IGF-I treatment facilitates transition from parenteral to enteral nutrition in rats with short bowel syndrome

The goal of growth factor treatment in patients with short bowel syndrome (SBS) is to facilitate transition from parenteral to enteral feedings. Ideal use of growth factors would be acute treatment that produces sustained effects. We investigated the ability of acute insulin-like growth factor I (IGF-I) treatment to facilitate weaning from total parenteral nutrition (TPN) to enteral feeding in a rat model of SBS. After a 60% jejunoileal resection + cecectomy, rats treated with IGF-I or vehicle were maintained exclusively with TPN for 4 days and transitioned to oral feeding. TPN and IGF-I were stopped 7 days after resection, and rats were maintained with oral feeding for 10 more days. In IGF-I-treated rats, serum concentration of IGF-I and final body weight were significantly greater because of a proportionate increase in carcass lean body mass than in vehicle-treated rats. Acute IGF-I treatment induced sustained jejunal hyperplasia on the basis of significantly greater concentrations of jejunal mucosal protein and DNA without a change in histology or sucrase activity. These results demonstrate that acute IGF-I facilitates weaning from parenteral to enteral nutrition in association with maintenance of a greater body weight and serum IGF-I concentration in rats with SBS.     

Nutritional regulation of milk protein messenger RNA concentrations in mammary acini isolated from lactating rats

The effect of starvation, starvation and refeeding and feeding a low-protein diet on concentrations of the mRNAs for the alpha-, beta- and gamma-caseins, alpha-lactalbumin and whey acidic protein has been determined using dot-blot hybridization analyses with total RNA extracted from mammary acini isolated from lactating rats. Starvation for 48 h decreased the concentrations of all RNA species to between 5 and 20% of those for rats feeding ad libitum when expressed on a DNA basis. Refeeding for 24h restored the concentrations to control values. Consumption of a low protein diet reduced the concentrations of each mRNA by about 50%. Only minor changes were detected in the mRNA concentrations for alpha-casein, alpha-lactalbumin and whey acidic protein in samples prepared at six hourly intervals from rats receiving a restricted intake (40% ad libitum) of the control diet.     

酪酸梭菌活菌散在防治早产儿喂养不耐受方面的应用

目的观察和评价酪酸梭菌活菌散防治早产儿喂养不耐受的临床疗效。方法将56例早产儿随机分成观察组和对照组,观察组30例,对照组26例。对照组给予早产儿配方奶及部分肠外营养等常规治疗,观察组在常规治疗基础上同时添加酪酸梭菌活菌散。观察2组早产儿恢复出生体重、达到全胃肠喂养时间及发生喂养不耐受等情况。结果观察组早产儿恢复出生体重、达到全胃肠喂养时间明显短于对照组(P<0.01或P<0.05),喂养不耐受的发生率也显著少于对照组(P<0.05)。结论早产儿服用酪酸梭菌活菌散,对防治喂养不耐受具有积极的作用,能减少早产儿喂养过程中呕吐、胃潴留、腹胀的发生,促进患儿早期的生长发育,缩短达到全胃肠喂养的时间。     

Physiological effects of enteral and parenteral feeding on pancreaticobiliary secretion in humans

In the nutritional management of digestive disorders, it is important to know the relative secretory and metabolic responses to enteral and parenteral feeding. Twenty-seven healthy volunteers were studied while receiving either oral drinks or duodenal infusions of a complex formula diet, duodenal or intravenous infusions of elemental (protein as free amino acids, low fat) formulae, or saline. Pancreaticobiliary secretory responses were measured by nasoduodenal polyethylene glycol perfusion and aspiration, while monitoring blood hormone and nutrient levels. Diets were matched for protein (1.5 g x kg(-1) x d(-1)) and energy (40 kcal x kg(-1) x d(-1)). Compared with placebo, all oroenteral diets stimulated amylase, lipase, trypsin, and bile acid secretion and increased plasma concentrations of gastrin and cholecystokinin, whereas intravenous feeding did not. The complex formula produced a similar response whether given as drinks or duodenal infusions. Changing the duodenal formula to elemental reduced enzyme secretion by 50%, independently of CCK. Higher increases in plasma insulin, glucose, and amino acids were noted with intravenous feeding. Delivering food directly to the intestine by a feeding tube does not reduce pancreaticobiliary secretion. Enteral "elemental" formulae diminish, but only intravenous feeding avoids pancreatic stimulation. Intravenous administration impairs metabolic clearance.     

