Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK.
Faculty of Health, University of Plymouth, Plymouth, UK.
J Hum Nutr Diet. 2021 Feb;34(1):24-32. doi: 10.1111/jhn.12830. Epub 2020 Nov 2.
Breast milk is the feed of choice for premature infants, although its nutritional composition is not always sufficient to meet their raised nutritional requirements. The addition of a multi-nutrient breast milk fortifier (BMF) to breastmilk is recommended; however, international guidelines on the use of BMF are inconsistent. The present study aimed to explore the use of BMF in preterm infants by paediatric dietitians in the UK.
A questionnaire was designed and sent to members of the British Dietetic Association neonatal specialist group (n = 100) using a secure online platform. Descriptive statistics were calculated.
Forty dietitians completed the survey, all of whom used BMF. Local hospital BMF guidelines were available to 77.5% (n = 31). The most commonly used criteria for commencing BMF were: tolerating a feed volume of 150 mL kg day (72.5%, n = 29), a gestational age <34 weeks (67.5%, n = 27) and a birth weight <1500 g (60%, n = 24). The primary contraindication for the use of BMF was necrotising enterocolitis (NEC). The majority of respondents used standard fortification, with individualised fortification available to only 12.5% (n = 5). The most common indicators for discontinuing BMF were on discharge home (67.5%, n = 27), satisfactory growth (65%, n = 26) or feeding directly from the breast (62.5%, n = 25).
Although BMF is used more proactively in UK neonatal units than previously, variation in practice remains. Individualised fortification is very uncommon and caution remains regarding risk of NEC. The development of national guidelines on the use of BMF would help to standardise nutritional care in neonatal units.
母乳是早产儿的首选喂养方式，尽管其营养成分并不总是足以满足其较高的营养需求。建议在母乳中添加多种营养素的母乳强化剂（BMF）；然而，国际使用 BMF 的指南并不一致。本研究旨在探索英国儿科营养师在早产儿中使用 BMF 的情况。
使用安全的在线平台，向英国饮食协会新生儿专家小组的成员（n=100）设计并发送了一份问卷。计算了描述性统计数据。
40 名营养师完成了调查，他们都使用了 BMF。77.5%（n=31）的营养师可获得当地医院的 BMF 指南。开始使用 BMF 的最常用标准是：耐受 150 mL/kg 天的喂养量（72.5%，n=29）、胎龄<34 周（67.5%，n=27）和出生体重<1500g（60%，n=24）。使用 BMF 的主要禁忌症是坏死性小肠结肠炎（NEC）。大多数受访者使用标准强化剂，只有 12.5%（n=5）可使用个体化强化剂。停止使用 BMF 的最常见指标是出院回家（67.5%，n=27）、生长满意（65%，n=26）或直接母乳喂养（62.5%，n=25）。
尽管英国新生儿病房中 BMF 的使用比以前更加积极，但实践仍存在差异。个体化强化剂非常少见，对于 NEC 的风险仍需谨慎。制定关于 BMF 使用的国家指南将有助于规范新生儿病房的营养护理。
