Çok Düşük Doğum Ağırlıklı İnfantlarda Tam Enteral Beslenmeye Geçiş Süresine Etki Eden Faktörler

Yıl 2021, Cilt: 15 Sayı: 4, 257 - 261, 16.07.2021

Merve Küçükoğlu Keser , Aslıhan Köse Esin Okman , Esra Özmen Fatma Sarı , Cüneyt Tayman , Evrim Alyamac Dizdar

https://doi.org/10.12956/tchd.688924

Öz

Amaç: Tam enteral beslenmeye erken geçiş protein katabolizmasını önleyerek bebeklerin büyüme ve gelişimine olumlu katkı sağlar. Bu çalışmada çok düşük doğum ağırlıklı preterm bebeklerde tam enteral beslenmeye geçiş süresine etki eden faktörlerin belirlenmesi amaçlandı.

Gereç ve Yöntemler: Doğum ağırlığı ≤1500 gr ve gestasyon yaşı ≤32 hafta olan preterm bebeklerin demografik verileri, tam enteral beslenmeye geçiş süreleri, hastanede yatış süreleri, taburculuktaki vücut ağırlıkları ve baş çevreleri, günlük kilo alımları, bronkopulmoner displazi (BPD), nekrotizan enterokolit (NEK), intraventriküler kanama (IVK), respiratuar distres sendromu (RDS), geç neonatal sepsis (GNS) ve mortalite oranları kaydedildi. Veriler tam enteral beslenmeye geçiş zamanına göre ilk 10 günde geçenler erken, 10 günden uzun sürede geçenler ise geç şeklinde gruplandırılarak karşılaştırıldı.

Bulgular: Çalışmaya 474 bebek dahil edildi. Bebeklerin 91’i, ilk 10 günde, 383’ü ise 10 günden sonra tam enteral beslenmeye geçen bebeklerdi. Ortanca (IQR) gestasyon haftası sırasıyla 29 (28-30) ve 28 (27-29) hafta, doğum ağırlığı 1240 (1080-1350) gr ve 1030 (850-1190) gr’dı. Tam enteral beslenmeye erken geçen bebeklerde hastanede yatış süresi daha kısa olarak saptandı (p<0.01). GNS ve BPD oranları enteral beslenmeye geç ulaşanlarda anlamlı olarak daha yüksekti (p<0.01). NEK, Grade 3-4 IVK ve mortalite oranları gruplar arasında benzerdi. Doğum ağırlığının düşük olması, RDS varlığı ve annede preeklampsi varlığı, tam enteral beslenmeye geçiş zamanının gecikmesi açısından risk faktörleri olarak bulundu.

Sonuç: Yenidoğan yoğun bakım ünitelerinde izlenen preterm bebeklerin tam enteral beslenmeye erken başlaması morbiditeler üzerine fayda sağlar. Bu durum bebeklerde hastane yatış sürelerini azaltarak büyümelerine katkı sağlayabilir. Preterm doğumların önlenmesi, RDS ve preeklampsinin engellenmesi, tam enteral beslenmeye geçişi kolaylaştırmaktadır.

Anahtar Kelimeler

Beslenme, çok düşük doğum ağırlığı, preterm, Enteral beslenme

Factors Affecting the Full Enteral Feeding in Very Low Birth Weight Preterm Infants

Öz

Objective: Early transition to full enteral nutrition prevents protein catabolism and has a positive impact on the growth and development of infants. The aim of this study was to determine the factors affecting the time to full enteral feeding in very low birth weight infants.

Material and Methods: Demographic data of infants with birth weight ≤1500 g and gestational age ≤32 weeks, time to full enteral feeding, weights and head circumference at discharge, daily weight gain, duration of hospital stay, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), respiratory distress syndrome (RDS), late neonatal sepsis (LNS) and mortality rates were recorded. Data were compared by grouping according to the time of transition to full enteral nutrition as early in the first 10 days and delayed in more than 10 days.

Results: Totally 474 infants were included in the study. Of those 91 infants achieved full enteral feeding in the first 10 days and 383 of them after 10 days. Median gestational age were 29 and 28 weeks and birth weights were 1240 g and 1030 g respectively. While the duration of hospital stay was shorter in the early enteral feeding group (p <0.01), late neonatal sepsis and BPD rates were significantly higher in late arriving enteral feeding (p <0.01). NEC, Grade 3-4 IVH and mortality rates were similar between the groups. Low birth weight, presence of RDS and maternal preeclampsia were found to be risk factors for delayed transition to full enteral feeding.

