切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2023, Vol. 19 ›› Issue (03) : 309 -314. doi: 10.3877/cma.j.issn.1673-5250.2023.03.010

论著

极低出生体重儿出生时血清25-羟维生素D水平与其生后早期喂养不耐受关系的临床分析
李聪, 徐艳, 吴铭, 丁瑞东, 王军†()   
  1. 徐州医科大学附属医院新生儿科，徐州　221000
  • 收稿日期:2022-12-09 修回日期:2023-05-20 出版日期:2023-06-01
  • 通信作者: 王军

Relationship between serum 25(OH)D levels at birth and early feeding intolerance in very low birth weight infants

Cong Li, Yan Xu, Ming Wu, Ruidong Ding, Jun Wang†()   

  1. Department of Neonatology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
  • Received:2022-12-09 Revised:2023-05-20 Published:2023-06-01
  • Corresponding author: Jun Wang
  • Supported by:
    National Natural Science Foundation of China(81904249)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李聪, 徐艳, 吴铭, 丁瑞东, 王军. 极低出生体重儿出生时血清25-羟维生素D水平与其生后早期喂养不耐受关系的临床分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 309-314.

Cong Li, Yan Xu, Ming Wu, Ruidong Ding, Jun Wang. Relationship between serum 25(OH)D levels at birth and early feeding intolerance in very low birth weight infants[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(03): 309-314.

目的

探讨极低出生体重儿(VLBWI)出生时，血清25-羟维生素D[25(OH)D]水平与其生后7 d内(以下简称为生后早期)喂养不耐受(FI)的关系。

方法

选择2020年9月至2022年4月于徐州医科大学附属医院新生儿重症监护病房(NICU)收治的161例VLBWI为研究对象。采取回顾性分析法，根据生后早期是否发生FI，将其分为FI组(n＝82)和喂养耐受(FT)组(n＝79)。检测2组VLBWI出生时的血清25(OH)D水平，收集2组VLBWI临床相关资料。采用χ2检验及独立样本t检验，以及多因素非条件logistic回归分析法，对本研究VLBWI生后早期FI影响因素，分别进行单因素及多因素分析。本研究经徐州医科大学附属医院医学伦理委员会审核通过(审批文号：XYFY2022-KL044)，并征得所有患儿监护人同意、签署知情同意书。

结果

①单因素分析结果显示：FI组VLBWI的胎儿宫内窘迫、出生时轻度窒息、机械通气治疗时间>96 h、开奶延迟及胎粪排出延迟发生率，均显著高于FT组；而出生时血清25(OH)D水平，则显著低于FT组，并且差异均有统计学意义(P<0.05)。②多因素非条件logistic回归分析结果显示：机械通气治疗时间>96 h(OR＝4.483，95%CI：1.449~13.865，P＝0.009)，开奶延迟(OR＝5.908，95%CI：1.599~21.823，P＝0.008)及胎粪排出延迟(OR＝5.248，95%CI：1.539~17.898，P＝0.008)，均是VLBWI生后早期发生FI的独立危险因素；而出生时血清25(OH)D水平较高(OR＝0.474，95%CI：0.367~0.614，P<0.001)，是VLBWI生后早期发生FI的保护因素。

结论

VLBWI出生时血清25(OH)D水平低，可能增加其生后早期FI发病风险。生后早期合理补充维生素D，或可降低VLBWI的生后早期FI发病率。

关键词: 婴儿，极低出生体重, 喂养不耐受, 维生素D, 重症监护病房，新生儿, 危险因素, 影响因素分析
Objective

To investigate the relationship between serum 25-hydroxy vitamin D[25(OH)D] levels at birth and feeding intolerance (FI) within 7 d after birth (hereinafter referred to as early postnatal period) in very low birth weight infants (VLBWI).

Methods

A total of 161 VLBWI admitted to the Neonatal Intensive Care Unit (NICU) of the Affiliated Hospital of Xuzhou Medical University from September 2020 to April 2022 were included in this study, retrospective analysis was conducted. According to whether FI occurred in early postnatal period, they were divided into FI group (n=82) and feeding tolerance (FT) group (n=79). Serum 25(OH)D levels of VLBWI at birth were detected in 2 groups, and clinical data of 2 groups were collected. Univariate and multivariate analysis of the influencing factors of FI in early postnatal period in VLBWI in this study were performed by chi-square test and independent sample t test, and multivariate unconditional logistic regression analysis, respectively. This study was approved by the Medical Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (Approval No. XYFY2022-KL044), and all the guardians of the children with the consent and signed informed consents were obtained.

