Effect Of The Start Time Of Enteral Nutrition On The Growth Index And Digestive Function Of The Extremely Low Birth Weight Infant

Objective Extremely low birth weight infant(ELBWI)is pointed out that the newborn birth weight is often less than 1000 g.ELBWI each organization organ development is not mature,development of gastrointestinal function is perfect,sucking and swallowing function,feeding intolerance,appear easily leading to gastric contents retention,repeated vomiting,reflux,abdominal pain of different level,leading to ELBWI malnutrition,palace retardation(Extrauterine growth restriction,EUGR) and Necrotizing enterocolitis(Necrotizing enterocolitis,NEC) and the corresponding complications. In recent years due to the diagnosis and treatment technology and Neonatal intensive care(Neonatal intensive care unit,NICU) level enhancement,prompting ELBWI rescue success rate increased year by year. ELBWI early nutrition supply,especially in the NICU hospitalization of nutrition,for it can catch up with palace growth,achieve catch-up growth instead of the nervous system in the late development condition has a very close relationship. Foreign ELBWI early feeding have comparatively perfect nutrition solutions,such as the Canadian Mc Master university multidisciplinary working group to carry on the literature review, on the basis of evidence-based,formed the very low birth weight feeding guide:ELBWI to whole gastrointestinal feed(Total enteral nutrition,TEN); Feeding frequency;The nutritional feeding trace enteral feeding(Minimal enteral bean, MEF);Nutritional feeding;Start feeding dairy products(choice mother milk,second donated milk.If are unable to obtain,can choose preterm milk powder.); Line ELBWI feeding of noninvasive ventilation; With hypotension ELBWI feeding; Using indomethacin or ibuprofen treatment of premature infant feeding;The evaluation of feeding tolerance;The processing of gastric retention;Gastroesophageal reflux of nursing time and way;Slow tube feeding raise and continuous drip feed, prevent loss of nutrients;Breast enhancer; Glycerine enema improved feeding tolerance and other related aspects of the guide. At present,the research on ELBWI feed and also less obvious deficiencies,significantly lagged behind the developed countries.Explore ELBWI enteral nutrition of different start time impact on ELBWI growth index and digestive function, thus for ELBWI early enteral nutrition(enteral nutrition,EN) management to provide more clinical basis.Methods1 Will be in January 2014 to December 2015 in four 3 armour hospital treated 76 cases of ELBWI was divided into three groups, three groups start enteral nutrition time respectively for ≤24 h(26 cases); 24 h- 72 h(25 cases); ≥72 h(25 cases). Hospital2 h, unified use of parenteral nutrient solution, within a week after the fed(1 week, 2weeks, 3 weeks, 4 weeks) were measured and recorded growth index and digestive function index.2 The growth index is to point to: body weight, body length, head circumference and related conditions. Whether ELBWI growth ideal evaluation index including weight gain, not only includes the change of the height(linear growth index), head circumference(evaluation) of the central nervous system development changes; Weekly record, body weight, body length, head circumference data analysis ELBWI early postnatal weight physiological decline range, as well as the weekly gain weight, height growth, increase in head circumference. Foreign ELBWI postnatal growth rate for the ideal: ELBWI average weight gain of 15 g- 20 g/kg. D, 0.8 1.1 cm long growth/w, head circumference growth of 0.5-1.0 cm/w [1], weight gain and even can reach 18 g- 20 g/kg.D [2], the early full term physiological weight loss range is less than 10%, and for ELBWI can be raised to 15%-20%.3 The digestive function index: digestive function index is to point to: milk supply growth, gastric retention, vomiting, constipation, abdominal distension and diarrhea.According to the result of mice experiment research of pathology, completely Parenteral nutrition(Total Parenteral nutrition, TPN) mice fasting 72 h will render it flattens intestinal mucosal atrophy, intestinal villus, in turn, led to the decrease of the gastrointestinal tract function [3], affect the implementation of enteral nutrition, and the sooner you start EN the help to promote the mature of gastric bowel function, further encourage ELBWI as quickly as possible to reach TEN [4]. Start EN time on whether there is a feeding intolerance: the amount of vomiting and vomiting, whether to have gastric contents of residue and residues, whether abdominal distension, and abdominal distention, constipation, for relationship between the incidence of shape and number of stool, after the raw milk supply growth in presence of influence.Results1 between January 2014 and December 2015 in four 3 armour hospital treated 76 cases of ELBWI is divided into three groups, three groups start EN time respectively for ≤24h(26 cases); 24 h- 72 h(25 cases); ≥ 72 h(25 cases). 1 case of gastrointestinal absorption function is poorer, 1 case was complicated by NEC, exit in 2 cases, and finally into the study of 74 cases.2 Enteral nutrition start time impact on growth and development indexes: ≤ 24 h ELBWI and acuity ≥72 h group ELBWI after 1 in the whole growth long group is significantly higher than 24 h- 72 h ELBWI ≤24 h group and ≥ 72 h group h ELBWI contrast difference is not significant; Three groups of different EN start time for weight loss to the lowest time node, restore to the time when the birth weight no statistically significant effect. Three groups of different EN start time impact on weight,head circumference growth difference is not significant; ≤24 h group ELBWI PICC catheter time is less than the other two groups, 24 h- 72 h and ≥72 h or group ELBWI there was no statistically significant difference in; Of ≥72 h group ELBWI up to TEN or more time significantly longer than the other two groups ELBWI acuities were≤24 h and 24 h- 72 h group ELBWI contrast difference is not significant, but collect data expressed ELBWI early EN have a tendency to reduce the hospitalization days.3 Enteral nutrition start time effect on the digestive function: data analysis showed that enteral nutrition group start time ≤ 24 h ELBWI postnatal 1 week Wei Yang Liang(milk) is significantly higher than other two groups ELBWI, at the same time, according to data of 24 h- 72 h group ELBWI postnatal 1 week ELBWI raw milk supply is significantly higher than≥72 h or group after 1 week milk; Gave birth to two weeks,three weeks after the EN group start time≤24 h ELBWI group and 24 h- 72 h ELBWI ELBWI raw milk supply is significantly higher than≥72 h or group after two weeks,three weeks of milk supply, ≤24 h ELBWI group and 24 h- 72 h ELBWI between 2weeks after birth, there was no statistically significant difference three weeks of milk supply. To ELBWI 4 weeks after birth, there was no statistically significant difference between groups milk supply. Three groups of enteral nutrition start time had no significant effect on total bilirubin(TBIL). EN start time on whether vomiting, gastric contents whether retention and retention amount, whether abdominal distention and whether the degree of abdominal distension, constipation, diarrhea and diarrhea have no obvious effect on the number of times the incidence.Discuss According to an analysis of 74 clinical cases of collecting≤24 h ELBWI group start enteral nutrition, the growth and development indexes weight, height growth and head circumference were obviously better than that of the 24 h- 72 h and ≥72 h or two groups;Digestive function index of ≤ 24 h group start enteral nutrition ELBWI, raw milk supply growth was significantly better than that of the 24 h- 72 h and ≥ 72 h of two or more groups. Provide the basis for ELBWI advocate early feeding.