目的 分析早期母乳及母乳强化剂喂养对极低出生体重儿(VLBWI)生长发育和营养状态的影响,为临床应用提供参考依据。方法 选取2016年1月—2019年5月重庆市开州区人民医院新生儿重症监护室收治的300例VLBWI为研究对象,根据喂养方式的不同分为母乳组、母乳及母乳强化剂组、早产儿配方奶组、母乳及早产儿配方奶组,比较四组VLBWI的生长发育、营养状况以及并发症发生情况。结果 生长指标的比较中,四组VLBWI平均体重增长率、平均身长周增长率、平均头围周增长率以及恢复至出生体重时间比较,差异均无统计学意义(F=0.083、1.217、1.225、1.512,P＞0.05);并发症的比较中,母乳及母乳强化剂组VLBWI喂养不耐受率及坏死性小肠结肠炎明显低于早产儿配方奶组、母乳及早产儿配方奶组(χ²=14.620、10.170、6.996、5.042,P＜0.05),在支气管肺发育不良、院内感染及视网膜病变方面,四组间比较差异无统计学意义(χ²=1.542、0.896、0.779,P＞0.05)。结论 采用早期母乳及母乳强化剂的喂养方式,不会影响极低出生体重儿的生长发育及营养状况,可以降低喂养不耐受、坏死性小肠结肠炎并发症的发生率,可在临床大力推广应用。

Objective To investigate the effect of early breast milk and breast milk fortifiers on the growth and development as well as nutritional status of very low birth weight infants(VLBWI),so as to provide evidence for clinical application. Methods A total of 300 cases of VLBWI admitted to the neonatal intensive care unit of People′s Hospital of Kaizhou District from January 2016 to May 2019 were selected as the study objects. According to different feeding methods,the infants were divided into breast milk group,breast milk combined with breast milk fortifier group,premature formula milk group,breast milk combined with premature formula milk group,with 75 cases in each group. The growth and development,nutritional status and complications of the four groups were compared. Results There was no significant difference in average weight growth rate,average body length growth rate,average head circumference growth rate and time taken to recover to birth weight among the four groups(F=0.083,1.217,1.225,1.512,P＞0.05).The rates of feeding intolerance and necrotizing enterocolitis in the breast milk combined with breast milk fortifier group were significantly lower than those in the preterm formula milk group,breast milk combined with preterm formula milk group(x²=14.620,10.170, 6.996,5.042,P＜0.05).In terms of the rates of bronchopulmonary dysplasia,nosocomial infection and retinopathy,the difference was not statistically significant among the four groups(x²=1.542,0.896,0.779,P＞0.05). Conclusions The growth,development and nutritional status of very low birth weight infants fed with early breast milk and breast milk fortifiers will not be impacted. Meanwhile,early breast milk and breast milk fortifiers can reduce the incidence of feeding intolerance and complications of necrotizing enterocolitis,which can be promoted in clinical practice.