Results

① Results of univariate analysis showed that: the incidence rates of fetal distress, mild asphyxia at birth, mechanical ventilation treatment duration>96 h, delayed timing of initiation of feeds and delayed meconium excretion in FI group were higher than those in FT group; while the level of serum 25(OH)D at birth was lower than that in FT group, and the differences were all statistically significant (P<0.05). ② Multivariate unconditional logistic regression analysis showed that mechanical ventilation treatment duration>96 h (OR=4.483, 95%CI: 1.449-13.865, P=0.009), delayed timing of initiation of feeds (OR=5.908, 95%CI: 1.599-21.823, P=0.008) and delayed meconium excretion (OR=5.248, 95%CI: 1.539-17.898, P=0.008) were all independent risk factors of FI occurrence in early postnatal period in VLBWI. A higher level of serum 25(OH)D at birth (OR=0.474, 95%CI: 0.367-0.614, P<0.001) was a protective factor of FI occurrence in early postnatal period in VLBWI.

Conclusions

Low serum 25(OH)D level at birth in VLBWI may increase the risk of FI in early postnatal period. Reasonable supplementation of vitamin D in early postnatal period may reduce the incidence of FI in early postnatal period in VLBWI.

Key words: Infant, very low birth weight, Feeding intolerance, Vitamin D, Intensive care units, neonatal, Risk factors, Root cause analysis
表1 VLBWI生后早期发生FI影响因素的单因素分析
组别 例数 男性[例数(%)] 胎龄(周，±s) BW(g，±s) 剖宫产娩出[例数(%)] 母亲产前使用激素[例数(%)] 胎膜早破>18 h[例数(%)]
FI组 82 48(58.5) 30.4±1.8 1 277±147 61(74.4) 55(67.0) 29(35.3)
FT组 79 52(65.8) 30.3±0.9 1 271±149 54(68.4) 57(72.2) 33(41.8)
]统计量   χ2＝0.91 t＝－0.48 t＝－0.29 χ2＝0.72 χ2＝0.49 χ2＝0.70
P值   0.341 0.632 0.771 0.397 0.484 0.404
组别 例数 母亲合并子痫前期[例数(%)] 胎儿宫内窘迫[例数(%)] 出生季节[例数(%)]
春季(3~5月) 夏季(6~9月) 秋季(10~11月) 冬季(12月~次年2月)
FI组 82 26(31.7) 24(29.3) 24(29.3) 17(20.7) 21(25.6) 20(24.4)
FT组 79 22(27.8) 12(15.2) 18(22.8) 21(26.6) 16(20.3) 24(30.4)
统计量   χ2＝0.29 χ2＝4.59 χ2＝2.26
P值   0.593 0.032 0.520
组别 例数 出生时轻度窒息[例数(%)] 机械通气治疗时间>96 h[例数(%)] 开奶延迟[例数(%)] 胎粪排出延迟[例数(%)] 出生时血清25(OH)D水平(ng/mL，±s)
FI组 82 52(63.4) 48(58.5) 32(39.0) 34(41.5) 8.2±2.3
FT组 79 31(39.2) 27(34.2) 15(19.0) 13(16.5) 14.1±3.3
统计量   χ2＝9.41 χ2＝9.60 χ2＝7.82 χ2＝12.17 t＝12.96
P值   0.002 0.002 0.005 <0.001 <0.001
表2 VLBWI生后早期发生FI影响因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
胎儿宫内窘迫(vs未发生胎儿宫内窘迫) 1.110 0.733 2.295 0.130 3.034 0.722~12.751
出生时轻度窒息(vs未发生轻度窒息) 0.325 0.548 0.352 0.553 1.384 0.473~4.049
机械通气治疗时间>96 h(vs ≤96 h) 1.500 0.576 6.780 0.009 4.483 1.449~13.865
开奶延迟(vs首次开奶时间≤生后3 d) 1.776 0.667 7.098 0.008 5.908 1.599~21.823
胎粪排出延迟(vs首次胎粪排出时间≤48 h) 1.658 0.626 7.016 0.008 5.248 1.539~17.898
出生时血清25(OH)D水平 －0.746 0.131 31.240 <0.001 0.474 0.367~0.614
[1]
