目的 分析早产儿生后早期母乳各大营养成分变化的特点,初步探讨提供早产儿个性化营养支持的必要性。 方法 收集2017年1-12月在南京医科大学附属常州妇幼保健院分娩产妇70人的母乳140份,用MIRIS母乳分析仪检测母乳中宏量营养成分及能量,比较不同早产儿性别、乳母年龄和不同分娩方式初乳和过渡乳母乳营养成分的差异及随着出生天数所发生的变化。 结果 1)早产母乳中初乳蛋白质含量大于过渡乳(P<0.01);初乳的脂肪、碳水化合物和能量低于过渡乳(P<0.05)。2)≤ 30周早产初乳蛋白质含量最高,与30+1~33+6周组和≥34周组比较差异有统计学意义(P<0.05);≤ 30周早产初乳能量显著低于30+1~33+6周(P<0.05),而脂肪、碳水化合物差异无统计学意义(P>0.05);3)不同胎龄的三组过渡乳中蛋白质、脂肪、能量差异均无统计学意义(P>0.05);碳水化合物分别为(6.28±0.57)、(6.61±0.43)、(6.36±0.81) g/100 ml,随着孕周增加而增加,差异有统计学意义(P＝0.04)。4)母乳营养成分含量在孕母生育年龄、分娩方式、婴儿性别、出生体重方面差异均无统计学意义。5)线性拟合后发现母乳中蛋白质在生后持续下降,其折点天数在第11天,同时,线性拟合发现脂肪、糖类和能量含量呈增长趋势,脂肪变化的折点在出生后第9天,而糖类以及能量在出生14 d内呈近似线性增长关系。结论 早产初乳、过渡乳营养成分差异显著,母乳营养成分含量与孕母生育年龄、分娩方式、婴儿性别、出生体重无相关性。早产儿早期蛋白质累计缺乏以及蛋白质/热卡比例较低,且早产母亲母乳成分的个体差异较大,应该对母乳中蛋白质含量和热卡密度进行“目标性”强化,对母乳添加剂添加需进一步研究。
Abstract
Objective To study the dynamic changes in macronutrients and energy in human milk from mothers at early stage of premature infants, in order to explore the necessity of providing individualized nutrition support for premature infants. Methods A total of 140 human milk samples were collected from 70 women who delivered preterm infants from January to December 2017.Macronutrients and energy were tested using MIRJS human milk analyzer.The difference on the macronutrients and energy in different genders, maternal age, delivery mode, colostrum and transition milk group were analyzed and the changes were observed. Results 1) The protein level in colostrum from mother of premature was higher than that of transitional milk (P<0.01), while the fats, carbohydrates and energy were significantly lower in colostrum (P<0.05).2) The colostrum from mothers of premature infants with a gestational age of ≤30 weeks had significantly higher levels of protein than those of 30+1-33+6 weeks and ≥34 weeks group (P<0.05).And the energy level in colostrum of ≤ 30 weeks group were significantly lower than that of 30+1-33+6 weeks group (P<0.05), while the differences on fats and carbohydrates were not significant (P>0.05).3) The proteins, fats and energy levels in transition milk groups at different gestational age groups were not significantly different(P＞0.05).While the carbohydrates significantly increased with the older of gestational age [(6.28±0.57), (6.61±0.43), (6.36±0.81) g/100 ml), P=0.04].4) No significant difference was found on the content of macronutrients and energy in groups with different maternal childbearing age, delivery modes, infants′ gender and birth weight.5) The protein levels in breast milk were continuously declining while the fats, carbohydrates and energy levels were continuously increasing after linear fit.The tuning days of protein, fats, carbohydrates and energy levels were in the eleventh, ninth and fourteenth day after birth. Conclusions The levels of macronutrients and energy in milk from mothers of premature infants vary significantly between colostrum and transitional milk.Micronutrient and energy levels are not correlated with mothers′ childbearing age, delivery mode, infants′ gender and birth weight.Moreover, the proteins and ratio of protein/calorie are low in early stage of premature, and the compositions vary from person to person.Therefore, the protein content and calorie density of breast milk should be targeted to strengthen, and further study is warranted to explore the timing and composition of premature infants′ human milk additives.
