Division of Neonatology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA.
Westchester Medical Center, Division of Newborn Medicine, Maria Fareri Children's Hospital, Valhalla, New York, USA.
Breastfeed Med. 2020 Jun;15(6):362-369. doi: 10.1089/bfm.2019.0214. Epub 2020 Apr 20.
An exclusive human milk (EHM) diet in extremely low birth weight (ELBW) infants (birth weight ≤1,000 g) is linked to an increased likelihood of extrauterine growth restriction (EUGR, weight <10% at discharge). Past studies associated EUGR with worse neurodevelopmental (ND) outcomes; however, its impact when an EHM diet is used is unknown. Determine whether EUGR adversely affects 2-year ND outcomes of ELBW infants fed an EHM diet. Secondary aims were to compare short-term morbidities and growth through 2 years corrected age (CA). Prospective cohort study of ELBW infants fed an EHM diet until 34 weeks corrected gestational age and assessed at 2 years CA. ND outcomes between EUGR and non-EUGR infants were compared using the Bayley Scales of Infant Development 3rd Ed (BSID-III). Eighty-one ELBW infants survived, 44 were seen for follow-up, and 16 (36%) were EUGR. Baseline characteristics and Neonatal Intensive Care Unit (NICU) morbidities were similar. There were no statistically significant differences (median [25-75%]) between EUGR and non-EUGR groups in cognition, (90 [80-99] versus 95 [90-104]), language (84 [68-105] versus 89 [75-100]), or motor composite scores (87 [74-96] versus 91 [88-96]). Weight -scores during NICU stay dropped in both groups, more pronounced for the EUGR infants. There was no difference in linear or head growth. In our institution, ND outcomes at 2 years CA for ELBW infants fed an EHM diet were similar regardless of EUGR status. This suggests a neuroprotective effect of EHM diet in the ELBW population, despite weight gain velocity during NICU stay.
在极低出生体重儿（ELBW，出生体重≤1000g）中，采用人乳（EHM）喂养与宫外生长受限（EUGR，出院时体重<10%）的可能性增加有关。过去的研究将 EUGR 与更差的神经发育（ND）结果相关联；然而，当使用 EHM 饮食时，其影响尚不清楚。确定 EUGR 是否对接受 EHM 饮食喂养的 ELBW 婴儿的 2 年 ND 结果产生不利影响。次要目标是通过 2 年校正年龄（CA）比较短期发病率和生长情况。对接受 EHM 饮食喂养至校正胎龄 34 周并在 2 年 CA 时进行评估的 ELBW 婴儿进行前瞻性队列研究。使用贝利婴幼儿发展量表第 3 版（BSID-III）比较 EUGR 和非 EUGR 婴儿的 ND 结果。81 名 ELBW 婴儿存活，44 名接受随访，16 名（36%）发生 EUGR。基线特征和新生儿重症监护病房（NICU）发病率相似。在认知（90 [80-99] 与 95 [90-104]）、语言（84 [68-105] 与 89 [75-100]）或运动综合评分（87 [74-96] 与 91 [88-96]）方面，EUGR 和非 EUGR 组之间无统计学差异（中位数 [25-75%]）。两组的 NICU 住院期间体重评分均下降，EUGR 婴儿下降更为明显。线性或头围生长无差异。在我们的机构中，接受 EHM 饮食喂养的 ELBW 婴儿在 2 年 CA 时的 ND 结果相似，无论 EUGR 状态如何。这表明 EHM 饮食在 ELBW 人群中具有神经保护作用，尽管 NICU 住院期间体重增加速度较快。