何洋，李文星，唐军，等. 早产儿喂养不耐受临床诊疗指南(2020)[J]. 中国当代儿科杂志，2020, 22(10): 1047-1055. DOI: 10.7499/j.issn.1008-8830.2008132.
[2]
路军英，刘丹. 早产儿喂养不耐受的临床特征及影响因素[J]. 实用临床医药杂志，2015, 19(3): 151-152. DOI: 10.7619/jcmp.201503053.
[3]
Barbalho SM, Goulart RA, Araújo AC, et al. Irritable bowel syndrome: a review of the general aspects and the potential role of vitamin D[J]. Expert Rev Gastroenterol Hepatol, 2019, 13(4): 345-359. DOI: 10.1080/17474124.2019.1570137.
[4]
Panarese A, Pesce F, Porcelli P, et al. Chronic functional constipation is strongly linked to vitamin D deficiency[J]. World J Gastroenterol, 2019, 25(14)：1729-1740. DOI: 10.3748/wjg.v25.i14.1729.
[5]
Basu S, Smith S. Macrolides for the prevention and treatment of feeding intolerance in preterm low birth weight infants: a systematic review and Meta-analysis[J]. Eur J Pediatr, 2021, 180(2): 353-378. DOI: 10.1007/s00431-020-03814-1.
[6]
李颖，崔其亮，吴繁. 胎龄<32周早产儿喂养不耐受情况回顾性分析[J]. 中华新生儿科杂志，2020, 35(3): 175-180. DOI: 10.3760/cma.j.issn.2096-2932.2020.03.004.
[7]
中华医学会儿科学分会儿童保健学组，《中华儿科杂志》编辑委员会. 儿童微量营养素缺乏防治建议[J]. 中华儿科杂志，2010, 48(7): 502-509. DOI: 10.3760/cma.j.issn.0578-1310.2010.07.006.
[8]
邵肖梅，叶鸿瑁，丘小汕. 实用新生儿学[M]. 5版. 北京：人民卫生出版社，2018: 83-88, 575-578.
[9]
张李霞，戴怡蘅. 硫胺素水平与极低出生体重儿喂养不耐受的相关性[J]. 中华新生儿科杂志，2021, 36(5): 54-57. DOI: 10.3760/cma.j.issn.2096-2932.2021.05.012.
[10]
杨嘉琛，朱绪亮，郑亚文，等. 早产儿喂养不耐受的高危因素[J]. 广东医学，2009, 30(7): 1083-1085. DOI：10.3969/j.issn.1001-9448.2009.07.026.
[11]
Dutta S, Singh B, Chessell L, et al. Guidelines for feeding very low birth weight infants[J]. Nutrients, 2015, 7(1): 423-442. DOI: 10.3390/nu7010423.
[12]
庄思齐. 中国新生儿营养支持临床应用指南(2013年更新版)解读[J]. 临床儿科杂志，2014, 32(9): 801-803. DOI: 10.3969/j.issn.1000-3606.2014.09.001.
[13]
中华预防医学会儿童保健分会. 中国儿童维生素A、维生素D临床应用专家共识[J]. 中国儿童保健杂志，2021, 29(1): 110-116. DOI: 10.11852/zgetbjzz2020-2118.
[14]
Zhu Z, Yuan L, Wang J, et al. Mortality and morbidity of infants born extremely preterm at tertiary medical centers in China from 2010 to 2019[J]．JAMA Netw Open, 2021, 4(5): e219382. DOI: 10.1001/jamanetworkopen.2021.9382.
[15]
余章斌，韩树萍，陈玉林，等. 我国早产儿喂养不耐受危险因素的Meta分析[J]. 中国新生儿科杂志，2010, 25(6): 346-350. DOI: 10.3969/j.issn.1673-6710.2010.06.008.
[16]
杨玲蓉，李桦，张彤，等. 维生素D缺乏与早产儿坏死性小肠结肠炎的相关性[J]. 中国当代儿科杂志，2018, 20(3): 178-183. DOI: 10.7499/j.issn.1008-8830.2018.03.003.
[17]
Cantorna MT, Snyder L, Arora J. Vitamin A and vitamin D regulate the microbial complexity, barrier function, and the mucosal immune responses to ensure intestinal homeostasis[J]. Crit Rev Biochem Mol Biol, 2019, 54(2): 184-192. DOI: 10.1080/10409238.2019.1611734.
[18]
Fakhoury HMA, Kvietys PR, AlKattan W, et al. Vitamin D and intestinal homeostasis: barrier, microbiota, and immune modulation[J]. J Steroid Biochem Mol Biol, 2020, 200: 105663. DOI: 10.1016/j.jsbmb.2020.105663.
[19]
