家庭内鼻饲喂养：儿童患者的喂养状况和生长结局
家庭肠内营养是一种为慢性疾病患儿提供营养的安全方法，其优点包括：缩短住院时间、降低花费、降低营养不良相关并发症的风险。然而，出院后家庭肠内营养随访效果报道不多。
美国纽约西奈山伊坎医学院为了评估鼻饲喂养出院患儿后续喂养状态及其对生长发育的影响，对2010年1月～2013年3月美国纽约西奈山医疗中心出院后依赖于鼻饲的患儿进行了回顾研究。
结果共入组了87例患儿，平均年龄为1.2岁。最常见的诊断为先天性心脏病（47%）、代谢性疾病（17%）、神经功能损伤（10%）、肝脏疾病（9%）、早产（8%）和炎性肠病（6%）。在近期随访中，44例（50.6%）完全经口喂养，8例（9.2%）一直依赖鼻饲喂养，9例（10.3%）利用胃造瘘术放置的导管喂养，9例（10.3%）死亡，17例（19.5%）转院或失访。鼻饲喂养的平均终止时间为4.8月。从出院到随访6～12周后体重指数变化有统计学意义，平均值±标准差从13.78±2.82变化为14.58±2.1（P=0.02）。神经损伤患儿的体重Z评分有显著变化（-3.84→-3.34；P=0.02）。早产儿的身高Z评分有显著变化（-3.84→-3.34；P=0.02）。其他诊断患儿的身高和体重Z评分无显著变化。
因此，鼻饲喂养有助于慢性疾病患儿出院后短期的生长发育。
JPEN J Parenter Enteral Nutr. 2016;40(3):350-4.
Home Nasogastric Feeds: Feeding Status and Growth Outcomes in a Pediatric Population.
Rosen D, Schneider R, Bao R, Burke P, Ceballos C, Hoffstadter-Thal K, Benkov K.
Department of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY.
BACKGROUND: Home enteral nutrition (HEN) is a safe method for providing nutrition to children with chronic diseases. Advantages of HEN include shorter hospitalizations, lower cost, and decreased risk of malnutrition-associated complications. Follow-up after hospital discharge on HEN is limited. The purpose of this study was to look at children discharged on nasogastric (NG) feeds to assess follow-up feeding status and impact on growth.
METHODS: A retrospective chart review was conducted of pediatric patients discharged from Mount Sinai Medical Center on NG feeds between January 2010 and March 2013.
RESULTS: A total of 87 patients were included. Average age was 1.2 years. The most common diagnoses were congenital heart disease (47%), metabolic disease (17%), neurologic impairment (10%), liver disease (9%), prematurity (8%), and inflammatory bowel disease (6%). At most recent follow-up, 44 (50.6%) were on full oral feeds, 8 (9.2%) were still on NG feeds, 9 (10.3%) had a gastrostomy tube placed, 9 (10.3%) were deceased, and 17 (19.5%) had transferred care or were lost to follow-up. Average time to discontinuation of NG feeds was 4.8 months. Change in body mass index from hospital discharge to follow-up visit 6 to 12 weeks after discharge was statistically significant, from a mean (SD) of 13.78 (2.82) to 14.58 (2.1) (P = .02). Change in weight z score was significant for neurologic impairment (-1.35 to -0.04; P = .03). Height z score change was significant for prematurity (-3.84 to -3.34; P = .02). There was no significant change in height or weight z scores for the other diagnoses.
CONCLUSIONS: NG feeds can help to improve short-term growth after hospital discharge in children with chronic illnesses.
KEYWORDS: enteral nutrition; home nutrition support; pediatrics
PMID: 25261413
DOI: 10.1177/0148607114551967
