Meinzen-Derr J, Poindexter B, Wrage L, Morrow A L, Stoll B, Donovan E F
Division of Neonatology, Department of Pediatrics, Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA.
J Perinatol. 2009 Jan;29(1):57-62. doi: 10.1038/jp.2008.117. Epub 2008 Aug 21.
To determine the association between human milk (HM) intake and risk of necrotizing enterocolitis (NEC) or death among infants 401 to 1000 g birth weight.
Analysis of 1272 infants in the National Institute of Child Health and Human Development Neonatal Network Glutamine Trial was performed to determine if increasing HM intake was associated with decreased risk of NEC or death. HM intake was defined as the proportion of HM to total intake, to enteral intake and total volume over the first 14 days. Known NEC risk factors were included as covariates in Cox proportional hazard analyses for duration of survival time free of NEC.
Among study infants, 13.6% died or developed NEC after 14 days. The likelihood of NEC or death after 14 days was decreased by a factor of 0.83 (95% confidence interval, CI 0.72, 0.96) for each 10% increase in the proportion of total intake as HM. Each 100 ml kg(-1) increase in HM intake during the first 14 days was associated with decreased risk of NEC or death (hazard ratio, HR 0.87 (95% CI 0.77, 0.97)). There appeared to be a trend towards a decreased risk of NEC or death among infants who received 100% HM as a proportion to total enteral intake (HM plus formula), although this finding was not statistically significant (HR 0.85 (95% CI 0.60, 1.19)).
These data suggest a dose-related association of HM feeding with a reduction of risk of NEC or death after the first 2 weeks of life among extremely low birth weight infants.
确定出生体重在401至1000克的婴儿中，母乳摄入量与坏死性小肠结肠炎（NEC）风险或死亡之间的关联。
对美国国立儿童健康与人类发展研究所新生儿网络谷氨酰胺试验中的1272名婴儿进行分析，以确定母乳摄入量增加是否与NEC风险或死亡风险降低相关。母乳摄入量定义为出生后头14天内母乳占总摄入量、肠内摄入量和总体积的比例。已知的NEC风险因素作为协变量纳入Cox比例风险分析，以计算无NEC生存时间的持续时间。
在研究婴儿中，13.6%在14天后死亡或发生NEC。总摄入量中母乳比例每增加10%，14天后发生NEC或死亡的可能性降低0.83倍（95%置信区间，CI 0.72，0.96）。出生后头14天内母乳摄入量每增加100 ml·kg⁻¹，与NEC或死亡风险降低相关（风险比，HR 0.87（95%CI 0.77，0.97））。作为肠内总摄入量（母乳加配方奶）的比例，接受100%母乳的婴儿发生NEC或死亡的风险似乎有降低趋势，尽管这一发现无统计学意义（HR 0.85（95%CI 0.60，1.19））。
这些数据表明，在极低出生体重儿出生后的前两周，母乳喂养与NEC或死亡风险降低之间存在剂量相关关联。