Du J, Chen Y, Shi Y, et al. 1, 25-dihydroxyvitamin D protects intestinal epithelial barrier by regulating the myosin light chain kinase signaling pathway[J]. Inflamm Bowel Dis, 2015, 21(11): 2495-2506. DOI: 10.1097/MIB.0000000000000526.
[20]
Moore TA, Pickler RH. Feeding intolerance, inflammation, and neurobehaviors in preterm infants[J]. J Neonatal Nurs, 2017, 23(3): 134-141. DOI: 10.1016/j.jnn.2016.09.009.
[21]
Goswami S, Flores J, Balasubramanian I, et al. 1, 25-dihydroxyvitamin D3 and dietary vitamin D reduce inflammation in mice lacking intestinal epithelial cell Rab11a[J]. J Cell Physiol, 2021, 236(12): 8148-8159. DOI: 10.1002/jcp.30486.
[22]
Almeida A, Mitchell AL, Boland M, et al. A new genomic blueprint of the human gut microbiota[J]. Nature, 2019, 568(7753): 499-504. DOI: 10.1038/s41586-019-0965-1.
[23]
Wang S, Wang L, Fan X, et al. An insight into diversity and functionalities of gut microbiota in insects[J]. Curr Microbiol, 2020, 77(9): 1976-1986. DOI: 10.1007/s00284-020-02084-2.
[24]
Singh P, Kumar M, Al Khodor S. Vitamin D deficiency in the gulf cooperation council: exploring the triad of genetic predisposition, the gut microbiome and the immune system[J]. Front Immunol, 2019, 10: 1042. DOI: 10.3389/fimmu.2019.01042.
[25]
Bashir M, Prietl B, Tauschmann M, et al. Effects of high doses of vitamin D3 on mucosa-associated gut microbiome vary between regions of the human gastrointestinal tract[J]. Eur J Nutr, 2016, 55(4): 1479-1489. DOI: 10.1007/s00394-015-0966-2.
[1] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[2] 马艳波, 华扬, 刘桂梅, 孟秀峰, 崔立平. 中青年人颈动脉粥样硬化病变的相关危险因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 822-826.
[3] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[4] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[5] 吴方园, 孙霞, 林昌锋, 张震生. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 45-47.
[6] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[7] 陈旭渊, 罗仕云, 李文忠, 李毅. 腺源性肛瘘经手术治疗后创面愈合困难的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 82-85.
[8] 黄汇, 朱信强. 131I治疗45岁以下分化型甲状腺癌的疗效及影响因素[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 627-630.
[9] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[10] 李婷, 张琳. 血清脂肪酸代谢物及维生素D水平与结直肠癌发生的关系研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 661-665.
[11] 毛永欢, 仝瀚文, 缪骥, 王行舟, 沈晓菲, 喻春钊. 造口旁疝危险因素预测模型构建[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 682-687.
[12] 倪文凯, 齐翀, 许小丹, 周燮程, 殷庆章, 蔡元坤. 结直肠癌患者术后发生延迟性肠麻痹的影响因素分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 484-489.
[13] 陆猛桂, 黄斌, 李秋林, 何媛梅. 蜂蛰伤患者发生多器官功能障碍综合征的危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1010-1015.
[14] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[15] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号