Cocoa extract protects against early alcohol-induced liver injury in the rat

Oxidants have been shown to be involved in alcohol-induced liver injury. This study was designed to determine whether cocoa flavonoid extract, composed mostly of epicatechin and epicatechin oligomers, protects against early alcohol-induced liver injury in rats. Male Wistar rats were fed high-fat liquid diets with or without ethanol (10-14 g/kg per day) and cocoa extract (400 mg/kg per day) continuously for 4 weeks using an enteral feeding protocol. Mean body weight gains ( approximately 4 g/day) were not significantly different between treatment groups. Cocoa extract did not affect average daily urine ethanol concentrations ( approximately 200mg/dL). After 4 weeks, serum alanine amino transferase levels of the ethanol group were increased nearly fourfold (110+/-16 IU/L) compared to control values (35+/-3 IU/L); this effect of ethanol was blocked by cocoa extract (60+/-6 IU/L). Additionally, enteral ethanol caused severe fat accumulation, mild inflammation, and necrosis in the liver; cocoa extract significantly blunted these changes. Increases in liver TNFalpha protein levels caused by ethanol were completely blocked by cocoa extract. Further, ethanol significantly increased the accumulation of protein adducts of 4-hydroxynonenal, a product of lipid peroxidation serving as an index of oxidative stress; again this was counteracted by the addition of cocoa extract. These results indicate that dietary flavanols such as those found in cocoa can prevent early alcohol-induced liver injury.     

Phenytoin-valproate interaction: importance of saliva monitoring in epilepsy.

Sodium valproate is often used with phenytoin when epilepsy cannot be controlled by a single drug. Sodium valproate depresses phenytoin protein binding and so invalidates plasma phenytoin monitoring as a means of determining precise phenytoin dosage requirements. Plasma and saliva phenytoin and plasma valproate concentrations were measured in 42 patients with epilepsy receiving both drugs. Phenytoin protein binding was also measured by ultrafiltration in 19 of these patients and 19 patients taking phenytoin alone. Saliva phenytoin concentration bore the same close correlation to unbound (therapeutically active) phenytoin in patients receiving both drugs as it did in patients receiving phenytoin alone, whereas plasma total phenytoin did not. The same therapeutic range for saliva phenytoin (4-9 mumol/1; 1-2 microgram/ml) was therefore valid in both groups. The depression of phenytoin binding was directly related to the plasma concentration of valproate both in random samples taken from the 42 patients and in samples taken throughout the day in two of these patients. This was confirmed in vitro. Even when the concentration of valproate is known the degree of binding cannot be predicted. Saliva rather than plasma monitoring of phenytoin treatment is therefore valuable in the presence of valproate and with reduced phenytoin binding from any cause.     

Free oxygen radical-induced lipid peroxidation and antioxidant in infants receiving total parenteral nutrition