Conclusion: Early achievement of full enteral feeding in very low birth weight preterm infants might have beneficial effects on morbidities. This might contribute to the growth of infants by decreasing duration of hospitalization. Prevention of preterm births, prevention of RDS and preeclampsia facilitate the transition to full enteral nutrition.

Anahtar Kelimeler

nutrition, preterm, Very low birth weight infants, Enteral feeding

Kaynakça

• KAYNAKLAR 1. Salas AA, Li P, Parks K, Lal CV, Martin CR, Carlo WA. Early progressive feeding in extremely preterm infants: a randomized trial. Am J Clin Nutr. 2018;107(3):365-370.
• 2. Türk Neonataloji Derneği Prematüre ve Hasta Term Bebeğin Beslenmesi Rehberi 2014, http://www.neonatology.org.tr/wp-content/uploads/2016/12/premature_rehber_son_son.pdf
• 3. Ong KK, Kennedy K, Castaneda-Gutierrez E, et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr. 2015;104(10):974-986.
• 4. Tipici BE, Akbulut G. Preterm yenidoğanlarda enteral beslenme desteği. Beslenme ve Diyet Dergisi 2014;42(1):59-64.
• 5. Cortez J, Makker K, Kraemer DF, Neu J, Sharma R, Hudak ML. Maternal milk feedings reduce sepsis, necrotizing enterocolitis and improve outcomes of premature infants. J Perinatol. 2018;38(1):71-74.
• 6. Corpeleijn WE, Kouwenhoven SM, Paap MC, et al. Intake of own mother’s milk during the first days of life is associated with decreased morbidity and mortality in very low birth weight infants during the first 60 days of life. Neonatology. 2012;102(4):276-281.
• 7. Barr PA, Mally PV, Caprio MC. Standardized Nutrition Protocol for Very Low‐Birth‐Weight Infants Resulted in Less Use of Parenteral Nutrition and Associated Complications, Better Growth, and Lower Rates of Necrotizing Enterocolitis. Journal of Parenteral and Enteral Nutrition, 2018;43:540-549.
• 8. Manea A, Boia M, Iacob D, Dima M, Iacob RE. Benefits of early enteral nutrition in extremely low birth weight infants. Singapore Med J. 2016;57(11):616–618.
• 9. Thureen, PJ, The Neonatologist's Dilemma: Catch-up Growth or Beneficial Undernutrition in Very Low Birth Weight Infants-What Are Optimal Growth Rates? Journal of Pediatric Gastroenterology and Nutrition. 2017;45:152-154.
• 10. Kongwattananakul K, Saksiriwuttho P, Chaiyarach S, Thepsuthammarat K. Incidance, characteristics, maternal complications and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome. Int J Womans Health. 2018;10:371-377.
• 11. Zuspan FP, New concepts in the understanding of hypertansive diseases during pregnancy. Clin Perinatol. 1991;18:653-659.
• 12. Pezzati M, Dani C, Tronchin M, Filippi L, Rossi S, Rubaltelli FF. Prediction of early tolerance to enteral feeding by measurement of superior mesenteric artery blood flow velocity: appropriate-versus small-for-gestational-age preterm infants. Acta Pediatrica. 2004;93:797-802.
• 13. Ersch J, Baenziger O, Bernet V, Bucher HU, Feeding problems in preterm infants of preeklamptic mothers, Journal of Paediatrics and Child Health, 2008;44:651-655.
• 14. Corvaglia L, Fantini MP, Aceti A et al. Predictors of full enteral feding achievement in very low birth weight infants. PLoS One. 2014;9(3):e92235.
• 15. Kandasamy Y. Infection control during administration of parenteral nutrition in preterm babies. Arch Dis Child Fetal Neonatal Ed. 2009;94(1):78.
• 16. Nangia S, Vadivel V, Thukral A, Saili A. Early Total Enteral Feeding versus Conventional Enteral Feeding in Stable Very-Low-Birth-Weight Infants: A Randomised Controlled Trial. Neonatology 2019;115:256-262.
• 17. Maas C, Franz AR, Krogh Svon, Arand J, Poets CF. Growth and morbidity of extremely preterm infants after early full enteral nutrition. Arch Dis Child Fetal Neonatal Ed. 2017;0:1-3.
• 18. Waard M, Li Y, Zhu Y et al. Time to Full Enteral Feeding for Very Low-Birth-Weight Infants Varies Markedly Among Hospitals Worldwide But May Not Be Associated With Incidence of Necrotizing Enterocolitis: The NEOMUNE-NeoNutriNet Cohort Study. Journal of Parenteral and enteral nutrition. 2018;00(0):1-10.