본문 바로가기
KERD
논문KCI 등재

미숙아의 장관영양

Enteral Feeding for Preterm Infants-Benefits and Risks

신종범
대한신생아학회 (THE KOREAN SOCIETY OF NEONATOLOGY)|2009.11|Neonatal medicine|제16권 제2호|pp. 121-130

2

조회

0

다운로드

3

인용

0

참고문헌

키워드

Preterm infantsEnteral feedingEarly trophic feeding

초록

Over the past 20 years, neonatal mortality rates for preterm infants, particularly those born extremely preterm and with a very low birth weight, have decreased steadily. As more very immature preterm infants survive, provision of enteral feeding has become a major focus of concern. According to many experts on neonatal nutrition, the goal for the nutrition of preterm infants should be to achieve a postnatal growth rate approximating that of a normal fetus of the same gestational age. Total parenteral nutrition for maintaining nutritional integrity is mandatory before successful transition to enteral feeding. Early initiation of trophic enteral feeding is vital for postnatal adaptation. Recently published randomized controlled trials provide no evidence to support the practice of postponing enteral feeding to reduce the incidence of necrotizing enterocolitis. Early trophic feeding yields demonstrable benefits and there is currently no evidence of any adverse effects following early feeding. Preterm milk from the infant's own mother is the milk of choice, which can always be supplemented with a human milk fortifier. Here we review over 50 randomized controlled trials and over seven systematic reviews published on neonatal parenteral and enteral feeding of preterm infants. Neonatologists must make use of the evidence from these studies as a reference for feeding protocols for preterm infants in their NICUs are to be based.

Abstract

Over the past 20 years, neonatal mortality rates for preterm infants, particularly those born extremely preterm and with a very low birth weight, have decreased steadily. As more very immature preterm infants survive, provision of enteral feeding has become a major focus of concern. According to many experts on neonatal nutrition, the goal for the nutrition of preterm infants should be to achieve a postnatal growth rate approximating that of a normal fetus of the same gestational age. Total parenteral nutrition for maintaining nutritional integrity is mandatory before successful transition to enteral feeding. Early initiation of trophic enteral feeding is vital for postnatal adaptation. Recently published randomized controlled trials provide no evidence to support the practice of postponing enteral feeding to reduce the incidence of necrotizing enterocolitis. Early trophic feeding yields demonstrable benefits and there is currently no evidence of any adverse effects following early feeding. Preterm milk from the infant's own mother is the milk of choice, which can always be supplemented with a human milk fortifier. Here we review over 50 randomized controlled trials and over seven systematic reviews published on neonatal parenteral and enteral feeding of preterm infants. Neonatologists must make use of the evidence from these studies as a reference for feeding protocols for preterm infants in their NICUs are to be based.

참고문헌 (51)

