目的 分析母乳喂养对不同出生胎龄早产儿的重要性。方法 639例出生胎龄28+3~36+6周的早产儿中单纯母乳喂养组（亲乳母乳喂养，未添加强化剂）237例，以及单纯配方奶（液态早产奶）喂养组402例。比较喂养方式对体重增长，白蛋白（ALB）、碱性磷酸酶（ALP）水平，以及喂养不耐受发生率、坏死性小肠结肠炎（NEC）、早产儿视网膜病（ROP）等并发症发生率的影响。结果 与配方奶喂养相比，母乳喂养的出生胎龄28~30周早产儿日体重增长较快，喂养不耐受、NEC患病率较低，碱性磷酸酶较高，白蛋白较低，差异有统计学意义（P < 0.05）；贫血、ROP、BPD、院内感染患病率及住院时间的差异均无统计学意义（P > 0.05）。出生胎龄31~33周的早产儿母乳喂养组较配方奶组日体重增长快，喂养不耐受率低，住院时间短，碱性磷酸酶高，差异均具有统计学意义（P < 0.05）；两组间NEC、贫血、ROP、BPD、院内感染的发生率及白蛋白的差异无统计学意义（P > 0.05）。出生胎龄34~36周早产儿不同喂养方式组的各项指标差异均无统计学意义（P > 0.05）。结论 母乳喂养对出生胎龄28~33周早产儿体重的增长，喂养不耐受率的降低，住院时间的缩短以及NEC发生率的减低有重要意义。
Abstract
Objective To investigate the importance of breastfeeding in preterm infants with various gestational ages. Methods A total of 639 preterm infants with a gestational age of 28+3-36+6 weeks were enrolled, and according to the feeding pattern, they were divided into exclusive breastfeeding group (n=237) and formula milk feeding group (fed with liquid milk for preterm infants; n=402). These two feeding patterns were compared in terms of their effects on weight gain, laboratory markers including albumin (Alb) and alkaline phosphatase (ALP), incidence rate of feeding intolerance, and incidence rates of complications including necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). Results Compared with the formula milk feeding group, the breastfeeding group had a significantly faster increase in body weight, a significantly lower incidence rate of NEC, a significantly higher ALP level, and a significantly lower Alb level in the preterm infants with a gestational age of 28-30 weeks (P < 0.05); there were no significant differences between the two groups in the incidence rates of anemia, ROP, bronchopulmonary dysplasia (BPD), and nosocomial infection and length of hospital stay (P > 0.05). For the preterm infants with a gestational age of 31-33 weeks, the breastfeeding group had a significantly faster increase in body weight, a significantly lower incidence rate of feeding intolerance, a significantly shorter length of hospital stay, and a significantly higher ALP level (P < 0.05); there were no significant differences between the two groups in the incidence rates of NEC, anemia, ROP, BPD, and nosocomial infection and the Alb level (P > 0.05). For the preterm infants with a gestational age of 34-36 weeks, there were no significant differences in these indices between the two groups (P > 0.05). Conclusions Breastfeeding plays an important role in increasing body weight, reducing the incidence rates of feeding intolerance and NEC, and shortening the length of hospital stay in preterm infants with a gestational age of 28-33 weeks.
关键词
母乳喂养 /
配方奶喂养 /
早产儿
Key words
Breastfeeding /
Formula milk feeding /
Preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Rochow N, Landau-Crangle E, Fusch C. Challenges in breast milk fortification for preterm infants[J]. Curr Opin Clin Nutr Metab Care, 2015, 18(3):276-284.
[2] Jadcherla SR, Kliegman RM. Studies of feeding intolerance in very low birth weight infants:definition and significance[J]. Pediatrics, 2002, 109(3):516-517.
[3] 邵肖梅, 叶鸿瑁, 邱小汕, 等. 实用新生儿学[M]. 北京:人民卫生出版社, 2011:337-343, 401-408, 416-422, 477-481, 887-891, 663-665.
[4] 贾系群, 刘翠青, 纪素粉, 等. 影响早产儿贫血的相关因素分析[J]. 中国新生儿科杂志, 2014, 29(3):179-182.
[5] Dritsakou K, Liosis G, Valsami G, et al. Improved outcomes of feeding low birth weight infants with predominantly raw human milk versus donor banked milk and formula[J]. Matern Fetal Neonatal Med, 2016, 29(7):1131-1138.
[6] Lugonja N, Spasić SD, Laugier O, et al. Differences in direct pharmacologic effects and antioxidative properties of mature breast milk and infant formulas[J]. Nutrition, 2013, 29(2):431-435.
[7] Chatterton DE, Nguyen DN, Bering SB, et al. Anti-inflammatory mechanisms of bioactive milk proteins in the intestine of newborns[J]. Int J Biochem Cell Biol, 2013, 45(8):1730-1747.
[8] Lönnerdal B, Kvistgaard AS, Peerson JM, et al. Growth, nutrition, and cytokine response of breast-fed infants and infants fed formula with added bovine osteopontin[J]. J Pediatr Gastroenterol Nutr, 2016, 62(4):650-657.
[9] Peterson R, Cheah WY, Grinyer J, et al. Glycoconjugates in human milk:protecting infants from disease[J]. Glycobiology, 2013, 23(12):1425-1438.
[10] Rogier EW, Frantz AL, Bruno ME, et al. Secretory antibodies in breast milk promote long-term intestinal homeostasis by regulating the gut microbiota and host gene expression[J]. Proc Natl Acad Sci U S A, 2014, 111(8):3074-3079.
[11] Hair AB, Peluso AM, Hawthorne KM, et al. Beyond necrotizing enterocolitis prevention:Improving outcomes with an exclusive human milk-based diet[J]. Breastfeed Med, 2016, 11(2):70-74.
[12] Hill DR, Newburg DS. Clinical applications of bioactive milk components[J]. Nutr Rev, 2015, 73(7):463-476.
[13] Bode L. Human milk oligosaccharides:every baby needs a sugar mama[J]. Glycobiology, 2012, 22(9):1147-1162.
[14] Hassiotou F, Hartmann PE. At the dawn of a new discovery:the potential of breast milk stem cells[J]. Adv Nutr, 2014, 5(6):770-778.
[15] Manzoni P, Stolfi I, Pedicino R, et al. Human milk feeding prevents retinopathy of prematurity (ROP) in preterm VLBW neonates[J]. Early Hum Dev, 2013, 89(Suppl 1):S64-S68.
[16] Johnson TJ, Patel AL, Bigger HR, et al. Economic benefits and costs of human milk feedings:a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants[J]. Adv Nutr, 2014, 5(2):207-212.
[17] Park J, Knafl G, Thoyre S, et al. Factors associated with feeding progression in extremely preterm infants[J]. Nurs Res, 2015, 64(3):159-167.
[18] Tinnion RJ, Embleton ND. How to use…alkaline phosphatase in neonatology[J]. Arch Dis Child Educ Pract Ed, 2012, 97(4):157-163.
PDF(1383 KB)
