Lapillonne Alexandre, Bronsky Jiri, Campoy Cristina, Embleton Nicholas, Fewtrell Mary, Fidler Mis Nataša, Gerasimidis Konstantinos, Hojsak Iva, Hulst Jessie, Indrio Flavia, Molgaard Christian, Moltu Sissel Jennifer, Verduci Elvira, Domellöf Magnus
Paris Descartes University, APHP Necker-Enfants Malades hospital, Paris, France.
CNRC, Baylor College of Medicine, Houston, TX.
J Pediatr Gastroenterol Nutr. 2019 Aug;69(2):259-270. doi: 10.1097/MPG.0000000000002397.
Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm infants. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a review of the literature with the aim to provide guidance on how to feed infants born LMPT, and identify gaps in the literature and research priorities.Only limited data from controlled trials are available. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. They frequently have feeding difficulties that delay hospital discharge, and poorer rates of breastfeeding initiation and duration compared with term infants. This review also identified that moderately preterm infants frequently exhibit postnatal growth restriction.The ESPGHAN CoN strongly endorses breast milk as the preferred method of feeding LMPT infants and also emphasizes that mothers of LMPT infants should receive qualified, extended lactation support, and frequent follow-up. Individualized feeding plans should be promoted. Hospital discharge should be delayed until LMPT infants have a safe discharge plan that takes into account local situation and resources.In the LMPT population, the need for active nutritional support increases with lower gestational ages. There may be a role for enhanced nutritional support including the use of human milk fortifier, enriched formula, parenteral nutrition, and/or additional supplements, depending on factors, such as gestational age, birth weight, and significant comorbidities. Further research is needed to assess the benefits (improved nutrient intakes) versus risks (interruption of breast-feeding) of providing nutrient-enrichment to the LMPT infant.
尽管晚期或中度早产（LMPT）婴儿是早产儿中数量最多的群体，但目前明显缺乏针对他们的营养指南和要求。欧洲儿科胃肠病学、肝病学和营养学会（ESPGHAN）营养委员会（CoN）对文献进行了综述，旨在为如何喂养LMPT婴儿提供指导，并找出文献中的空白和研究重点。目前仅有来自对照试验的有限数据。晚期早产儿有一些独特的、往往未被认识到的易损性，使他们容易出现较高的营养相关发病率和再次入院率。他们经常有喂养困难，这会延迟出院，而且与足月儿相比，母乳喂养的开始率和持续时间较低。该综述还发现，中度早产儿经常出现出生后生长受限的情况。ESPGHAN CoN强烈支持将母乳作为喂养LMPT婴儿的首选方法，并强调LMPT婴儿的母亲应获得合格的、延长的泌乳支持和频繁的随访。应推广个性化喂养计划。在LMPT婴儿有一个考虑到当地情况和资源的安全出院计划之前，应延迟出院。在LMPT人群中，随着胎龄降低，积极营养支持的需求增加。根据胎龄、出生体重和重大合并症等因素，强化营养支持可能会发挥作用，包括使用母乳强化剂、强化配方奶、肠外营养和/或额外补充剂。需要进一步研究来评估为LMPT婴儿提供营养强化的益处（改善营养素摄入）与风险（中断母乳喂养）。