  1. Hay WW Jr, "Strategies for feeding the preterm infant", Neonatology, 94, pp.245~254 (2008)
  2. Berseth CL, "Enteral nutrients promote postnatal maturation of intestinal motor activity in preterm infants", Am J Physiol, 264, pp.G1046~G1051 (1993)
  3. Caicedo RA, "The developing intestinal ecosystem: implications for the neonate", Pediatr Res, 58, pp.625~628 (2005)
  4. Greer FR, "Feeding the premature infant in the 20th century", J Nutr, 131, pp.426s~430s (2001)
  5. Gordon HH, "Feeding of premature infants. A comparison of human and cow's milk", Am J Dis Child, 73, pp.442~452 (1947)
  6. Heird WC, "Historic perspective: Total parenteral nutrition", Neoreviews, 4, pp.e137~e139 (2003)
  7. Davies DP, "The first feed of low birthweight infants. Changing attitudes in the twentieth century", Arch Dis Child, 53, pp.187~192 (1978)
  8. Raiha NC, "Milk protein quantity and quality in low-birthweight infants: I. Metabolic responses and effects on growth", Pediatrics, 57, pp.656~684 (1976)
  9. Lucas A, "Gut hormones and 'Minimal Enteral Feeding'", Acta Paediatr Scand, 75, pp.719~723 (1986)
  10. Lau C, "Oral feeding in the preterm infant", Neoreviews, 7, pp.e19~e27 (2006)
  11. Yu VY, "Enteral feeding in the preterm infant", Early Hum Dev, 56, pp.89~115 (1999)
  12. Dunn L, "Beneficial effects of early hypocaloric enteral feeding on neonatal gastrointestinal function: preliminary report of a randomized trial", J Pediatr, 112, pp.622~629 (1988)
  13. Johnson CR, "The trophic action of gastrointestinal hormones", Gastroenterology, 70, pp.277~278 (1976)
  14. Berseth CL, "Effect of early feeding on maturation of the preterm infants' small intestine", J Pediatr, 120, pp.947~953 (1992)
  15. Berseth CL, "Minimal enteral feedings", Clin Perinatol, 22, pp.195~205 (1995)
  16. Tyson JE, "Trophic feeding for parenterally fed infants", The Cochrane Database Syst Rev, 20(3), pp.CD000504~ (2005)
  17. McClure RJ, "Randomized controlled study of clinical outcome following trophic feeding", Arch Dis Child Fetal Neonatal Ed, 82, pp.F29~F33 (2008)
  18. McKeown RE, "Role of delayed feeding and of feeding increments in necrotizing enterocolitis", J Pediatr, 121, pp.764~770 (1992)
  19. Kennedy KA, "Rapid versus slow rate of advancement of feedings for promoting growth and preventing necrotizing enterocolitis in parenterally fed low-birth-weight infants", Cochrane Database Syst Rev, 2, pp.CD001241~ (2009)
  20. Hsueh W, "Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts", Pediatr Dev Pathol, 6, pp.6~23 (2003)
  21. Moody GJ, "Feeding tolerance in premature infants fed fortified human milk", J Pediatr Gastroenterol Nutr, 30, pp.408~412 (2000)
  22. Lander A, "The risks and benefits of cisapride in premature neonates, infants, and children", Arch Dis Child, 79, pp.469~470 (1998)
  23. Costalos C, "Erythromycin as a prokinetic agent in preterm infants", J Pediatr Gastroenterol Nutr, 34, pp.23~25 (2002)
  24. Ng PC, "Randomised controlled trial of oral erythromycin for treatment of gastrointestinal dysmotility in preterm infants", Arch Dis Child Fetal Neonatal Ed, 84, pp.F177~F182 (2001)
  25. Stenson BJ, "Influence of erythromycin on establishment of feeding in preterm infants: observations from a randomised controlled trial", Arch Dis Child Fetal Neonatal Ed, 79, pp.F212~F214 (1998)
  26. Patole SK, "Can prophylactic oral erythromycin reduce time to full enteral feeds in preterm neonates?", Int J Clin Pract, 54, pp.504~508 (2000)
  27. Ng PC, "Use of oral erythromycin for the treatment of gastrontestinal dysmotility in preterm infants", Neonatology, 95, pp.97~104 (2009)
  28. Ng E, "Erythromycin for feeding intolerance in preterm infants", The Cochrane Database of Syst Rev, 3, pp.CD001815~ (2008)
  29. Oei J, "A placebo-controlled trial of low-dose erythromycin to promote feed tolerance in preterm infants", Acta Paediatr, 90, pp.904~908 (2001)
  30. ElHennawy AA, "Erythromycin fails to improve feeding outcome in feeding-intolerant preterm infants", J Pediatr Gastroenterol Nutr, 37, pp.281~286 (2003)
  31. Ng SC, "Establishing enteral feeding in preterm infants with feeding intolerance: a randomized controlled study of low-dose erythromycin", J Pediatr Gastroenterol Nutr, 37, pp.554~558 (2003)
  32. Cairns P, "Randomised controlled trial of low- dose erythromycin in preterm infants with feed intolerance (abstract)", Pediatr Res, 51, pp.379A~380A (2002)
  33. Aly H, "Erythromycin and feeding intolerance in premature infants: a randomized trial", J Perinatol, 27, pp.39~43 (2007)
  34. Nuntnarumit P, "Efficacy of oral erythromycin for treatment of feeding intolerance in preterm infants", J Pediatr, 148, pp.600~605 (2006)
  35. Ng PC, "High-dose oral erythromycin decreased the incidence of parenteral nutrition-associated cholestasis in preterm infants", Gastroenterology, 132, pp.1726~1739 (2007)
  36. Lucas A, "Breast milk and neonatal necrotising enterocolitis", Lancet, 339, pp.1519~1523 (1990)
  37. Furman L, "The effect of maternal milk on neonatal morbidity of very low-birth-weight infants", Arch Pediatr Adolesc Med, 157, pp.66~71 (2003)
  38. Hylander MA, "Human milk feedings and infection among very low birth weight infants", Pediatrics, 102, pp.e38~ (1998)
  39. de Silva A, "Does human milk reduce infection rates in preterm infants? A systematic review", Arch Dis Child Fetal Neonatal Ed, 89, pp.F509~F513 (2004)
  40. Lucas A, "Breast milk and subsequent intelligence quotient in children born preterm", Lancet, 339, pp.261~264 (1992)
  41. Hylander MA, "Association of human milk feedings with a reduction in retinopathy of prematurity among very low birthweight infants", J Perinatol, 21, pp.356~362 (2001)
  42. Schanler RJ, "The use of human milk for premature infants", Pediatr Clin North Am, 48, pp.207~219 (2001)
  43. Henderson G, "Formula milk versus preterm human milk for feeding or low birth weight infants", The Cochrane Database of Syst Rev, 2, pp.CD002972~ (2009)
  44. Schanler RJ, "Randomized trial of donor human milk versus preterm formula as substitutes for mothers' own milk in the feeding of extremely premature infants", Pediatrics, 116, pp.400~406 (2005)
  45. Hay WW Jr, "Workshol summary: nutrition of the extremely low birth weight infant", Pediatrics, 104, pp.1360~1368 (1999)
  46. Schanler RJ, "Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula", Pediatrics, 103, pp.1150~1157 (1999)
  47. Yu VY, "Breast milk feeding in very low birthweight infants", Aust Paediatr J, 17, pp.186~190 (1981)
  48. Gartner LM, "American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk", Pediatrics, 115, pp.496~506 (2005)
  49. Kuschel CA, "Multicomponent fortified human milk for promoting growth in preterm infants", The Cochrane Database of Syst Rev, 1, pp.CD000343~ (2004)
  50. Yu JE, "Effect of maeil human milk fortifier on growth and bone mineralization in preterm infants", J Korean Soc Neonatol, 12, pp.32~41 (2005)
  51. 최희원, "극소 저체중출생아에서 강화된 모유와 미숙아 전용분유가 성장 및 임상에 미치는 효과", Korean Journal of Pediatrics, 51(7), pp.704~712 (2008), 대한소아과학회

