Optimal timing for introducing enteral nutrition in the neonatal intensive care unit

Asia Pac J Clin Nutr. 2015;24(2):219-26. doi: 10.6133/apjcn.2015.24.2.14.


Objective: To identify the optimal time for introducing enteral nutrition to critically ill neonates.

Methods: This prospective cohort study included all eligible critically ill neonates who were admitted to a multidisciplinary tertiary neonatal intensive care unit (NICU) between 1st June and 30th November 2013. Nutrient intake and clinical outcomes during NICU stay were recorded. The effect of early (<24 hours after NICU admission) and delayed (>=24 hours) enteral nutrition introduction on clinical outcomes was assessed.

Results: Energy deficit in critically ill neonates was frequent: 84.7% could not achieve the caloric goal during the NICU stay. Growth retardation was common especially among the preterm: the frequency of neonates whose weight was below the 10th percentile increased significantly from 21.6% on admission to 67.6% at discharge. Compared with delayed enteral nutrition, early enteral nutrition was associated with better median time to starting weight gain (0 vs 6 days, p=0.0002), a lower chance of receiving parenteral nutrition (41.7% vs 95.9%, p<0.0001), shorter NICU stays (196 vs 288 hours, p=0.0001), fewer hours on mechanical ventilation and a lower chance of developing pulmonary infection (37.5% vs 56.0%, p=0.005). The accumulated energy deficit to the subjects who were exposed to delayed nutrition could not be compensated by subsequent nutrition. Neonates who underwent mechanical ventilation had suboptimal nutrient delivery: they took longer to gain weight and were more likely to develop respiratory distress and receive parenteral nutrition.

Conclusions: Early enteral nutrition initiation (<24 hours) is recommended. Neonates with mechanical ventilation should be monitored with particular attention.

目的:确定危重新生儿行肠内营养(enteral nutrition,EN)的最佳时间。方 法:本研究为前瞻性队列研究,观察时间为2013 年6 月1 日至2013 年11 月 30 日。纳入对象是进入新生儿重症监护室(NICU)接受治疗且日龄为1-28 天 的所有危重新生儿。记录这部分患儿在NICU 期间营养摄入情况和临床结局相 关指标,评价早期EN(入监护室24 hrs 内)和延迟开始的EN(大于24 hrs) 对患儿临床结局的影响。结果:热卡摄入不足在危重症新生儿中很普遍: 84.7%的患儿住NICU 期间热卡摄入无法达到推荐摄入量。生长迟缓在患儿住 NICU 期间普遍存在,尤其是早产儿:低于同日龄体重第10 百分位的患儿入 院时的比例为21.6%,出院时增加到 67.6%。入院24 hrs 内开始EN 相比延迟 开始EN,可以缩短入院后体重持续下降时间(0 d vs 6 d, p=0.0002),减少肠 外营养使用率(41.7% vs 95.9%,p<0.0001)和肺炎发生率(37.5% vs 56%, p=0.005), 缩短住NICU 时间(195.5 hrs vs 288 hrs,p=0.0001)和呼吸机使用 时间,并且增加患儿住NICU 期间平均每天能量摄入量。使用机械通气患儿与 非机械通气患儿相比:入院后体重持续下降时间长,呼吸窘迫发生率和肠外营 养使用率高。 结论:危重新生儿需尽早开始EN 支持治疗,推荐入NICU 后 24 hrs 内进行,机械通气新生儿住NICU 期间营养摄入情况应引起重视。.

MeSH terms

  • Cohort Studies
  • Critical Illness
  • Energy Intake
  • Enteral Nutrition / methods*
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature, Diseases / therapy
  • Intensive Care Units, Neonatal*
  • Intensive Care, Neonatal / methods*
  • Length of Stay
  • Male
  • Parenteral Nutrition
  • Prospective Studies
  • Respiration, Artificial
  • Time Factors
  • Weight Gain