Bigger H R, Fogg L J, Patel A, Johnson T, Engstrom J L, Meier P P
Rush University Medical Center, Chicago, IL, USA.
J Perinatol. 2014 Apr;34(4):287-91. doi: 10.1038/jp.2014.5. Epub 2014 Feb 13.
The objective of this study was to compare the currently used human milk (HM) quality indicators that measure whether very low-birthweight (VLBW; <1500 g birthweight) infants 'ever' received HM and whether they were still receiving HM at discharge from the neonatal intensive care unit (NICU) to the actual amount and timing of HM received.
This study used data from a large NIH-funded cohort study and calculated whether VLBW infants ever received HM (HM-Ever) and of these infants, the percentage who were still receiving HM at NICU discharge (HM-DC). Then, the HM-DC indicator (exclusive, partial and none) was compared with the amount and timing of HM feedings received by these same infants.
Of the 291 VLBW infants who met inclusion criteria, 285 received some HM (HM-Ever=98%). At NICU discharge (HM-DC), 24.2, 15.1 and 60.7% were receiving exclusive, partial and no HM, respectively. Of the 60.7% infants with no HM-DC, some had received higher amounts of HM during the NICU hospitalization than infants categorized as exclusive and partial for HM-DC. Of the infants with no HM-DC, 76.8 and 59.7% had received exclusive HM during the days 1-14 and days 1-28 exposure periods, respectively.
The average daily dose (HM-DD; in ml kg(-1) d(-1)) and cumulative percentage (HM-PCT; as % of cumulative enteral intake) of HM feedings were sufficient to significantly reduce the risk of multiple morbidities, including late-onset sepsis, necrotizing enterocolitis, neurocognitive delay and rehospitalization, in the majority of the VLBW infants who were discharged with no HM-DC. Quality indicators that focus on the amount and timing of HM feedings in the NICU should be added to the HM-Ever and HM-DC measures.
本研究的目的是比较当前使用的母乳（HM）质量指标，这些指标衡量极低出生体重（VLBW；出生体重<1500g）婴儿“是否曾经”接受过母乳以及他们在从新生儿重症监护病房（NICU）出院时是否仍在接受母乳，与实际接受的母乳量和时间。
本研究使用了一项由美国国立卫生研究院资助的大型队列研究的数据，计算VLBW婴儿是否曾经接受过母乳（曾经接受母乳，HM-Ever），以及在这些婴儿中，在NICU出院时仍在接受母乳的百分比（出院时接受母乳，HM-DC）。然后，将HM-DC指标（纯母乳喂养、部分母乳喂养和无母乳喂养）与这些相同婴儿接受的母乳喂养量和时间进行比较。
在符合纳入标准的291名VLBW婴儿中，285名接受了一些母乳（曾经接受母乳，HM-Ever = 98%）。在NICU出院时（出院时接受母乳，HM-DC），分别有24.2%、15.1%和60.7%的婴儿接受纯母乳喂养、部分母乳喂养和无母乳喂养。在60.7%无出院时接受母乳的婴儿中，一些婴儿在NICU住院期间接受的母乳量高于被归类为出院时接受纯母乳喂养和部分母乳喂养的婴儿。在无出院时接受母乳的婴儿中，分别有76.8%和59.7%在1 - 14天和1 - 28天的暴露期内接受过纯母乳喂养。
母乳喂养的平均每日剂量（母乳每日剂量，HM-DD；单位为ml·kg⁻¹·d⁻¹）和累积百分比（母乳累积百分比，HM-PCT；占累积肠内摄入量的百分比）足以显著降低大多数无出院时接受母乳的VLBW婴儿发生多种疾病的风险，包括晚发性败血症、坏死性小肠结肠炎、神经认知延迟和再次住院。应将关注NICU中母乳喂养量和时间的质量指标添加到曾经接受母乳和出院时接受母乳的衡量标准中。
