Herber-Jonat S
Klinikum der Universität München, Klinik und Poliklinik für Frauenheilkunde und Geburthilfe--Grosshadern, München.
Z Geburtshilfe Neonatol. 2007 Feb;211(1):8-12. doi: 10.1055/s-2006-942116.
Preterm infants have fewer nutrient reserves at birth than term infants. Additional physiological and metabolic stress factors, such as infection or respiratory distress, can affect their nutritional needs and metabolism. Hence, the provision of appropriate nutrition for growth and development is a cornerstone of care of preterm infants. Well infants of a gestational age > 34 weeks are usually able to suck effectively and coordinate swallowing and breathing. Therefore establishment of breast feeding seems reasonable for newborns of this gestational age. For less mature infants, national and international advisory boards also recommend enteral human milk feeding early postnatally. Challenges remain, particularly in establishing evidence-based standards of breastfeeding and the use of human milk for preterm infants in the intensive-care nursery. This article highlights the aspects of growth and nutritional needs, infection prophylaxis and neurological development with regard to the use of human milk versus formula for the preterm infant. Approaches to the initiation and maintenance of milk supply and the decision about when to replace gavage by breast feeding are illustrated.
早产儿出生时的营养储备比足月儿少。其他生理和代谢应激因素，如感染或呼吸窘迫，会影响他们的营养需求和代谢。因此，提供适当的营养以促进生长发育是早产儿护理的基石。孕龄大于34周的健康婴儿通常能够有效地吸吮，并协调吞咽和呼吸。因此，对于这个孕龄的新生儿来说，建立母乳喂养似乎是合理的。对于不太成熟的婴儿，国家和国际咨询委员会也建议在出生后早期进行肠内人乳喂养。挑战依然存在，尤其是在确立基于证据的母乳喂养标准以及在重症监护病房中对早产儿使用人乳方面。本文重点介绍了在早产儿使用人乳与配方奶方面，关于生长和营养需求、感染预防以及神经发育的各个方面。文中还阐述了启动和维持乳汁供应的方法，以及关于何时由母乳喂养取代管饲喂养的决策。
