| Background Neonatal feeding intolerance is a common problem in preterm infants.Functional immaturity of gastrointestinal tract predisposes preterm infants to feeding intolerance. Preterm infants often manifest emesis, abdominal distention, gastric retention, and so on after being fed. Due to feeding intolerance, preterm infants get less calorie via the gastrointestinal tract, with protein deficiency; their weight does not increase or decrease, they grow or recover slowly, the length of hospital stay increases,and even their survival rate decreases. The incidence of feeding intolerance increases with decreasing gestational age and birth weight.Early minimal enteral feeding or trophic feedings can facilitate the development and maturity of the gastrointestinal tract,enhance its enzyme activity, promote the release of gastrointestinal hormones, increase blood flow to the gastrointestinal tract, improve gastrointestinal motility, establish a normal flora, and prevent or minimize feed intolerance in preterm infants.Touch consisted of tactile stimulation of the body and passive movements of the limbs, which developed favorable effects in preventing or minimizing feed intolerance in preterm infants. Preterm infants can intake more milk, gain more weight, and their head circumference and height grow faster after touched.Currently, little research on how to prevent neonatal feeding intolerance is conducted.In this study,the effect of touch with early minimal enteral feeding preventing feeding intolerance in preterm infants is observed.Objective To evaluate the effect of touch with early minimal enteral feeding in preventing feeding intolerance in preterm infants, explore feeding strategies in preterm infants, and provide clinical evidence for feeding preterm infants.Methods 189 preterm infants admitted in Shandong University Affiliated Provincial Hospital from November 2008 to November 2009 were observed.The average gestational age is 33.7±2.0W, the average birth weight is 2.0±0.5kg. According to gestational age,96 preterm infants were allocated in A group(GA>34W), 93 preterm infants were allocated in B group(GA<34W). A group were randomly divided into A1 groups (n= 32), A2 group (n=32) and A3 group (n=32). B group were also randomly divided into B1 groups (n=31), B2 group (n=31) and B3 group (n=31).The clinical data such as weight, feeding volumes, calorie intakes, gastric residual volumes, frequencies of vomiting, and stool were recorded daily. The time of regaining birth weight, time of parenteral nutrition, time of reaching full enteral nutrition and the length of hospital stay were also recorded.Results1.Feeding effect of preterm infantsFor GA≥34W preterm infants, A1 group, A2 group took significantly more milk and caloric than A3 group via the gastrointestinal tract (P<0.05). For GA<34W preterm infants, B1 group, B2 group took significantly more milk and caloric than B3 group via the gastrointestinal tract (P<0.01). B1 group took significantly more milk and caloric than B2 group via the gastrointestinal tract (P<0.01).For GA>34W preterm infants, A1 group took significantly less time in regaining birth weight than A2 group, A3 group respectively (P<0.05,<0.01); A2 group took significantly less time in regaining birth weight than A3 group (P＜0.05). A1 group took significantly less time in reaching 50kcal/kg/d caloric intake than A3 group via the gastrointestinal tract (P0.01). A1 group, A2 group took significantly less time in reaching 80kcal/kg/d caloric intake than A3 group via the gastrointestinal tract respectively (P<0.05,0.01). A1 group, A2 group took significantly less time in reaching l00kcal/kg/d caloric intake than A3 group via the gastrointestinal tract (P＜0.01).For GA<34W preterm infants, B1 group took significantly less time in regaining birth weight than B2 group, B3 group (P<0.01). B1 group took significantly less time in reaching 50kcal/kg/d caloric intake than B2, B3 group via the gastrointestinal tract respectively (P<0.01). B1 group took significantly less time in reaching 80kcal/kg/d caloric intake via the gastrointestinal tract than B3 group via the gastrointestinal tract respectively (P<0.05,0.01). B1 group took significantly less time in reaching l00kcal/kg/d caloric intake than B3 group via the gastrointestinal tract (P<0.01).For GA≥34W preterm infants, A1 group daily gained more weight than A2 group, A3 group respectively (P＜0.01). A2 group daily gained more weight than A3 group (P＜0.05). For GA＜34W preterm infants, B1 group daily gained more weight than B2 group,B3 group respectively (P<0.01). B2 group daily gained more weight than B3 group (P＜0.01).For GA≥34W preterm infants, A1 group daily defecated more frequently than A3 group (P<0.05).For GA<34W preterm infants, B1 group daily defecated more frequently than B2 group, B3 group (P＜0.01).For GA>34W preterm infants, PN time of A1 group was significantly shorter than that of A3 group (P＜0.01). A1 group and A2 group reached enteral feeding earlier than A3 group (Pall＜0.01). Hospitalization time of Al group and A2 group were significantly shorter than that of A3 group respectively (P<0.01).For GA<34W preterm infants, PN time of B1 group and B2 group was significantly shorter than that of B3 group respectively (P<0.01). B1 group reached enteral feeding earlier than the B3 group (P<0.01). Hospitalization time of B1 group was significantly shorter than that of B3 group (P<0.05).2.Incidence of feeding intoleranceFor GA>34W preterm infants, the incidence of feeding intolerance of Al group was lower than A3 group (P<0.0125).For GA<34W preterm infants,the incidence of feeding intolerance of B1 group was lower than B2 group, B3 group respectively (P＜O.0125).3.Comparison of indicators between GA≥34W preterm infants and GA< 34W preterm infantsGA>34W preterm infants regained birth weight more quickly, earlier reached 50,80,100kcal/kg/d caloric intake, took more milk and calorie via the gastrointestinal tract than GA<34W preterm infants(P<0.01 respectively). GA≥34W preterm infants gained more weight,defecate more frequently than GA<34W preterm infants respectively (P<0.05,<0.01). PN time, the time to reaching full enteral feeding, the hospitalization time of GA>34W preterm infants were shorter than that of GA<34W preterm infants (P<0.01).Conclusions1.Touch with early minimal enteral feeding can promote the development and mature of preterm infants gastrointestinal tract, improve their gastrointestinal motility.2.Touch with early minimal enteral feeding can shorten PN time, the time of reaching full volume feeding, the length of hospital stay in preterm infants. 3.Touch with early minimal enteral feeding can enhance the tolerance of enteral feeding in preterm infants.4. The incidence of feeding intolerance increases with decreasing gestational age. |
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