Mukhopadhyay Kanya, Narnag Anil, Mahajan Rama
Division of Neonatology, Department of Pediatrics, PGIMER, Chandigarh 160 012, India.
Indian Pediatr. 2007 Apr;44(4):286-90.
To study the effects of human milk fortification on short term growth and biochemical parameters in preterm very low birth weight (VLBW) appropriate for gestation (AGA) and small for gestation (SGA) babies.
Prospective, randomized controlled trial.
Level III neonatal unit.
Preterm infants weighing < or = 1500 grams and < or = 34 weeks of gestation born between March 2001 to June 2002.
Babies (n =166) were randomized in two groups either to get fortified human milk or exclusive human milk along with mineral and vitamin supplementation when feed volume reached 150 mL/Kg/day. Fortification was done with a powdered fortifier added in expressed breast milk and continued till the baby reached 2 Kg or full breast feeds. Primary outcome measures were Short-term growth (daily weight, length and head circumference (HC) weekly) till discharge or 2 Kg.
Fortification (n = 85, birth weight 1202 g, gestation 30.8 wk) resulted in better growth in preterm VLBW babies as compared to control group (n=81, birth weight 1259 g, gestation 31.3 wk). Weight gain (15.1 and 12.9 g/kg/d, P <0.001), length (1.04 and 0.86 cm/week, P = 0.017) and HC (0.83 and 0.75 cm/week, P<0.001) increased significantly in fortified group. SGA babies showed significant improvements in weight (16 g/Kg/d and 12.9 g/kg/d, P = 0.002) and length (1.09 cm/week and 0.92 cm/week, P = 0.042) in fortified group (n = 38) as compared to control group (n = 29). In AGA subgroup, there was significant increase (P = 0.006) in length (1 cm vs 0.82 cm) in fortified group but no difference in weight (P = 0.12) or HC (P=0.054) in fortified (n=47) vs control (n=52) group. Biochemical parameters were comparable, however feed intolerance was more in control group.
Preterm VLBW babies showed better growth with human milk fortification. The effect is significant in SGA (weight and length)rather than AGA (only length) babies.
研究母乳强化对适于胎龄（AGA）和小于胎龄（SGA）的早产极低出生体重（VLBW）婴儿短期生长及生化指标的影响。
前瞻性随机对照试验。
三级新生儿病房。
2001年3月至2002年6月出生的体重≤1500克、胎龄≤34周的早产儿。
166例婴儿随机分为两组，当喂养量达到150毫升/千克/天时，一组接受强化母乳，另一组接受纯母乳并补充矿物质和维生素。通过向挤出的母乳中添加粉状强化剂进行强化，持续至婴儿体重达到2千克或完全母乳喂养。主要观察指标为直至出院或体重达到2千克时的短期生长情况（每日体重、每周身长和头围）。
与对照组（81例，出生体重1259克，胎龄31.3周）相比，强化组（85例，出生体重1202克，胎龄30.8周）的早产极低出生体重婴儿生长情况更好。强化组的体重增加（分别为15.1和12.9克/千克/天，P<0.001）、身长（分别为1.04和0.86厘米/周，P = 0.017）和头围（分别为0.83和0.75厘米/周，P<0.001）显著增加。与对照组（29例）相比，强化组（38例）的小于胎龄儿体重（分别为16克/千克/天和12.9克/千克/天，P = 0.002）和身长（分别为1.09厘米/周和0.92厘米/周，P = 0.042）有显著改善。在适于胎龄亚组中，强化组（47例）与对照组（52例）相比，身长有显著增加（P = 0.006，分别为1厘米和0.82厘米），但体重（P = 0.12）和头围（P = 0.054）无差异。生化指标相当，但对照组的喂养不耐受情况更多。
早产极低出生体重婴儿通过母乳强化生长情况更好。这种效果在小于胎龄儿（体重和身长）中比在适于胎龄儿（仅身长）中更显著。