关键词
早产儿 /
初乳 /
过渡乳 /
母乳成分
Key words
premature infants /
colostrum /
transition milk /
components of human milk
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参考文献
[1] 韩树萍.母乳喂养对新生儿重症监护病房早产儿的益处[J].中国新生儿科杂志,2015,30(3):161-163.
[2] 陈自励.能否常规应用地塞米松促进极低出生体重儿拔管和撤机[J].中国当代儿科杂志,2007,9(3):260-263.
[3] 龚建梅,张劲松.低出生体重儿喂养困难的影响因素及早期干预[J].中国儿童保健杂志,2018,26(5):507-509.
[4] Kimak KS, de Castro Antunes MM, Braga TD, et al.Influence of enteral nutrition on occurrences of necrotizing enterocolitis in very-low-birth-weight infants[J].J Pediatr Gastroenterol Nutr,2015,61(4):445-450.
[5] Rochat TJ, Houle B, Stein A, et al.Exclusive breastfeeding and cognition, executive function, and behavioural disorders in primary school-aged children in rural South Africa:A Cohort Analysis[J].PLoS Med,2016,13(6):e1002044.
[6] Belfort MB, Anderson PJ, Nowak VA, et al.Breast milk feeding, brain development, and neurocognitive outcomes:a 7-year longitudinal study in infants born at less than 30 weeks′ gestation[J].J Pediatr,2016,177:133-139.
[7] 尹亚楠,罗碧如.母乳喂养的研究进展[J].中华妇幼临床医学杂志,2013,9(6):837-841.
[8] Geddes DT, Prescott SL.Developmental origins of health and disease:The role of human milk in preventing disease in the 21st century [J].J Hum Lact,2013,29 (2):23-127.
[9] McCrory C, Layte R.Breastfeeding and risk of overweight and obesity at nine-years of age[J].Soc Sci Med,2012,75(75):323-330.
[10] 中国医师协会新生儿科医师分会营养专业委员会,中国医师协会儿童健康专业委员会母乳库学组,《中华儿科杂志》编辑委员会.新生儿重症监护病房推行早产儿母乳喂养的建议[J].中华儿科杂志,2016,54(1):13-15.
[11] Gitte Z, Jesper FG, Mette VH.The content of macronutrients in milk from mothers of very preterm infants is highly variable[J].Dan Med J,2013,60(6):A4613.
[12] Chang N, Jung JA, Kim H, et al.Macronutrient compositiong of human milk from Korean mothers of full term infants born at 37-42 gestational weeks[J].Nutrition Research and Practice,2015,9(4):433-438.
[13] 柯海劲,吴婕翎,郭勇,等.早产低出生体重儿婴儿期追赶生长情况分析[J].中国儿童保健杂志,2018,26(4):427-429.
[14] Agostoni C, Buonocore G, Carnielli VP, et al.Enteral nutrient supply for preterm infants:commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition[J].J Pediatr Gastroenterol Nutr,2010,50(1):85-91.
[15] Arslanoglu S, Moro GE,Ziegler EE.Preterm infants fed fortified human milk receive less protein than they need[J].J Perinatol,2009,29:489-492.
[16] Henriksen C, Westerberg AC, Ronestad A, et al.Growth and nutrient intake among very-low-birth-weight infants fed fortified human milk during hospitalization[J].Br J Nutr,2009,102:1179-1186.
[17] Sullivan S, Schanler RJ, Kim JH, et a1.An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine-based products[J].J Pediatr,2010,156:562-567.
[18] McLeod G, Sherriff J, Hartmann PE, et al.Comparing different methods of human breast milk fortification using measured v.assumed macronutrient composition to target reference growth:a randomised controlled trial[J].Br J Nutr,2016,115(3):431-439.
[19] 何必子, 孙秀静, 王丹华,等.强化母乳喂养对住院早产儿生长代谢的影响[J].中华围产医学杂志,2013,16(7):404-409.
[20] Arslanoglu S, Moro GE, Ziegler EE.Adjustable fortification of human milk fed to preterm infants:dose it make a difference?[J].J Perinatol,2006,26:614-621.
基金
常州市科技局社会发展课题(CE20165050)
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