Clinical features and risk factors of feeding intolerance in premature infants / 中华围产医学杂志

ABSTRACT

Objective:To investigate the clinical features and risk factors of feeding intolerance in premature infants.Methods:This is a retrospective study involving premature infants who were hospitalized in Peking University Third Hospital from January to December 2017. Those in the feeding intolerance group (FI group) were further divided into subgroups of gestational age (GA) < 31 weeks group and GA ≥ 31 weeks group, as well as birth weight (BW)<1 250 g group and BW≥1 250 g group. Medical records of all subjects were reviewed to retrieve relevant clinical information. Independent-samples t-test, Chi-square test, and logistic regression tests were used for statistical analysis. Results:There were 612 eligible subjects with 182 (29.7%) in the FI group and 430 (70.3%) in the feeding tolerance (FT) group. (1) In the FI group, there were 103 (56.6%) males and 79 (43.4%) females with an average GA of (30.6±2.3) weeks and BW of (1 298±417) g, and 134 (73.6%) were very low birth weight premature infants. Among the patients with FI, there were 93 in the GA<31 weeks group and 89 in the GA≥31 weeks group, and 93 in the BW<1 250 g group and 89 in the BW≥1 250 g group. The FI infants accounted for 63.2% of very low birth weight premature infants in the same period. (2) The age at diagnosis was (2.7±0.9) d and (13.2±6.9) d at recovery. And the duration of FI was (10.5±6.7) d. The main symptoms were gastric retention (100.0%, 182/182), abdominal distention (54.4%, 98/182) and vomiting (17.0%, 31/182). (3) FI in preterm infants with GA <31 weeks or BW <1 250 g occurred and disappeared later [GA subgroups: (2.4±0.8) vs (2.9±0.9) d, t=3.977 and (10.4±5.2) vs (16.0±7.3) d, t=5.935; BW subgroups: (2.5±0.9) vs (2.8±0.9) d, t=2.540 and (10.0±4.5) vs (16.3±7.4) d, t=6.951; all P<0.05] and had a longer duration than those with GA≥31 weeks or BW≥1 250 g [GA subgroups: (8.0±5.0) vs (13.0±7.3) d, t=5.450; BW subgroups: (7.5±4.3) vs (13.5±7.3) d, t=6.690; both P<0.05]. Premature infants with smaller GA took longer time to regain their birth weight [(9.4±4.1) vs (12.0±5.1) d, t=3.672, P<0.05] and those with lower BW were less likely to have symptom of vomiting [23.6% (21/89) vs 10.8% (10/93), χ2=5.308, P<0.05]. (4) Multivariate logistic regression analysis showed that BW was a protective factor for FI in premature infants ( OR=0.998, 95% CI: 0.997-0.998, P<0.001) and the independent risk factors for FI were neonatal respiratory distress syndrome ( OR=2.129, 95% CI: 1.163-3.897, P=0.014), multifetation ( OR=1.812, 95% CI: 1.116-2.941, P=0.016), caffeine citrate exposure within 48 h after birth ( OR=2.663, 95% CI: 1.619-4.381, P<0.001), continuous positive airway pressure (CPAP) treatment within 48 h after birth ( OR=5.211, 95% CI: 2.861-9.489, P<0.001) and intrauterine infection ( OR=1.988, 95% CI: 1.060-3.728, P=0.032). Conclusions:The incidence of feeding intolerance in premature infants is high. Premature infants with GA <31 weeks or BW <1 250 g may develop FI and recover at an older age, and suffer longer. Low BW, neonatal respiratory distress syndrome, multifetation, caffeine citrate exposure, or CPAP treatment within 48 h after birth and intrauterine infection are risk factors for FI in premature infants.