OBJECTIVE: Increased oxygen-derived free radical activity has been reported during total parenteral nutrition (TPN) in infants particularly linked to the fat infusion. It is possible that partial enteral feeding can ameliorate some of the complications of TPN. By this study we aimed to investigate free radical formation and antioxidant activity in term and preterm infants during TPN and/or enteral feeding. STUDY DESIGN: We had 6 groups of term and preterm infants made up of 10 patients each. Group I had only enteral feeding, Group II enteral plus parenteral feeding, Group III only parenteral feeding. Plasma malondialdehyde (MDA), superoxide dismutase (SOD), vitamin E and vitamin C levels were measured in all infants. Blood samples of infants receiving only TPN and TPN plus enteral feeding were measured on the 1st and 5th days, and 3h after the end of lipid infusion. RESULTS: There was no difference between the term and preterm infants in terms of MDA, SOD, vitamin C and E levels taken baseline and after parenteral, and enteral plus parenteral feeding on the 1st and 5th days. When 3 groups of both term and preterm infants were compared with each other none of the parameters showed a statistically significant difference. In addition, we compared baseline and 1st and 5th days of TPN therapy in both term and preterm infants fed only parenterally and enteral plus parenteral feedings. In term infants fed both parenterally and parenteral plus enterally, the MDA levels before TPN were significantly higher than that of the levels of patients on parenteral nutrition on the 5th day. On the 1st and 5th days of TPN therapy, the levels of vitamin C was significantly decreased, in term and preterm infants fed only parenterally, levels of vitamin E was increased, in term and preterm infants fed both parenterally and parenteral plus enterally. Also, when compared to their base line the SOD levels of the term infants detected on the 1st and 5th days were significantly high. CONCLUSION: Free radical production is increased by the administration of TPN and may be linked to its adverse effects. It may be assumed that long-term complications of preterm infants receiving TPN may be reduced by further strengthening the antioxidant capacities of the TPN solutions.     

Effects of postexercise carbohydrate-protein feedings on muscle glycogen restoration.

The purpose of this investigation was to determine the effects of postexercise eucaloric carbohydrate-protein feedings on muscle glycogen restoration after an exhaustive cycle ergometer exercise bout. Seven male collegiate cyclists [age = 25.6 +/- 1.3 yr, height = 180.9 +/- 3.2 cm, wt = 75.4 +/- 4.0 kg, peak oxygen uptake (VO(2 peak)) = 4.20 +/- 0.2 l/min] performed three trials, each separated by 1 wk: 1) 100% alpha-D-glucose [carbohydrate (CHO)], 2) 70% carbohydrate-20% protein (PRO)-10% fat, and 3) 86% carbohydrate-14% amino acid (AA). All feedings were eucaloric, based on 1.0 g. kg body wt(-1). h(-1) of CHO, and administered every 30 min during a 4-h muscle glycogen restoration period in an 18% wt/vol solution. Muscle biopsies were obtained immediately and 4 h after exercise. Blood samples were drawn immediately after the exercise bout and every 0.5 h for 4 h during the restoration period. Increases in muscle glycogen concentrations for the three feedings (CHO, CHO-PRO, CHO-AA) were 118 mmol/kg dry wt; however, no differences among the feedings were apparent. The serum glucose and insulin responses did not differ throughout the restoration period among the three feedings. These results suggest that muscle glycogen restoration does not appear to be enhanced with the addition of proteins or amino acids to an eucaloric CHO feeding after exhaustive cycle exercise.     

微生态制剂联合肠内营养对食管癌患者术后肠功能及营养状况的影响

目的探讨微生态制剂联合肠内营养对食管癌患者术后肠功能及营养状况的影响。方法选取2018年6月至2018年12月我院胸外科食管癌术后患者58例,随机分为观察组(n=27)和对照组(n=31)。对照组患者术后采用常规肠内肠外联合营养支持方案,观察组患者在对照组基础上给予微生态制剂(活菌型乳酸菌乳饮品)鼻饲。比较两组患者腹胀、腹泻的发生率,通气时间,首次排便时间,留置胃管时间,住院时间,住院总费用,血红蛋白、前白蛋白、转铁蛋白、白蛋白、视黄醇结合蛋白水平及出院时BMI值的变化。结果观察组患者术后发生腹胀和腹泻的比率明显低于对照组,通气时间、首次排便时间均早于对照组(P<0.05)。观察组患者首次饮水时间提前,胃管置留天数及术后住院天数也较对照组缩短(P<0.05)。两组患者出院时BMI值比较差异具有统计学意义(P<0.05)。结论微生态制剂(活菌型乳酸菌乳饮品)联合肠内营养能改善食管癌患者术后的肠功能,降低肠内营养不耐受的发生率,有利于肠内营养的实施,促进患者康复。     

