早期肠内喂养与早产儿支气管肺发育不良的关系研究

The relationship between early enteral feeding and bronchopulmonary dysplasia in preterm infants

摘要:

目的 探究早期肠内喂养与早产儿支气管肺发育不良（BPD）发生的关系。方法 选取2020年1月—2023年12月菏泽市立医院新生儿重症监护室收治的160例早产儿为研究对象，根据有无BPD分为BPD组110例和非BPD组50例。比较两组的临床资料、早期肠内喂养情况，采用多因素一般Logistic回归分析早产儿发生BPD的影响因素；构建列线图，绘制受试者工作特征（ROC）曲线。结果 BPD组的胎龄、Apgar评分均低于非BPD组（P <0.05），机械通气≥ 7 d占比、使用碳青霉烯类抗生素占比、使用肺表面活性物质占比及吸氧时间均高于非BPD组（P <0.05）。BPD组的首次达足量肠内喂养时间、最终达足量肠内喂养时间及肠内喂养开始时间均长于非BPD组（P <0.05），肠内喂养量、总热量摄入量低于非BPD组（P <0.05）。多因素一般Logistic回归分析结果显示：胎龄［O^R =0.546（95% CI：0.314，0.947）］、机械通气≥7 d ［O^R =1.697（95% CI：1.022，2.816）］、使用碳青霉烯类抗生素［O^R =1.879（95% CI：1.100，3.211）］、吸氧时间长［O^R =2.080（95% CI：1.231，3.514）］、最终达足量肠内喂养时间长［O^R =2.639（95% CI：1.343，5.184）］、肠内喂养量小［O^R =0.469（95% CI：0.257，0.854）］及肠内喂养开始时间长［O^R =2.036（95% CI：1.039，3.988）］均为早产儿发生BPD的危险因素（P <0.05）。ROC曲线结果表明，最终达足量肠内喂养时间、肠内喂养量、肠内喂养开始时间及三者联合预测早产儿发生BPD的敏感性分别为84.5%（95% CI：0.754，0.900）、80.0%（95% CI：0.713，0.870）、53.6%（95% CI：0.430，0.623）和91.8%（95% CI：0.850，0.962），特异性分别为78.0%（95% CI：0.640，0.885）、80.0%（95% CI：0.663，0.900）、78.0%（95% CI：0.640，0.885）和80.0%（95% CI：0.663，0.900），曲线下面积分别为0.832、0.831、0.687和0.881，联合预测效能更高。结论 早期肠内喂养与早产儿发生BPD有关。

Abstract:

Objective To explore the relationship between early enteral feeding and the development of bronchopulmonary dysplasia (BPD) in preterm infants.Methods A total of 160 preterm infants admitted to the neonatal intensive care unit (NICU) of Heze Municipal Hospital between January 2020 and December 2023 were included. The infants were categorized into the BPD group (n =110) and the non-BPD group (n =50) based on the presence of BPD. Clinical data and early enteral feeding characteristics were compared between the two groups. Multivariate logistic regression was used to analyze the factors influencing the development of BPD in preterm infants. A nomogram was established, and receiver operating characteristic (ROC) curves were constructed.Results The BPD group had significantly lower gestational age and Apgar scores than the non-BPD group (P <0.05). The proportions of mechanical ventilation ≥7 days, carbapenem antibiotic use, pulmonary surfactant use, and oxygen therapy duration were higher in the BPD group (P <0.05). The time to reach full enteral feeding, final full enteral feeding time, and start of enteral feeding were significantly longer in the BPD group, while daily enteral feeding volume and total caloric intake were lower (P <0.05). Multivariate logistic regression analysis identified the following risk factors for BPD (P < 0.05): lower gestational age [O^R =0.546 (95% CI: 0.314, 0.947)], mechanical ventilation ≥7 days [O^R =1.697 (95% CI: 1.022, 2.816)], carbapenem antibiotic use [O^R =1.879 (95% CI: 1.100, 3.211)], prolonged oxygen therapy [O^R =2.080 (95% CI: 1.231, 3.514)], delayed achievement of full enteral feeding [O^R =2.639 (95% CI: 1.343, 5.184)], lower enteral feeding volume [O^R =0.469 (95% CI: 0.257, 0.854)], and delayed initiation of enteral feeding [O^R =2.036 (95% CI: 1.039, 3.988)]. ROC curve analysis demonstrated that the sensitivities of delayed full enteral feeding time, enteral feeding volume, delayed start of enteral feeding, and the combined prediction for BPD were 84.5% (95% CI: 0.754, 0.900), 80.0% (95% CI: 0.713, 0.870), 53.6% (95% CI: 0.430, 0.623), and 91.8% (95% CI: 0.850, 0.962), respectively, while their specificities were 78.0% (95% CI: 0.640, 0.885), 80.0% (95% CI: 0.663, 0.900), 78.0% (95% CI: 0.640, 0.885), and 80.0% (95% CI: 0.663, 0.900). The areas under the curve (AUC) were 0.832, 0.831, 0.687, and 0.881, respectively, with the combined prediction showing the highest performance.Conclusion Early enteral feeding is associated with the occurrence of BPD in preterm infants.