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早产儿出院后生长状况评估与营养管理:ESPGHAN立场文件(2025)

制定者:
欧洲儿科胃肠病学、肝病学和营养协会(ESPGHAN,European Society for Paediatric Gastroenterology

2025年5月7日

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摘要:

中英对照

Objectives: The aim of the manuscript is to provide evidence‐based or expert consensus‐based recommendations for growth assessment and nutritional management of preterm‐born infants during the post‐discharge period.

Methods: The search was conducted in Pubmed, MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews using the MESH terms: infant, preterm infant, low birth weight, infant food, nutritional status, nutrients, breast feeding, infant formula, human milk, dietary supplements, vitamins, iron, vitamin D, minerals, energy intake, weaning, and baby led. Overall, 402 papers were identified and screened, from which 101 publications were included in the present position paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained through multiple e‐mail exchanges and meetings with the Committee of Nutrition of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition.

Results: Continuous growth monitoring through measurements of weight, length, and HC post‐discharge is recommended to identify growth faltering (GF) or undernutrition. To prevent disproportionate growth, weight‐for‐ length z‐scores should be included in the assessment when term equivalent age is reached. Infants discharged with a significant drop in weight and length, exceeding a −2 standard deviation loss, require tailored nutritional support to address long‐term growth challenges and to support recovery to normal growth rates. Breastfeeding is highly recommended for all infants when feasible. Infants needing to catch up in growth should be given supplements, such as HMF For those fed with formula, an adequate protein: energy ratio, minerals, and trace elements should be supplied to facilitate catch‐up growth. The start of solid foods should coincide with the infant's neurological developmental milestones, rather than adhering strictly to a set age. Vitamin D and iron supplementation (with regular ferritin monitoring) is recommended through at least 12 months CA.

Conclusion: For preterm infants, close monitoring of growth after discharge and nutritional assessment is essential to identify those at high risk for GF or undernutrition and to provide individualized nutritional support when needed. These patients should either be referred to a specialized center for pediatric nutritional care or, alternatively, their general pediatrician should receive appropriate training on the subject.

目标:本文旨在为早产儿出院后时期的生长评估和营养管理提供循证或基于专家共识的建议。

方法: 通过医学主题词(MESH terms)在PubMed、MEDLINE、EMBASE和Cochrane系统评价数据库中检索,检索词包括:婴儿、早产儿、低出生体重、婴儿食品、营养状况、营养素、母乳喂养、婴儿配方奶粉、人乳、膳食补充剂、维生素、铁、维生素D、矿物质、能量摄入、断奶、婴儿主导(喂养)。共检索到402篇文献并进行筛选,其中101篇被纳入本立场文件。在缺乏证据的情况下,建议反映作者们的综合专家意见。最终共识通过与欧洲儿科胃肠病学、肝病学和营养学会(ESPGHAN)营养委员会的多次邮件沟通和会议达成。

结果:建议出院后通过监测体重、身长和头围(HC)持续评估生长情况,以识别生长迟缓(GF)或营养不良。为避免生长不均衡,当矫正年龄达足月时,评估中应纳入身长别体重z评分。出院时体重和身长显著下降(超过-2个标准差)的婴儿,需接受个体化营养支持,以应对长期生长挑战并促进恢复至正常生长速率。   强烈建议尽可能对所有婴儿进行母乳喂养。需要追赶性生长的婴儿应给予补充剂(如母乳强化剂,HMF)。对于配方奶喂养的婴儿,应提供适当的蛋白质-能量比、矿物质和微量元素,以促进追赶性生长。   固体食物的引入应与婴儿的神经发育里程碑同步,而非严格遵循固定年龄。建议至少在矫正年龄(CA)12个月内补充维生素D和铁(并定期监测铁蛋白)。

结论:对于早产儿,出院后密切监测生长情况和进行营养评估至关重要,这有助于识别出有生长迟缓或营养不良高风险的婴儿,并在需要时提供个体化营养支持。这些患儿应转诊至儿科营养专科中心,或其全科儿科医生应接受相关主题的适当培训。

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早产儿出院后生长状况评估与营养管理:ESPGHAN立场文件(2025)
发布时间:  2025年5月7日
制定者:  
欧洲儿科胃肠病学、肝病学和营养协会(ESPGHAN,European Society for Paediatric Gastroenterology

84人浏览

0收藏

0次下载

摘要

Objectives: The aim of the manuscript is to provide evidence‐based or expert consensus‐based recommendations for growth assessment and nutritional management of preterm‐born infants during the post‐discharge period.

Methods: The search was conducted in Pubmed, MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews using the MESH terms: infant, preterm infant, low birth weight, infant food, nutritional status, nutrients, breast feeding, infant formula, human milk, dietary supplements, vitamins, iron, vitamin D, minerals, energy intake, weaning, and baby led. Overall, 402 papers were identified and screened, from which 101 publications were included in the present position paper. In the absence of evidence, recommendations reflect the authors' combined expert opinion. Final consensus was obtained through multiple e‐mail exchanges and meetings with the Committee of Nutrition of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition.

Results: Continuous growth monitoring through measurements of weight, length, and HC post‐discharge is recommended to identify growth faltering (GF) or undernutrition. To prevent disproportionate growth, weight‐for‐ length z‐scores should be included in the assessment when term equivalent age is reached. Infants discharged with a significant drop in weight and length, exceeding a −2 standard deviation loss, require tailored nutritional support to address long‐term growth challenges and to support recovery to normal growth rates. Breastfeeding is highly recommended for all infants when feasible. Infants needing to catch up in growth should be given supplements, such as HMF For those fed with formula, an adequate protein: energy ratio, minerals, and trace elements should be supplied to facilitate catch‐up growth. The start of solid foods should coincide with the infant's neurological developmental milestones, rather than adhering strictly to a set age. Vitamin D and iron supplementation (with regular ferritin monitoring) is recommended through at least 12 months CA.

Conclusion: For preterm infants, close monitoring of growth after discharge and nutritional assessment is essential to identify those at high risk for GF or undernutrition and to provide individualized nutritional support when needed. These patients should either be referred to a specialized center for pediatric nutritional care or, alternatively, their general pediatrician should receive appropriate training on the subject.

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