燕麦米汤对严重烧伤患者休克期肠道复苏的影响

目的：研究严重烧伤患者休克期经肠道给予燕麦米汤对肠道复苏的影响。方法：选取烧伤面积≥30%TBSA的患者42例,并随机分为：燕麦米汤组,伤后24h内开始经鼻肠管给予燕麦米汤;对照组,伤后24h内开始经鼻肠管给予50g/L葡萄糖盐水,连续4d,每组21例。在伤后1、2、3、4 d分别检测其血清二氨氧化酶（DAO）值及动脉血乳酸（LAC）含量,观察两组患者腹胀缓解时间、肠鸣音恢复时间等临床指标。结果：两组患者伤后血清二氨氧化酶及动脉血乳酸含量均呈下降趋势,燕麦米汤组血清二氨氧化酶在伤后2、3、4d显著低于对照组（P〈0.01）,而脉血乳酸含量在伤后2、3d显著低于对照组（P〈0.05或0.01）,治疗过程中燕麦米汤组其腹胀缓解时间、肠鸣音恢复时间、排气时间、开始完全肠内营养时间、继发感染例数均优于对照组（P〈0.01）。结论：在严重烧伤休克期尽早鼻饲燕麦米汤能较好地促进肠道复苏。     

预消化的肠内营养对ICU危重症患者的营养状况及肠内营养耐受性的影响

目的:研究预消化的肠内营养制剂对ICU危重症患者营养状况及肠内营养耐受性的影响。方法:本试验为前瞻、随机、对照、单盲研究,将符合入组条件的ICU患者随机分为试验组和对照组。试验组给予预消化型肠内营养制剂,而对照组给予整蛋白型肠内营养制剂进行营养支持。比较两组患者入组及营养支持2周后的营养指标、肠内营养耐受性及ICU住院天数等。结果:治疗2周后,试验组前白蛋白、转铁蛋白较对照组明显升高(P0.05),肠内营养不耐受、腹内压升高、腹泻、肠鸣音减弱及胃肠道出血发生率较对照组明显降低(P0.05),ICU住院时间也较对照组明显缩短(P0.05)。结论:预消化的肠内营养制剂对ICU患者有良好的治疗效果,可降低胃肠道不良反应发生率,提高耐受性,明显改善患者营养状况。     

Trypsin and splanchnic protein turnover during feeding and fasting in human subjects

Knowledge of the stimulatory effects of enteral and parenteral (intravenous) feeding on the synthesis and turnover of trypsin would help in the management of acute pancreatitis, because the disease is caused by the premature activation of trypsin. To investigate this, we labeled intravenous infusions with [1-(13)C]leucine and enterals with [(2)H]leucine and measured isotope enrichment of plasma, secreted trypsin, and duodenal mucosal proteins over 6 h by duodenal perfusion/aspiration and endoscopic biopsy. Thirty healthy volunteers were studied during fasting (n = 7), intravenous feeding (n = 6), or postpyloric enteral feeding [duodenal polymeric (n = 6), elemental duodenal (n = 6), and jejunal elemental (n = 5)]. All diets provided 1.5 g x kg(-1) x day(-1) protein and 40 kcal x kg(-1) x day(-1) energy. Results demonstrated that compared with fasting, enteral feeding increased the rate of appearance (71 +/- 4 vs. 91 +/- 5 min, P = 0.01) and secretion (546 +/- 80 vs. 219 +/- 37 U/h, P = 0.01) of newly labeled trypsin and expanded zymogen stores (1,660 +/- 237 vs. 749 +/- 133 units, P = 0.03). These differences persisted whether the feedings were polymeric or elemental, duodenal, or jejunal. In contrast, intravenous feeding had no effect on basal rates. Differential labeling of the plasma amino acid pool by enteral and intravenous isotope infusions suggested that 35% of absorbed amino acids were retained within the splanchnic bed during enteral feeding and that mucosal protein turnover increased from a fasting rate of 34 +/- 6 to 108 +/- 8%/day (P < 0.05) compared with no change after intravenous feeding. In conclusion, all common forms of enteral feeding stimulate the synthesis and secretion of pancreatic trypsin, and only parenteral nutrition avoids it.     

