各构成部分、确诊或疑似迟发性脓毒症、坏死性小肠结肠炎和脑性瘫痪。

 

结果

在被随机分组的2,804例婴儿中,较快加奶组1,224例(87.4%)和较慢加奶组1,246例(88.7%)的主要结局可以评估。较快加奶组1,224例婴儿中的802例(65.5%)和较慢加奶组1,246例婴儿中的848例(68.1%)在24月龄时达到了无中度或重度神经发育障碍的生存(校正风险比,0.96;95%置信区间[CI],0.92~1.01;P=0.16)。较快加奶组1,389例婴儿中的414例(29.8%)和较慢加奶组1,397例婴儿中的434例(31.1%)出现了迟发性脓毒症(校正风险比,0.96;95% CI,0.86~1.07)。较快加奶组1,394例婴儿中的70例(5.0%)和较慢加奶组1,399例婴儿中的78例(5.6%)出现了坏死性小肠结肠炎(校正风险比,0.88;95% CI,0.68~1.16)。

 

结论

在早期早产儿或极低出生体重儿中,在24月龄时无中度或重度神经发育障碍的生存方面,18 mL/kg的每日加奶速度与30 mL/kg的每日加奶速度无显著差异(由英国国家卫生研究院卫生技术评估项目[Health Technology Assessment Programme of the National Institute for Health Research]资助;SIFT在Current Controlled Trials注册号为ISRCTN76463425)。





作者信息

Jon Dorling, M.D., Jane Abbott, B.A., Janet Berrington, M.D., Beth Bosiak, M.Sc., Ursula Bowler, Elaine Boyle, Ph.D., Nicholas Embleton, M.D., Oliver Hewer, M.A., Samantha Johnson, Ph.D., Edmund Juszczak, M.Sc., Alison Leaf, M.D., Louise Linsell, D.Phil., Kenny McCormick, M.D., William McGuire, M.D., Omar Omar, M.Sc., Christopher Partlett, Ph.D., Mehali Patel, B.Sc., Tracy Roberts, Ph.D., Ben Stenson, M.D., and John Townend, Ph.D. for the SIFT Investigators Group*
From the Division of Neonatal–Perinatal Medicine, Dalhousie University, Halifax, NS, Canada (J.D.); and Bliss, London (J.A., M.P.), the National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford (B.B., U.B., O.H., E.J., L.L., O.O., C.P., J.T.), and John Radcliffe Hospital (K.M.), Oxford, the Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne (J.B., N.E.), the Department of Health Sciences, University of Leicester, Leicester (E.B., S.J.), the National Institute for Health Research Southampton Biomedical Research Centre, Department of Child Health, Southampton (A.L.), the Centre for Reviews and Dissemination, University of York, York (W.M.), the School of Health and Population Sciences, University of Birmingham, Birmingham (T.R.), and the Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh (B.S.) — all in the United Kingdom. Address reprint requests to Dr. Dorling at the Division of Neonatal–Perinatal Medicine, 5850/5980 University Ave., Halifax, NS B3K 6R8, Canada, or at jon.dorling@iwk.nshealth.ca. *A complete list of investigators in the SIFT Investigators Group and the continuing care sites is provided in the Supplementary Appendix, available at NEJM.org.

 

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