Hair Amy B, Hawthorne Keli M, Chetta Katherine E, Abrams Steven A
Department of Pediatrics, Section of Neonatology, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
BMC Res Notes. 2013 Nov 13;6:459. doi: 10.1186/1756-0500-6-459.
Despite current nutritional strategies, premature infants remain at high risk for extrauterine growth restriction. The use of an exclusive human milk-based diet is associated with decreased incidence of necrotizing enterocolitis (NEC), but concerns exist about infants achieving adequate growth. The objective of this study was to evaluate growth velocities and incidence of extrauterine growth restriction in infants ≤ 1250 grams (g) birth weight (BW) receiving an exclusive human milk-based diet with early and rapid advancement of fortification using a donor human milk derived fortifier.
In a single center, prospective observational cohort study, preterm infants weighing ≤ 1250 g BW were fed an exclusive human milk-based diet until 34 weeks postmenstrual age. Human milk fortification with donor human milk derived fortifier was started at 60 mL/kg/d and advanced to provide 6 to 8 additional kilocalories per ounce (or 0.21 to 0.28 kilocalories per gram). Data for growth were compared to historical growth standards and previous human milk-fed cohorts.
We consecutively evaluated 104 infants with mean gestational age of 27.6 ± 2.0 weeks and BW of 913 ± 181 g (mean ± standard deviation). Weight gain was 24.8 ± 5.4 g/kg/day with length 0.99 ± 0.23 cm/week and head circumference 0.72 ± 0.14 cm/week. There were 3 medical NEC cases and 1 surgical NEC case. 22 infants (21%) were small for gestational age at birth. Overall, 45 infants (43%) had extrauterine growth restriction. Weight velocity was affected by day of fortification (p = 0.005) and day of full feeds (p = 0.02). Our cohort had significantly greater growth in weight and length compared to previous entirely human milk-fed cohorts.
A feeding protocol for infants ≤ 1250 g BW providing an exclusive human milk-based diet with early and rapid advancement of fortification leads to growth meeting targeted standards with a low rate of extrauterine growth restriction. Consistent nutritional policies using this approach may be considered for this population.
尽管有当前的营养策略，早产儿宫外生长受限的风险仍然很高。采用纯以人乳为基础的饮食与坏死性小肠结肠炎（NEC）发病率降低相关，但对于婴儿能否实现充足生长存在担忧。本研究的目的是评估出生体重（BW）≤1250克的婴儿在使用源自捐赠人乳的强化剂进行早期快速强化的情况下，采用纯以人乳为基础的饮食时的生长速度和宫外生长受限的发生率。
在一项单中心前瞻性观察队列研究中，体重≤1250克的早产儿接受纯以人乳为基础的饮食，直至孕龄34周。使用源自捐赠人乳的强化剂对人乳进行强化，起始量为60毫升/千克/天，并逐步增加，以使每盎司额外提供6至8千卡热量（或每克额外提供0.21至0.28千卡热量）。将生长数据与历史生长标准和先前以人乳喂养的队列进行比较。
我们连续评估了104例婴儿，其平均孕龄为27.6±2.0周，体重为913±181克（平均值±标准差）。体重增加为24.8±5.4克/千克/天，身长为0.99±0.23厘米/周，头围为0.72±0.14厘米/周。有3例医学性NEC病例和1例外科性NEC病例。22例婴儿（21%）出生时小于胎龄。总体而言，45例婴儿（43%）有宫外生长受限。体重增长速度受强化开始日（p = 0.005）和完全经口喂养日（p = 0.02）的影响。与先前完全以人乳喂养的队列相比，我们的队列在体重和身长方面有显著更大的增长。
对于出生体重≤1250克的婴儿，一种喂养方案是提供纯以人乳为基础的饮食，并进行早期快速强化，这会使生长达到目标标准，且宫外生长受限发生率较低。对于这一人群，可考虑采用这种方法的一致营养策略。
