PDF(Pubmed)
Abstract：
The nutrition of preterm infants remains contaminated by wrong beliefs that reflect inexactitudes and perpetuate old practices. In this narrative review, we report current evidence in preterm neonates and in preterm neonates undergoing surgery. Convictions that necrotizing enterocolitis is reduced by the delay in introducing enteral feeding, a slow advancement in enteral feeds, and the systematic control of residual gastric volumes, should be abandoned. On the contrary, these practices prolong the time to reach full enteral feeding. The length of parenteral nutrition should be as short as possible to reduce the infectious risk. Intrauterine growth restriction, hemodynamic and respiratory instability, and patent ductus arteriosus should be considered in advancing enteral feeds, but they must not translate into prolonged fasting, which can be equally dangerous. Clinicians should also keep in mind the risk of refeeding syndrome in case of high amino acid intake and inadequate electrolyte supply, closely monitoring them. Conversely, when preterm infants undergo surgery, nutritional strategies are still based on retrospective studies and opinions rather than on randomized controlled trials. Finally, this review also highlights how the use of adequately fortified human milk is strongly recommended, as it offers unique benefits for immune and gastrointestinal health and neurodevelopmental outcomes.
摘要：
早产儿的营养仍然被错误的信念所污染，这些信念反映了无礼并使旧的习俗永存。在这篇叙述性评论中，我们报告了早产新生儿和接受手术的早产新生儿的现有证据.认为延迟引入肠内喂养可减少坏死性小肠结肠炎，肠内喂养的缓慢进展，以及对残余胃容量的系统控制，应该被遗弃。相反,这些做法延长了达到完全肠内喂养的时间。肠外营养的长度应尽可能短，以降低感染风险。宫内生长受限,血流动力学和呼吸不稳定，在推进肠内喂养时应考虑动脉导管未闭，但它们不能转化为长时间的禁食，这可能同样危险。临床医生还应该记住，在氨基酸摄入量高和电解质供应不足的情况下，再喂养综合征的风险，密切监视他们。相反，当早产儿接受手术时，营养策略仍基于回顾性研究和观点,而非随机对照试验.最后,这篇评论还强调了如何强烈建议使用充分强化的人乳，因为它为免疫和胃肠道健康以及神经发育结果提供了独特的益处。