添加益生菌的早期滋养量肠内营养对 重症脑卒中患者呼吸机相关性肺炎的影响

目的探讨早期给予添加益生菌的滋养量肠内营养(EN)对重症脑卒中患者呼吸机相关性肺炎(VAP)的影响。方法选择2015年10月1日至2017年10月1日我院神经内科收治的接受鼻饲饮食及机械通气的重症脑卒中患者56例,随机分为对照组和观察组各28例。对照组患者在入院48h内给予早期肠内营养支持治疗,观察组在对照组基础上常规给予双歧杆菌乳杆菌三联活菌片鼻饲,并给予滋养量肠内营养支持治疗(起始量10～20mL鼻饲低速泵入)。比较两组患者治疗后肠内营养达标时间、肠内营养并发症发生率、营养状态指标、炎症因子水平、呼吸机相关性肺炎发生率、脱机成功率及病死率。结果治疗后,观察组患者腹胀、腹泻、应激性高血糖发生率较低,肠内营养达标时间较短。同时观察组患者血清白蛋白、前白蛋白、淋巴细胞计数均高于对照组,血WBC、CRP、PCT水平均低于对照组。观察组患者脱机成功率相对较高,呼吸机相关性肺炎发生率相对较低。观察组患者GCS评分、APACHEⅡ评分及病死率相对较低,但差异均无统计学意义(P0.05)。结论早期给予添加益生菌的滋养量肠内营养有助于提高患者肠内营养的耐受性,改善患者营养状态,降低炎性因子水平,有助于减少呼吸机相关性肺炎发生率。     

Preterm birth makes the immature intestine sensitive to feeding-induced intestinal atrophy

Preterm birth and formula feeding predispose to small intestinal dysfunction, which may lead to necrotizing enterocolitis (NEC). In piglets, we tested whether the physiological and environmental transitions occurring at birth affect the response of the immature intestine to enteral feeding. Pig fetuses (106 days gestation, term = 115 days) were prepared with esophageal feeding tubes and fed either sow's colostrum (n = 8) or infant formula (n = 7) in utero. After 24 h of oral feeding, the pig fetuses were delivered by cesarean section and their gastrointestinal morphology and function were compared with those of preterm newborn (NB) littermates that were not fed (n = 8) or fed colostrum (n = 7) or formula (n = 13) for 24 h after birth. Before birth, both colostrum and formula feeding resulted in marked increases in intestinal mass, brush-border enzyme activities, and plasma glucagon-like peptide 2 concentrations, to levels similar to those in NB colostrum-fed piglets. In contrast, NB formula-fed piglets showed reduced intestinal growth, decreased brush-border enzyme activities, and intestinal lesions, reflecting NEC. NB formula-fed pigs also showed impaired enterocyte endocytotic function and decreased antioxidative capacity, whereas brush-border enzyme mRNA levels were unaltered, relative to NB colostrum-fed pigs. Our results indicate that the feeding-induced growth and enzyme maturation of the immature intestine are not birth dependent. However, with a suboptimal diet (milk formula), factors related to preterm birth (e.g., microbial colonization and metabolic and endocrine changes) make the immature intestine sensitive to atrophy and development of NEC.     

深度水解蛋白配方奶在不同体重早产儿喂养中的临床效果观察

目的:评估深度水解配方奶(eHPF)在不同体重早产儿早期喂养中临床应用效果。方法:选取2017年9月至2018年12月出生的早产儿,分为极低出生体重儿组(体重1000-1500g之间)62例和低出生体重儿(体重1500-2000g之间)100例,每组再随机分为两组,分别予以深度水解蛋白奶(eHPF)和早产儿配方奶(SPF)喂养。极低出生体重儿组于12小时后开始微量喂养,低出生体重儿12小时内适量喂养;极低出生体重儿组深度水解蛋白奶喂养2周后改早产儿奶喂养,低出生体重儿组深度水解蛋白奶1周后改早产儿奶喂养。比较深度水解蛋白奶在不同体重早产儿早期喂养中的临床应用效果,不同体重早产儿恢复出生体重时间、每日体重增长速度、胃管留置时间、完全肠内喂养天数、住院天数、喂养不耐受发生率、宫外发育迟缓发生率及尿素氮、碱性磷酸酶指标。结果:深度水解蛋白喂养组极低出生体重儿/低出生体重儿恢复出生体重天数、完全肠道喂养天数、胃管留置时间、住院天数较早产儿奶喂养组明显缩短(P0.05),每天体重增长优于早产儿组,喂养不耐受、宫外发育迟缓发生率明显低于早产儿组(P0.05),尿素氮、碱性磷酸酶无统计学差异(P0.05)。结论:深度水解蛋白奶用于不同体重早产儿早期喂养效果明显优于早产儿配方奶,其更有助于早产儿的生长发育。     

