日本新生児成育医学会雑誌　第33巻　第3号　104 ～ 111頁（2021年）

日本新生児成育医学会雑誌　33(3)：580-587；2021　

受付日：2020．06．18

受理日：2021．03．29

当院NICU 退院時あるいは外来経過観察中に哺乳不良のため経管栄養を導入した児の検討

Infants Who Showed Feeding Difficulty at Discharge of NICU or During Follow-Up Period

東京都立大塚病院　新生児科

Neonatal Division, Department of Pediatrics, Tokyo Metropolitan Ohtsuka Hospital

大橋祥子・片山大地・中村千紘・高橋　恵・瀬谷　恵・小野山陽祐・岡田真衣子・高下敦子・藤中義史・増永　健・瀧川逸朗

Shoko OHASHI，Daichi KATAYAMA，Chihiro NAKAMURA，Megumi TAKAHASHI，Megumi SEYA， Yosuke ONOYAMA，Maiko OKADA，Atsuko KOGE，Yoshinori FUJINAKA，Ken MASUNAGA，Itsuro TAKIGAWA

Key Words：feeding difficulty，feeding disorder，VLBWI，NICU，gavage feeding

今回我々はNICU 退院時に経管栄養を要した症例や退院後に哺乳不良となった症例を後方視的に検討した。2013 ～ 2017 年に当院を退院し，経管栄養を要したあるいは指導を行った児は25 例（A 群），退院後に経管栄養を導入した児は4 例（B 群）だった。A 群を経口摂取に関連する先天異常を伴わない17 例（A1 群）と伴う8 例（A2 群）と分けたところ，A1 群はいずれも極低出生体重児（以降VLBWI）だった。同期間に入院したVLBWI 301 例のうち，経管栄養を要さなかった284 例と，A1 群から低酸素性虚血性脳症の1 例を除いた16 例とで比較したところ，慢性肺疾患の合併が多く未熟性が強かった。経口哺乳練習やリハビリテーションの開始も有意に遅く，これらの早期導入が予後改善につながるかが今後の検討課題と考えた。B 群のように退院後にも哺乳不良が顕在化する症例もあるため，長期の摂食の問題を念頭に経過観察を行う必要がある。

We investigated infants with feeding difficulties at the time of discharge from the NICU and after discharge. The patients were categorized into three groups：Group A, infants who required tube feeding at NICU discharge and had no congenital anomalies related to feeding difficulties; Group B, infants who required tube feeding at NICU discharge and had congenital anomalies related to feeding difficulties; and Group C, infants who were found to have feeding difficulties and required feeding tube after discharge. In Group B, there was an effect of the underlying disease on the subsequent course of the infants. An infant of Group A with hypoxic ischemic encephalopathy was excluded for further investigation. All patients of Group A were very low birth weight infants （VLBWIs）；Group A had more complications and prematurity compared to the VLBWIs who did not require feeding tube. Of the Group A infants, the mean postmenstrual age at the start of oral feeding and rehabilitation was significantly later than the other VLBWIs in our NICU in same period. Therefore, it is important to examine whether the early introduction of these measures leads to an improved prognosis. In some cases, eating disorders may become apparent after discharge from the hospital, and thus it is important to keep this point in mind during follow-up.