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母乳对预防坏死性小肠结肠炎及产后生长影响的回顾性分析

A retrospective analysis of the effect of human milk on prevention of necrotizing enterocolitis and postnatal growth.

作者信息

Chowning R, Radmacher P, Lewis S, Serke L, Pettit N, Adamkin D H

机构信息

Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.

Kosair Children's Hospital NICU, Louisville, KY, USA.

出版信息

J Perinatol. 2016 Mar;36(3):221-4. doi: 10.1038/jp.2015.179. Epub 2015 Dec 3.

Abstract

OBJECTIVE

The objective of this study is to determine whether the use of donor human milk (DHM) in very low birth weight (VLBW, ⩽1500 g) neonates in a large neonatal intensive care unit (NICU) affected the rate of necrotizing enterocolitis (NEC) or impacted growth.

STUDY DESIGN

This was a retrospective chart review of 550 VLBW neonates following the introduction of DHM as the preferred diet if maternal breast milk (MBM) was not available. Demographics, growth parameters, incidence of NEC or death and days of DHM or MBM were extracted from charts.

RESULT

Compared with infants who received human milk (HM) on fewer than 50% of hospital days, neonates who received HM on ⩾50% of hospital days had equivalent growth outcomes but lower rates of NEC (NEC 3.4 vs 13.5%, P<0.001) and mortality (1.0 vs 4.2%, P=0.017). Growth and NEC rates were inversely correlated with the duration of exposure to HM.

CONCLUSION

HM should always be the diet of choice in preterm infants. DHM is a safe alternative, if MBM is not available. Although the use of HM is associated with lower rates of NEC, growth rates were significantly lower in infants with significant HM intake. The decline in growth rates following the introduction of DHM should draw attention to optimize fortification of all HM feedings.

摘要

目的

本研究的目的是确定在大型新生儿重症监护病房(NICU)中,极低出生体重(VLBW,≤1500g)新生儿使用捐赠人乳(DHM)是否会影响坏死性小肠结肠炎(NEC)的发生率或影响生长情况。

研究设计

这是一项对550例VLBW新生儿的回顾性病历审查,研究在无法获得母亲母乳(MBM)时将DHM作为首选饮食后这些新生儿的情况。从病历中提取人口统计学信息、生长参数、NEC或死亡的发生率以及DHM或MBM的使用天数。

结果

与在住院天数中接受母乳(HM)少于50%的婴儿相比,在住院天数中接受HM≥50%的新生儿生长结果相当,但NEC发生率较低(NEC分别为3.4%和13.5%,P<0.001),死亡率也较低(分别为1.0%和4.2%,P=0.017)。生长和NEC发生率与接触HM的持续时间呈负相关。

结论

HM应始终是早产儿的首选饮食。如果无法获得MBM,DHM是一种安全的替代选择。虽然使用HM与较低的NEC发生率相关,但大量摄入HM的婴儿生长速度明显较低。引入DHM后生长速度的下降应引起关注,以优化所有HM喂养的强化措施。

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