中国新生儿重症监护病房中极低出生体重婴儿的肠内喂养实践与指南依从性：一项多中心横断面调查

摘要(中文译文)

本研究旨在调查新生儿重症监护病房（NICU）极低出生体重（VLBW）婴儿肠内喂养的现状，并评估其对指南和证据的依从性。于2024年8月至11月开展了关于VLBW婴儿肠内喂养实践的在线调查。通过二维码和调查链接向山东省护理学会的合作机构发放。将调查结果与VLBW婴儿肠内营养相关证据和指南的推荐意见进行比较。共邀请47家NICU参与本次调查。其中，32家NICU（68.1%）已建立专门针对VLBW婴儿的标准化喂养方案。所有机构均将母乳作为首选，但53.2%的NICU具备母乳或捐赠母乳作为启动肠内喂养的奶源。39家NICU（83.0%）在24小时内启动肠内喂养。41家NICU（87.3%）每2~3小时进行一次肠内喂养，每日增加量为13（2，15）ml。各NICU根据热量或容量目标界定完全肠内喂养，并依据指南和本地经验制定。具体而言，27家NICU（57.4%）将其定义为平均摄入量（123.4±21.8）kcal/kg/d，37家NICU（78.7%）将其定义为（138.4±35.7）ml/kg/d。初始肠内喂养量及达到完全肠内喂养所需时间根据出生体重采取不同管理方式。当婴儿摄入量达到（74.9±33.7）ml/kg/d时启动母乳强化，但仅20家NICU（42.6%）将其作为常规营养支持措施。约30%的机构常规测量胃残余量。根据残余量多少，胃残余液或被重新喂养给婴儿或被丢弃。尽管临床实践与VLBW婴儿的证据和指南基本一致，但在母乳强化的使用和时机等方面仍存在差异。本研究不仅提供了区域数据，还分析了证据与临床实践之间的实施差距。通过分析这些差异，本研究识别了NICU营养管理中的不足，为早产儿护理的持续质量改进提供了依据。

Abstract

This study aimed to investigate the current status of enteral feeding for VLBW infants in NICUs, and to assess compliance with guidelines and evidence. Online survey on enteral feeding practices for VLBW infants was conducted from August to November 2024. The Quick Response Code and link of this survey were distributed to partner institutions of the Shandong Nursing Association. The results were compared with recommendations from the evidence and guidelines on enteral nutrition for VLBW infants. 47 NICUs were invited to participate in this survey. Among these, 32 NICUs (68.1%) had established the standardized feeding protocol specifically designed for VLBW infants. All institutions prioritize breast milk as the preferred choice, but 53.2% of NICUs have breast milk or donated breast milk available as the source of milk for initiating enteral feeding. 39 NICUs (83.0%) initiate enteral feeding within 24 h. 41 NICUs (87.3%) administered enteral feeding every 2-3 h, with a daily volume increase of 13 (2, 15) ml. NICUs defined full enteral feeding based on either caloric or volume targets, established in accordance with guidelines and local experience. Specifically, 27 NICUs (57.4%) defined it as a mean intake of (123.4 ± 21.8) kcal/kg/day, and 37 NICUs (78.7%) defined it as (138.4 ± 35.7) ml/kg/day. Initial enteral feeding volumes and the time required to reach full enteral feeding were managed differently based on birth weight. Human milk fortification was initiated when the infant's intake reached (74.9 ± 33.7) ml/kg/day, but only 20 NICUs (42.6%) adopted it as a routine nutritional support measure. Approximately 30% of institutions routinely measured gastric residual volume. Depending on the volume, gastric residuals were either re-fed to the infant or discarded. While the clinical practices were aligned with evidence and guidelines for VLBW infants, divergence remained in areas such as the use and timing of human milk fortification. This study not only provides regional data but also analyzes implementation gaps between evidence and clinical practice. By analyzing these discrepancies, this study identified deficiencies in nutritional management within NICUs and provides a basis for continuous quality improvement in the care of preterm infants.

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