Control of protease secretion in the intestine of fifth instar larvae of Rhodnius prolixus.

Groups of four Rhodnius prolixus larvae in the 5th-instar received no food or were given once only through a special feeder, similar weights of food solutions. These were either protein solutions (whole human blood, its plasma or erythrocytes, egg albumin, bovine serum albumin, haemoglobin) or non-protein solutions (saline, casein hydrolysate, dextran, maltose). Following feeding, the protein content and caseinolytic activity of the larval midgut homogenates, determined between the 3rd and 14th days, were practically the same in starved larvae and in larvae receiving non-protein solutions. In the protein-fed larvae the protein content and the specific protease activity increased. These findings exclude neurosecretory control and indicate that ingested protein stimulate the proteolytic activity of R. prolixus midgut.     

Effects of enteral glutamine on gut mucosal protein synthesis in healthy humans receiving glucocorticoids

In hypercatabolic patients, the beneficial effects of glutamine on gut mucosa could be partly due to a stimulation of protein synthesis. The fractional synthesis rate (FSR) of gut mucosal protein was measured in four groups of healthy volunteers treated with glucocorticoids for 2 days. Two groups were studied in the postabsorptive state while receiving glutamine or a nitrogen equivalent (control) and two groups in the fed state with or without glutamine, using a 5-h intravenous infusion of [(13)C]leucine, [(2)H(5)]phenylalanine, and cortisone. After nutrient and tracer infusion, duodenal biopsies were taken. In the postabsorptive state, FSR of gut mucosal protein were 87 and 76%/day in the control group and 130% (P = 0.058 vs. control) and 104% (P = 0.17 vs. control)/day in the glutamine group, with leucine and phenylalanine as tracers, respectively. During feeding, FSR did not increase and no significant difference was observed between glutamine and control groups. Overall, FSR of the four groups were two- to threefold higher than those obtained previously in healthy humans, suggesting that glucocorticoids may increase gut mucosal protein synthesis. However, in this situation, a moderate enteral glutamine supply failed to demonstrate a significant effect on gut mucosal protein synthesis in the postabsorptive state and during feeding.     

Unexpected suppression of free phenytoin concentration by salicylate in uremic sera due to the presence of inhibitors: MALDI mass spectrometric determination of molecular weight range of inhibitors

