儿科重症监护病房先天性心脏病患儿喂养不耐受的病例对照研究OA

Background Children with congenital heart disease(CHD)are a high-risk group in pediatric intensive care unit(PICU).They are prone to feeding intolerance(FI)due to heart dysfunction and low perfusion,which can lead to nutritional deficiencies,prolonged hospital stays,increased complications,and significantly affect prognosis.Objective To analyze the influencing factors and clinical outcomes of FI in children with CHD in PICU,in order to provide a basis for early intervention and optimized nutritional support.Design Case-control study.Methods Children with CHD who were admitted to PICU of Shengjing Hospital of China Medical University from January 2013 to December 2024,aged between 28 days and 1 year old,received extensively hydrolyzed formula for enteral nutrition(EN)support during hospitalization,and EN duration≥48 hours were enrolled.Children with major diseases causing nutrient intake disorders were excluded.The patients were divided into FI group and feeding tolerance(FT)group according to whether FI occurred within 7 days after EN.The FI group collected data on the most recent time before the occurrence of FI,and the time for data collection in the FT group was the time corresponding to the median number of days when FI occurred in the FI group,including general information,clinical manifestations,laboratory tests and treatment,and clinical outcomes.Univariate analysis and logistic regression multivariate analysis were used to explore the influencing factors of FI group.Main Outcome Measures Influencing factors and clinical outcomes of FI in children with CHD.Results A total of 197 cases met the criteria,including 53 cases(26.9%)in FI group and 144 cases(73.1%)in FT group.The median time of FI onset in the FI group was 4.0 days(2.0,5.0)after the start of enteral nutrition(EN).The main clinical symptoms of FI group were diarrhea,abdominal distension,and increased gastric residual volume.The modified ROSS score,C-reactive protein,and the proportion of using neuromuscular blocking agents in the FI group were all higher than those in the FT group,while albumin and hemoglobin levels in the FI group were lower than those in the FT group.All differences were statistically significant(P<0.05).Modified ROSS score was an independent risk factor for FI,OR=1.934(95%CI:1.532 to 2.443),P<0.001,and albumin was a protective factor for FI,OR=0.866(95%CI:0.787 to 0.953),P=0.003.In terms of clinical outcomes,the FI group had a longer length of stay in the PICU and a longer time to reach protein targets compared to the FT group.The proportion of feeding interruptions and the change in weight-for-age Z-score during hospitalization were also higher in the FI group than in the FT group(P<0.05),and all differences were statistically significant.Conclusion Modified ROSS score is an independent risk factor for FI,and albumin is a protective factor for FI.The length of stay in the PICU,the rate of feeding interruption,the change in weight-for-age Z-score during hospitalization in the FI group were higher than those in the FT group,the prognosis was worse than that of the FT group.