Zhang J, Li M M, Yu Z B, Liu F, Liu B B, Weng L, Chen X H, Han S P
Department of Pediatrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China.
Zhonghua Er Ke Za Zhi. 2020 May 2;58(5):387-391. doi: 10.3760/cma.j.cn112140-20190828-00548.
To investigate the current situation of human milk (HM) feeding in hospitalized very low and extremely low birth weight infants. The study retrospectively extracted the data of 601 infants with birth weight <1 500 g, and admitted within 24 hours after birth to the Neonatal Intensive Care Unit of Nanjing Maternity and Child Health Care Hospital from January 2016 to December 2018. The infants were grouped into exclusive mother's-own-milk (MOM) group, donor human milk (DHM) group (partial or none MOM), and mixed (HM and formula) feeding group according to the feeding strategy. Qualitative and quantitative variables in the three groups were compared with One-way ANOVA, Kruskal-Wallis test, Chi-square test or Fisher exact test. Kappa and McNemar test were used for consistency testing. Among the 601 infants (309 boys and 292 girls), 6 (1.0%) infants had never been fed with MOM. The gestational age and birth weight were (29.3±1.9) weeks and 1 260(1 115, 1 400) g in 601 infants. A total of 8 (1.3%) infants were grouped into MOM group, 542 (90.2%) were grouped into DHM group, and 51 (8.5%) were grouped into mixed feeding group. The percentage of enteral feedings with MOM in the stage of hospitalization 1-7 d, 8-14 d and 15-28 d were 73.6% (42.9%, 86.7%), 97.5% (78.6%, 100.0%) and 99.3% (93.0%, 100.0%), respectively (414.95, 0.01), and the pairwise comparison suggested that the stage of hospitalization 1-7 d was the lowest (adjusted both 0.05). The average weight adjusted daily dose of MOM were 9.7 (4.3, 18.2), 59.1 (26.5, 93.5) and 116.0 (60.3, 142.6) ml/(kg·d) in the stage of hospitalization 1-7 d, 8-14 d and 15-28 d, respectively (759.75, 0.01), and the pairwise comparison suggested that the stage of hospitalization 1-7 d was the lowest (adjusted both 0.05). The weight adjusted daily dose of MOM in exclusive MOM group, DHM and Mixed feeding group were 95.2 (40.0, 117.2), 82.9(53.6, 103.1) and 55.7 (16.6, 97.5) ml/(kg·d), respectively (10.78, 0.005).Additionally, the percentage and weight adjusted daily dose of MOM showed a general consistency of 0.703 (0.05, =0.408). The rate of exclusive MOM feeding is low, especially during the first 7 days of hospitalization. The percentage of total enteral feedings with MOM and the average weight adjusted daily dose of MOM can well evaluate the situation of HM feeding during hospitalization quantitively.
调查住院极低和超低出生体重儿母乳喂养的现状。本研究回顾性提取了2016年1月至2018年12月在南京市妇幼保健院新生儿重症监护病房出生体重<1500g且出生后24小时内入院的601例婴儿的数据。根据喂养策略，将婴儿分为纯母乳喂养组、捐赠母乳组（部分或无母乳喂养）和混合（母乳和配方奶）喂养组。三组中的定性和定量变量采用单因素方差分析、Kruskal-Wallis检验、卡方检验或Fisher确切概率法进行比较。Kappa检验和McNemar检验用于一致性检验。在601例婴儿（309例男婴和292例女婴）中，6例（1.0%）婴儿从未接受过母乳喂养。601例婴儿的胎龄和出生体重分别为（29.3±1.9）周和1260（1115，1400）g。共有8例（1.3%）婴儿被分为纯母乳喂养组，542例（90.2%）被分为捐赠母乳组，51例（8.5%）被分为混合喂养组。住院1-7天、8-14天和15-28天阶段母乳喂养的肠内喂养百分比分别为73.6%（42.9%，86.7%）、97.5%（78.6%，100.0%）和99.3%（93.0%，100.0%）（χ²=414.95，P=0.01），两两比较显示住院1-7天阶段最低（校正P均<0.05）。住院1-7天、8-14天和15-28天阶段母乳喂养的平均体重校正日剂量分别为9.7（4.3，18.2）、59.1（26.5，93.5）和116.0（60.3，142.6）ml/（kg·d）（F=759.75，P=0.01），两两比较显示住院1-7天阶段最低（校正P均<0.05）。纯母乳喂养组、捐赠母乳组和混合喂养组的体重校正日剂量分别为95.2（40.0，117.2）、82.9（53.6，103.1）和55.7（16.6，97.5）ml/（kg·d）（F=10.78，P=0.005）。此外，母乳喂养的百分比和体重校正日剂量显示总体一致性κ值为0.703（P<0.05，Z=0.408）。纯母乳喂养率较低，尤其是在住院的前7天。母乳喂养的肠内喂养总百分比和平均体重校正日剂量可以很好地定量评估住院期间的母乳喂养情况。
