Sachdev H P, Krishna J, Puri R K, Satyanarayana L, Kumar S
Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.
Lancet. 1991 Apr 20;337(8747):929-33. doi: 10.1016/0140-6736(91)91568-f.
This study was designed to determine the need for water supplementation to maintain water homoeostasis in exclusively breastfed infants during summer in a tropical country. A prestudy questionnaire revealed that 97% of 34 nurses and 63% of 70 doctors advocated such supplementation. 45 healthy, male, exclusively breastfed babies, aged 1-4 months, were recruited from a well-baby clinic. 9 who had never received supplemental water plus a random selection of 14 others were allocated to group I (breastmilk only); the remaining 22 infants were allocated to group II (breastmilk plus supplemental fluid according to the mother's usual practice). The babies were studied at the hospital for 8 h; breastmilk intake was measured by weighing the infant before and after each feed, water intake by calibrated bottles, and urine output by accurate collection and measurement. The maximum room temperatures were 34-41 degrees C and relative humidities 9-60% (below 50% in all but 3 infants). In group II the mean water intake was 11% (95% confidence interval 7-16%) of the total fluid intake. Both breastmilk intake (274 vs 210 ml) and total fluid intake (274 vs 233 ml) were higher in group I than in group II (p = 0.003, p = 0.073, respectively), after adjustment for age, weight, length, room temperature, and humidity. However, there were no significant differences between the groups in urine output, urine or serum osmolality, weight change, or rectal temperature whether or not the factors adjusted for included total fluid intake. Thus, exclusively breastfed infants do not need supplemental water to maintain water homoeostasis; a reduced breastmilk intake is a potential disadvantage of this practice.
本研究旨在确定在热带国家的夏季，纯母乳喂养婴儿维持水平衡是否需要补充水分。一项预研究问卷显示，34名护士中有97%以及70名医生中有63%主张进行这种补充。从一家健康婴儿诊所招募了45名年龄在1至4个月的健康纯母乳喂养男婴。9名从未接受过补充水分的婴儿以及随机挑选的另外14名婴儿被分配到第一组（仅母乳喂养）；其余22名婴儿被分配到第二组（母乳喂养加按母亲通常做法补充液体）。婴儿在医院接受8小时研究；每次喂奶前后通过称量婴儿体重来测量母乳摄入量，通过校准奶瓶测量水分摄入量，通过精确收集和测量来测定尿量。最高室温为34 - 41摄氏度，相对湿度为9 - 60%（除3名婴儿外，其他婴儿的相对湿度均低于50%）。在第二组中，平均水分摄入量占总液体摄入量的11%（95%置信区间为7 - 16%）。在对年龄、体重、身长、室温及湿度进行校正后，第一组的母乳摄入量（274 vs 210毫升）和总液体摄入量（274 vs 233毫升）均高于第二组（分别为p = 0.003，p = 0.073）。然而，无论是否对总液体摄入量等因素进行校正，两组在尿量、尿或血清渗透压、体重变化或直肠温度方面均无显著差异。因此，纯母乳喂养婴儿无需补充水分来维持水平衡；这种做法的一个潜在缺点是母乳摄入量减少。
