Cooke Richard J
Department of Pediatrics, University of California Davis, Sacramento, CA, USA.
Nestle Nutr Workshop Ser Pediatr Program. 2010;65:85-95; discussion 96-8. doi: 10.1159/000281149. Epub 2010 Feb 1.
A clear relationship exists between undernutrition, poorer growth and poor development in term and preterm infants. However, preterm infants are at greater risk than term infants. Undernutrition is more common and 'programmed' growth rates are almost six times faster. Thus, even short periods of nutritional deprivation may have significant effects. Recent advances have led to an improvement in early growth but very low birthweight infants remain small for gestational age at hospital discharge. Studies suggest that a 'window of opportunity' exists after hospital discharge, in that better growth between discharge and 2-3 months corrected age is paralleled by better development, and poorer growth is associated with poorer development. However, interventions aimed at improving growth and development have yielded varying results. This may partly be related to differences in study design as well as the composition of the nutrient-enriched formulas. Irrespective, one point is concerning, i.e. infant boys appear to be at a developmental disadvantage when fed a term infant formula after discharge. A single study has also suggested that dietary intervention can improve brain growth in term and preterm infants with perinatal brain injury. However, concern has been expressed about rapid 'catch-up' growth in preterm infants and the development of insulin resistance and visceral adiposity. Data from our group do not support the idea of increased or altered adiposity in preterm infants fed a nutrient-enriched formula after hospital discharge.
足月儿和早产儿的营养不良、生长发育较差之间存在明确的关联。然而，早产儿比足月儿面临更大的风险。营养不良更为常见，且“程序化”的生长速度几乎快六倍。因此，即使是短期的营养剥夺也可能产生重大影响。近期的进展已使早期生长情况有所改善，但极低出生体重儿在出院时仍小于胎龄。研究表明，出院后存在一个“机会窗口”，即出院至矫正年龄达2至3个月期间生长情况较好与发育较好并存，而生长较差则与发育较差相关。然而，旨在改善生长发育情况的干预措施产生了不同的结果。这可能部分与研究设计的差异以及营养强化配方奶的成分有关。无论如何，有一点令人担忧，即出院后给男婴喂足月婴儿配方奶时，他们似乎处于发育劣势。一项研究还表明，饮食干预可改善患有围产期脑损伤的足月儿和早产儿的脑生长。然而，人们对早产儿快速的“追赶性”生长以及胰岛素抵抗和内脏肥胖的发展表示担忧。我们团队的数据并不支持出院后喂养营养强化配方奶的早产儿肥胖增加或肥胖情况改变这一观点。
