摘要
目的通过前瞻性对照研究分析母乳强化剂在母乳喂养早产儿中的应用和强化母乳对住院早产儿短期生长及营养状况的影响，评估其有效性及安全性。方法2009年11月至2011年3月，四家三甲医院出生的早产儿根据人选标准纳入研究，根据喂养方式不同分为强化母乳实验组（住院期间母乳量占喂养总量的50％以上，母乳均来自早产儿自己的母亲，母乳不足部分由早产配方奶补充）和早产配方奶对照组（住院期间全部早产配方奶喂养）。比较两组早产儿一般情况、肠内外营养摄入、合并症及体格生长情况。结果符合人组标准完成实验的早产儿共125例，其中实验组62例，对照组63例。实验组出生体重（1429．1±209．0）g低于对照组（1514．0±210．5）g，而两组出生时胎龄、头围、身长及出院时校正胎龄、体重、头围、身长、住院时间、恢复出生体重13龄差异均无统计学意义（P〉0．05）。实验组第7天肠内热卡低于对照组（25VS．50kcal／kg）（1keal=4．1840kJ），（P=0．015），出生后2周，每周末肠内外热卡摄入差异均无统计学意义。两组总热卡达到120kcal／（kg·d）和奶量达150ml／（kg·d）的日龄无差别，实验组肠内热卡达100kcal／（kg·d）及奶量达120ml／（kg·d）的日龄比对照组要晚（17vs．13d；18VS．14d）。在完全胃肠喂养后两组平均每天蛋白质摄入差异无统计学意义，而实验组平均每天能量摄人高于对照组。两组在恢复出生体重后平均体重、头围及身长增长速率相似[16．9VS．16．2g／（kg·d）；0．7VS．0．6cnv／周；1．1VS．0．9cm／周]，两组小于胎龄儿的生长速率差别无统计学意义。两组在出生时血生化营养指标差异无统计学意义，出院时实验组血清尿素氮、前白蛋白水平低于对照组（2．20±1．17）mmol／LV8．（2．66±1．21）mmol／L（P=0．036）；（91．33±21．21）mg／Lvs．（107．0±33．58）mg／L（P=0．003），血钙高于对照组（2．48±0．21）mmol／LVS．（2．39±0．15）mmol／L，P=0．016，血磷和碱性磷酸酶差异无统计学意义（2．01±0．36）mmol／LVS．（2．02±0．42）mmol／L；（311．68±142）U／LVS．（284．67±111）U／L。实验组院内感染发生率明显低于对照组[10例（16．1％）VS．20例（31．7％），P=0．021]，其中血培养阳性的败血症实验组2例，而对照组6例。两组在喂养不耐受、坏死性小肠结肠炎（NEC）等发生率方面差异无统计学意义。实验组发生喂养不耐受的次数及持续时间均明显少于对照组。结论强化母乳喂养与早产配方奶喂养的早产儿在住院期间的生长速率相似，均可达到正常胎儿在宫内的生长速率；强化母乳喂养可降低早产儿院内感染发生率，减少喂养不耐受的时间，同时并不增加早产儿NEC的发生。
Objective To study the effects of human milk fortification on growth and safety in premature infants in China during hospital stay. Methods A prospective controlled study was conducted in 4 tertiary hospitals in Beijing and Shanghai, premature infants born from Nov. 2009 to Mar. 2011 were included according to certain enrollment criteria. Premature infants were divided into two groups： fortified human milk group, i. e. , FHM group who were fed with human milk over 50 percent during hospital stays,preterm formula was used for those whose mothers did not have enough milk, and preterm formula group as control who were fed fully with preterm formula. The enteral and parenteral nutritional intakes, complications and growth were compared between the two groups. Results Among the 125 cases included, 62 were in the HMF group, and 63 were in the preterm formula group. Birth weight of HMF group （ 1429. 1 ±209. 0）g was lower than that of the preterm formula group （ 1514. 0 _± 210. 5 ） g, there was no significant difference in gestational age, head circumference, length at birth, and correction gestational age at discharge, weight, head circumference and length at discharge, time for regaining birth weight, the mean daily protein, length of hospitalization between the two groups { P 〉 0. 05 ）. There was also no significant difference in the days for achieving total energy intake of 120 cal/（ kg · d） and 150 ml/（ kg · d） through enteral feeding between the two groups. The velocity of gaining weight, head circumference, and length after regaining birth weight 0. 7 vs. 0. 6 cm/W; 1.1 vs. 0. 9 cm/W were similar between the 2 groups. The biochemical parameters weresimilar at birth, but the serum urea nitrogen, prealbumin levels in FHM group were lower than those in the control group [（2.20±1.17） vs. （2.66±1.21） mmol/L（P=0.036）;（91.33±21.21） vs. （107.0± 33.58 ） mg/L（ P = 0. 003 ） ] , while the calcimn levels were higher than those of the control group [ （ 2.48 ± 0. 21 ） vs. （ 2. 39 ± 0. 15 ） mmol/L, P = 0. 016 ]. Serum alkaline phosphatase and phosphor showed no significant difference [ （ 2. 01 ± 0. 36 ） vs. （ 2. 02 ± 0. 42 ） m,nol/L ; （ 311.68 ± 142 ） vs. （ 284. 67 ± 111 ） U/ L]. Nosocomial infection in the FHM group was significantly lower than that in the control group [ 10 cases （16. 1% ）vs. 20 cases（31.7% ）, P = 0. 021 ], there was no significant difference in incidence of feeding intolerance, necrotizing enterocolitis （NEC） between the two groups. The frequency and lasting time of feeding intolerance was obviously less in the FHM group than that in the control group. Conclusion Premature infants fed with fortified human milk showed similar growth formula during hospital stay. FHM may decrease the incidence of intolerance. pattern to those fed with preterm nosocomial infection and feeding
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2012年第5期336-342,共7页
Chinese Journal of Pediatrics
关键词
婴儿
早产
母乳喂养
营养科学
Infant, Premature
Breast Feeding
Nutritional Sciences
