Rozé Jean-Christophe, Darmaun Dominique, Boquien Clair-Yves, Flamant Cyril, Picaud Jean-Charles, Savagner Christophe, Claris Olivier, Lapillonne Alexandre, Mitanchez Delphine, Branger Bernard, Simeoni Umberto, Kaminski Monique, Ancel Pierre-Yves
Department of Neonatal Medicine, Nantes University, CHU of Nantes, Nantes, France.
BMJ Open. 2012 Apr 5;2(2):e000834. doi: 10.1136/bmjopen-2012-000834. Print 2012.
Supplementation of breast milk is difficult once infants suckle the breast and is often discontinued at end of hospitalisation and after discharge. Thus, breastfed preterm infants are exposed to an increased risk of nutritional deficit with a possible consequence on neurodevelopmental outcome.
To assess the relationship between breast feeding at time of discharge, weight gain during hospitalisation and neurodevelopmental outcome.
Observational cohort study.
Two large, independent population-based cohorts of very preterm infants: the Loire Infant Follow-up Team (LIFT) and the EPIPAGE cohorts.
2925 very preterm infants alive at discharge.
Suboptimal neurodevelopmental outcome, defined as a score in the lower tercile, using Age and Stages Questionnaire at 2 years in LIFT and Kaufman Assessment Battery for Children Test at 5 years in EPIPAGE. Two propensity scores for breast feeding at discharge, one for each cohort, were used to reduce bias.
Breast feeding at time of discharge concerned only 278/1733 (16%) infants in LIFT and 409/2163 (19%) infants in EPIPAGE cohort. Breast feeding is significantly associated with an increased risk of losing one weight Z-score during hospitalisation (LIFT: n=1463, adjusted odd ratio (aOR)=2.51 (95% CI 1.87 to 3.36); EPIPAGE: n=1417, aOR=1.55 (95% CI 1.14 to 2.12)) and with a decreased risk for a suboptimal neurodevelopmental assessment (LIFT: n=1463, aOR=0.63 (95% CI 0.45 to 0.87); EPIPAGE: n=1441, aOR=0.65 (95% CI 0.47 to 0.89) and an increased chance of having a head circumference Z-score higher than 0.5 at 2 years in LIFT cohort (n=1276, aOR=1.43 (95% CI 1.02 to 2.02)) and at 5 years in EPIPAGE cohort (n=1412, aOR=1.47 (95% CI 1.10 to 1.95)).
The observed better neurodevelopment in spite of suboptimal initial weight gain could be termed the 'apparent breastfeeding paradox' in very preterm infants. Regardless of the mechanisms involved, the current data provide encouragement for the use of breast feeding in preterm infants.
一旦婴儿开始吸吮母乳，补充母乳就会变得困难，而且在住院结束时和出院后通常会停止。因此，母乳喂养的早产儿面临营养缺乏风险增加的问题，这可能会对神经发育结果产生影响。
评估出院时母乳喂养、住院期间体重增加与神经发育结果之间的关系。
观察性队列研究。
两个大型、独立的基于人群的极早产儿队列：卢瓦尔河婴儿随访团队（LIFT）队列和EPIPAGE队列。
2925名出院时存活的极早产儿。
神经发育结果欠佳，在LIFT队列中定义为2岁时使用年龄与发育进程问卷得分处于较低三分位数，在EPIPAGE队列中定义为5岁时使用考夫曼儿童评估量表测试得分处于较低三分位数。使用两个出院时母乳喂养的倾向得分，每个队列一个，以减少偏倚。
在LIFT队列中，出院时母乳喂养的婴儿仅278/1733（16%），在EPIPAGE队列中为409/2163（19%）。母乳喂养与住院期间体重Z评分下降一个标准差的风险显著增加相关（LIFT队列：n = 1463，调整后比值比（aOR）= 2.51（95%置信区间1.87至3.36）；EPIPAGE队列：n = 1417，aOR = 1.55（95%置信区间1.14至2.12）），与神经发育评估结果欠佳的风险降低相关（LIFT队列：n = 1463，aOR = 0.63（95%置信区间0.45至0.87）；EPIPAGE队列：n = 1441，aOR = 0.65（95%置信区间0.47至0.89）），并且在LIFT队列中2岁时（n = 1276，aOR = 1.43（95%置信区间1.02至2.02））和EPIPAGE队列中5岁时（n = 1412，aOR = 1.47（95%置信区间1.10至1.95））头围Z评分高于0.5的可能性增加。
尽管初始体重增加欠佳，但观察到的更好的神经发育情况在极早产儿中可称为“明显的母乳喂养悖论”。无论涉及何种机制，目前的数据为早产儿使用母乳喂养提供了鼓励。
