目的 探讨不同的奶方喂养对早产儿生长发育影响的研究。方法 选择本院新生儿科2011年1月-2015年12月247例800~1 500 g的早产儿,分为单纯生母母乳组78例(A组),生母母乳+母乳强化剂组75例(B组),无母乳愿意接受捐赠母乳者为捐赠母乳+母乳强化剂组49例(C组)和无母乳且不愿接受捐赠乳者予早产儿配方奶组45例(D组)。所有入选者均采取积极喂养措施,观察各组早产儿完全肠内喂养、体格生长发育、并发症发生情况、平均住院时间等项目。结果 头围、体重、身长等体格发育指标、喂养达100 Cal/(kg·d)时间、恢复出生体重的时间单纯生母母乳组较其他三组慢、静脉营养应用时间长,差异有统计学意义,其他三组之间差异无统计学意义;出院后1年内感染事件发生例次早产儿配方奶组较其他各组几率高,差异有统计学意义,其他三组之间差异无统计学意义;胆汁淤积发生率、住院时间、喂养不耐受、出院时宫外发育迟缓发生率等四组之间差异无统计学意义。结论 早产儿生母母乳加母乳强化剂为最佳奶方,其次为捐赠母乳加母乳强化剂,在两者均不能得到的情况下,早产儿配方奶也是为一种较好的奶方喂养方式。
Abstract
Objective To explore the effects of different milk feeding pattern on the growth and development of preterm infants. Method 247 cases of 800~1 500 g preterm infants from Jan.2011 to Dec.2015 were divided into mother breast milk group 78 cases (group A),the mother breast milk + human milk fortifier (HMF) 75 cases (group B),without mother breast milk accepting donor breast milk + HMF group 49 cases (group C) and without mother breast milk accepting the premature formula group 45 cases (group D).All infants were taken active feeding measures,with observation of full enteral feeding,physical growth and development,complications,the average length of hospital stay,etc. Results Mother breast milk group were lower than other three groups in physical development indexes such as the head circumference,weight and body length,time to enteral feeding at 100 Cal/(kg·d),regain birth weight time,while venous nutrition time was longer than other groups (P<0.05).There was no statistically significant difference between the other three groups.Preterm formula group had higher risk of infection within 1 year after discharge than other groups (P<0.05).There was no statistically significant difference in incidence of cholestasis,length of hospital stay,feeding intolerance and incidence of EUGR between the four groups (P>0.05). Conclusion The preterm birth mother milk + HMF is the best milk feeding pattern for preterm infants,followed by donor breast milk + HMF and preterm formula.
关键词
早产儿 /
母乳喂养 /
体格生长 /
营养 /
母乳强化剂
Key words
preterm infant /
breast feeding /
physical growth /
nutrition /
human milk fortifier
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参考文献
[1] 中华医学会肠外肠内营养学分会儿科协作组,中华医学会儿科学分会新生儿学组,中华医学会小儿外科学分会新生儿学组.中国新生儿营养支持临床应用指南[J].临床儿科杂志,2013,31(10):1177-1181.
[2] 韩露艳,王晨,李正红,等.早期营养支持策略对早产儿生长和代谢的影响[J].中国新生儿科杂志,2012,27(5):296-300.
[3] Lee PA,Houk CP.Cognitive and psychosocial development concerns in children born small for gestational age[J].Pediatr Endocrinol Rev,2012:10(2):209-216.
[4] 王丹华 超早产儿的喂养策略与临床实践[J].中国新生儿杂志2015,30(3):164-166.
[5] 中国医师协会新生儿专业委员会-营养专家委员会协作组.极低出生体质量早产儿院内营养现状多中心调查[J].临床儿科杂志,2015,33(1):32-37.
[6] Fanaro S.Feeding intolerance in the preterm infant[J].Early Hum Dev,2013,89(Suppl):13-20.
[7] 王学敏,朱艳萍,王莉.积极营养支持策略对早产儿宫外发育迟缓的影响[J].中国当代儿科杂志 2013,15(12):1054-1058.
[8] Bhatia J.Human milk and the premature infant[J].Ann Nutr Metab,2013,62(Suppl):3-8.
[9] Good M,Siggers RH,Sodhi CP,et al.Amniotic fluid inhibits Toll-like Receptor signaling in the fetal and neonatal intestinal pithelium[J].Proe Natl Acad Sci USA,2012,109(28):11330-11335.
[10] ESPGHAN Committee on Nutrion,Arslanoglu S,Corpeleijn W,et al.Donor human milk for preterm infants:current evidence and research directions[J].Pediatr Gastroenterol Nutr,2013,57(4):535-542.
[11] Tudehope DI.Human milk and the nutritional needs of reterminfants[J].J Pediatr,2013,162(Suppl):17-25.
[12] 庄思齐.中国新生儿营养支持临床应用指南(2013 年更新版) 解读[J].临床儿科杂志,2014,32(9):801-803.
[13] Johnson TJ,Patel AL,Bigger HR,et al.Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants[J].Neonatology,2015,107(2):271-276.
[14] 蒋静,钟晓云,龚华,等.院内不同喂养方式对早产/低出生体质量儿体格生长影响的比较[J].临床儿科杂志,2012,30(9):819-823.
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