母乳喂养可预防极低出生体重早产儿的早产儿视网膜病变（ROP）。

Human milk feeding prevents retinopathy of prematurity (ROP) in preterm VLBW neonates.

机构信息

Neonatal Intensive Care Unit, S. Anna Hospital, Torino, Italy.

出版信息

Early Hum Dev. 2013 Jun;89 Suppl 1:S64-8. doi: 10.1016/S0378-3782(13)70019-7.

DOI:10.1016/S0378-3782(13)70019-7

PMID:23809355

Abstract

BACKGROUND

Retinopathy of prematurity (ROP) is a multifactorial disease, but little is known about its relationships with neonatal nutritional policies. Human, maternal milk is the best possible nutritional option for all premature infants, including those at high risk for severe complications of prematurity, such as ROP.

OBJECTIVE

This is a secondary analysis of data collected during two multicenter RCTs performed consecutively (years 2004 through 2008) by a network of eleven tertiary NICUs in Italy. The two trials aimed at assessing effectiveness of fluconazole prophylaxis (Manzoni et al., N Engl J Med 2007 Jun 14;356(24):2483-95), and of bovine lactoferrin supplementation (Manzoni et al., JAMA 2009 Oct 7;302(13):1421-8), in prevention of invasive fungal infection, and of late-onset sepsis in VLBW infants, respectively. We tested the hypothesis that exclusive feeding with fresh maternal milk may prevent ROP of any stage - as defined by the ETROP study - in VLBW neonates, compared to formula feeding.

METHODS

We analyzed the database from both trials. Systematic screening for detection of ROP was part of the protocol of both studies. The definition of threshold ROP was as defined by the ETROP study. Univariate analysis was performed to look for significant associations between ROP and several possible associated factors, and among them, the type of milk feeding (maternal milk or formula for preterms). When an association was indicated by p < 0.05, multiple logistic regression was used to determine the factors significantly associated with ROP.

RESULTS

In both trials combined, 314 infants received exclusively human maternal milk (group A), and 184 a preterm formula because their mothers were not expected to breastfeed. The clinical, demographical and management characteristics of the neonates did not differ between the two groups, particularly related to the presence of the known risk factors for ROP. Overall, ROP incidence (any stage) was significantly lower in infants fed maternal milk (11 of 314; 3.5%) as compared to formula-fed neonates (29 of 184; 15.8%) (RR 0.14; 95% CI 0.12-0.62; p = 0.004). The same occurred for threshold ROP (1.3% vs. 12.3%, respectively; RR 0.19; 95% CI 0.05-0.69; p = 0.009). At multivariate logistic regression controlling for potentially confounding factors that were significantly associated to ROP (any stage) at univariate analysis (birth weight, gestational age, days on supplemental oxygen, systemic fungal infection, outborn, hyperglycaemia), type of milk feeding retained significance, human maternal milk being protective with p = 0.01.

CONCLUSIONS

Exclusive human, maternal milk feeding since birth may prevent ROP of any stage in VLBW infants in the NICU.

摘要

背景

早产儿视网膜病变（ROP）是一种多因素疾病，但对于其与新生儿营养政策的关系知之甚少。人乳是所有早产儿（包括那些有严重早产儿并发症风险的早产儿，如 ROP）的最佳营养选择。

目的

这是在意大利 11 家三级新生儿重症监护病房（NICU）网络连续进行的两项多中心随机对照试验（2004 年至 2008 年）期间收集的数据的二次分析。两项试验旨在评估氟康唑预防（Manzoni 等人，N Engl J Med 2007 年 6 月 14 日；356(24):2483-95）和牛乳铁蛋白补充（Manzoni 等人，JAMA 2009 年 10 月 7 日；302(13):1421-8）对预防侵袭性真菌感染和极低出生体重儿（VLBW）晚发性败血症的有效性，分别。我们检验了这样一个假设，即与配方喂养相比，新鲜人乳的纯母乳喂养可能会预防 VLBW 新生儿的任何阶段的 ROP - 如 ETROP 研究所定义。

方法

我们分析了两项试验的数据库。系统筛查以检测 ROP 是两项研究方案的一部分。ROP 的阈值定义与 ETROP 研究相同。进行单变量分析以寻找 ROP 与几个可能的相关因素之间的显著关联，其中包括母乳（早产儿）和配方奶（早产儿）喂养之间的关联。当 p<0.05 时，我们使用多元逻辑回归来确定与 ROP 显著相关的因素。

结果

在两项试验的组合中，314 名婴儿接受了纯人乳（A 组），184 名婴儿由于其母亲预计无法母乳喂养而接受了早产儿配方奶。两组新生儿的临床、人口统计学和管理特征没有差异，特别是与 ROP 的已知危险因素有关。总体而言，母乳喂养的婴儿（314 名中的 11 名，3.5%）ROP 发生率（任何阶段）明显低于配方喂养的婴儿（184 名中的 29 名，15.8%）（RR 0.14；95%CI 0.12-0.62；p=0.004）。阈值 ROP 也是如此（分别为 1.3%和 12.3%；RR 0.19；95%CI 0.05-0.69；p=0.009）。在多变量逻辑回归中，控制了单变量分析中与 ROP（任何阶段）显著相关的潜在混杂因素（出生体重、胎龄、补充氧气天数、全身真菌感染、外出、高血糖），母乳喂养方式仍然具有显著性，人乳喂养的保护性作用 p=0.01。