관련 논문AI추천

단일 신생아집중치료실에서 완전 모유 수유 적용 이후 괴사성 장염의 발생 빈도 감소김병일, 김지현, 신정민, 윤혜리, 정영화, 조한나, 최창원대한신생아학회 · Neonatal medicine2017 · 제24권 제3호극소 저체중 신생아의 예제제 정맥영양수액 공급에 의한 임상적 효과 평가민명숙, 성세인, 성지현, 이후경, 임나리, 전은용한국병원약사회 · 병원약사회지2021 · 제38권 제4호Nutritional Support Strategies for the Preterm Infant in the Neonatal Intensive Care UnitWilliam W. Hay, Jr.대한소아소화기영양학회 · Pediatric Gastroenterology, Hepatology & Nutrition2018 · 제21권 제4호미숙아의 효과적인 조기 정맥영양이병섭대한신생아학회 · Neonatal medicine2009 · 제16권 제2호미숙아의 퇴원 후 영양김이경대한신생아학회 · Neonatal medicine2009 · 제16권 제2호초극소 저출생 체중아(≤1,000 g)에서 조기에 시작하는 정맥 영양 공급의 효과김은선, 박원순, 성세인, 신정희, 신지헌, 안소윤, 장윤실, 정지미대한신생아학회 · Neonatal medicine2011 · 제18권 제1호

이 간행물의 다른 논문 (18건)

신생아 호흡곤란증후군에서 인공 폐 표면활성제 조기요법의 중요성과 필요성윤혜선, 김기수, 배종우, 김성미pp. 101-109미숙아의 효과적인 조기 정맥영양이병섭pp. 110-120미숙아의 퇴원 후 영양김이경pp. 131-136한국 미숙아 산모와 제대혈의 IL-10 유전자형 빈도와 신생아 호흡 곤란증 발생과의 연관성하은희, 김영주, 박혜숙, 서영주, 박은애, 조수진pp. 137-145기관지폐 이형성증에 대한 덱사메타손 구제 치료이현주, 최은진, 이주영, 손진아, 김은선, 이진아, 김이경, 최창원, 김병일, 김윤주, 이은희, 손세형, 정의석pp. 146-153
원문 보기