Salicylate displaces phenytoin from protein binding leading to an increase in free phenytoin concentration. We observed unexpected decreases in free phenytoin concentration in the presence of salicylate. Serum pools containing no phenytoin or salicylate were supplemented with the same concentrations of phenytoin. Then to the aliquots of the individual pool, no salicylate (control), 150, 300 and 500 microg/ml of salicylate (therapeutic range: 15-300 microg/ml) were added. Specimens were incubated at 37 degrees C for 2 h and after re-equilibration at room temperature for 20 min, total and free phenytoin (in the protein free ultrafiltrates) concentrations were measured using fluorescence polarization immunoassay on the TDx/FLX analyzer. We observed an increase in free phenytoin concentration from 1.91 microg/ml (in the absence of salicylate) to 2.39 microg/ml in the presence of 500 microg/ml salicylate (total phenytoin: 13.3 microg/ml) in the normal pool. In sharp contrast, the free phenytoin concentrations decreased from an initial concentration of 3.82 microg/ml to 2.52 microg/ml in the presence of 500 microg/ml of salicylate (total phenytoin: 13.2 microg/ml) in the uremic pool. We also treated the uremic pool with activated charcoal. In the original uremic pool, the initial free phenytoin concentration was 3.05 microg/ml and the free concentrations then decreased to 2.28 microg/ml in the presence of 300 microg/ml of salicylate. In contrast, in the charcoal treated pool, the initial free phenytoin concentration increased from 1.61 microg/ml to 3.23 microg/ml in the presence of 300 microg/ml of salicylate. More interestingly when uremic toxins were extracted back from charcoal with methanol and the dry residue was added to an aliquot of normal serum, the normal serum behaved like a uremic serum and free phenytoin concentration was significantly decreased in the presence of salicylate. When an aliquot of methanol extract was studied by Matrix-Assisted Laser Desorption Ionization Mass Spectrometry (scan up to 10,000), we observed no peak at molecular weight over 551, indicating that these inhibitors are small molecules. We also identified hippuric acid as one of the inhibitors.     

Delayed Initiation but Not Gradual Advancement of Enteral Formula Feeding Reduces the Incidence of Necrotizing Enterocolitis (NEC) in Preterm Pigs

Enteral formula feeding is a risk factor for necrotizing enterocolitis (NEC) in premature infants, yet studies are conflicting regarding the safest timing for introduction and advancement of feeds. Our aim was to test the effects of early vs. late initiation and abrupt vs. gradual advancement of enteral feeding of an intact vs. hydrolyzed protein formula on NEC incidence and severity in preterm pigs. In Experiment 1, preterm pigs received total parenteral nutrition (TPN) at birth with abrupt initiation of enteral formula feeds (50% full intake) on d of life (DOL) 2 (EA) or 5 (LA) while PN continued. Pigs were also fed formula containing either intact or hydrolyzed protein. In Experiment 2, preterm pigs received TPN at birth with enteral, hydrolyzed-protein formula feeds introduced on DOL 2 either abruptly (EA; 50% full feeds) or gradually (EG; 10–50% full feeds over 5 d) while PN continued. NEC incidence and severity were assessed based on macroscopic and histological scoring. In Experiment 1, NEC incidence (41% vs. 70%, P<0.05) and severity were reduced in LA vs. EA groups and LA was associated with a higher survival rate, daily weight gain and jejunum villus height. Piglets fed hydrolyzed vs. intact protein formula had lower stomach content weights and similar NEC incidence. In Experiment 2, NEC incidence and severity were not different between pigs the EG vs. EA group. Proinflammatory gene expression (IL-1β, IL-6 and S100A9) in the ileum was lower in both LA and EG vs. EA groups. In conclusion, delayed initiation but not gradual advancement of enteral feeding is protective against NEC in preterm pigs. Feeding hydrolyzed vs. intact protein formula improved gastric transit without affecting the NEC incidence.     

母乳联合鼠李糖乳杆菌预防早产儿喂养不耐受的疗效观察

目的观察母乳联合鼠李糖乳杆菌预防早产儿喂养不耐受的临床疗效。方法选取2016年2月至2017年2月武汉大学人民医院收治的80例生后24h内入住本院儿科新生儿病房的早产儿,随机分配成2组,其中研究组40例,对照组40例。研究组以新鲜母乳联合鼠李糖乳杆菌早期开奶喂养,对照组以早产儿配方奶早期开奶喂养,比较2组早产儿喂养不耐受症的发生率及其恢复出生体重时间、达全胃肠道喂养时间、体重增长速度和住院时间的差异。结果研究组患儿喂养不耐受发生率低于对照组,研究组恢复出生体重时间、达全胃肠道喂养时间及住院时间均短于对照组(P0.05),研究组患儿体重增加速度快于对照组(P0.05)。结论早产儿早期喂养母乳联合鼠李糖乳杆菌能够较早建立全胃肠道营养,减少早产儿喂养不耐受症的发生率,促进患儿体重增长,缩短恢复出生体重时间及达全胃肠道喂养时间,降低住院天数。