Liggins Institute, University of Auckland, Auckland, New Zealand.
Neonatal Services, Royal Women's Hospital, Melbourne, VIC, Australia.
Pediatr Res. 2021 Jan;89(2):313-317. doi: 10.1038/s41390-020-01252-1. Epub 2020 Nov 12.
Boys born preterm are recognised to be at higher risk of adverse outcomes than girls born preterm. Despite advances in neonatal intensive care and overall improvements in neonatal morbidity and mortality, boys born preterm continue to show worse short- and long-term outcomes than girls. Preterm birth presents a nutritional crisis during a critical developmental period, with postnatal undernutrition and growth-faltering common complications of neonatal intensive care. Furthermore, this preterm period corresponds to that of rapid in utero brain growth and development, and the developmental window relating to foetal programming of adult non-communicable diseases, the prevalence of which are associated both with preterm birth and sex. There is increasing evidence to show that from foetal life, boys and girls have different responses to maternal nutrition, that maternal breastmilk composition differs based on foetal sex and that early neonatal nutritional interventions affect boys and girls differently. This narrative review examines the evidence that sex is an important moderator of the outcomes of preterm nutrition intervention, and describes what further knowledge is required before providing nutrition intervention for infants born preterm based on their sex. IMPACT: This review examines the increasing evidence that boys and girls respond differently to nutritional stressors before birth, that maternal breastmilk composition differs by foetal sex and that nutritional interventions have different responses based on infant sex. Boys and girls born preterm are given standard nutritional support which does not take infant sex into account, and few studies of neonatal nutrition consider infant sex as a potential mediator of outcomes. By optimising early nutrition for boys and girls born preterm, we may improve outcomes for both sexes. We propose future studies of neonatal nutritional interventions should consider infant sex.
早产儿男孩比早产儿女孩面临更高的不良结局风险。尽管新生儿重症监护技术有所进步，新生儿发病率和死亡率也有所整体改善，但早产儿男孩的短期和长期结局仍比女孩差。早产儿在关键发育时期面临营养危机，新生儿重症监护的常见并发症是产后营养不足和生长迟缓。此外，这段早产儿时期与宫内大脑快速生长和发育时期相对应，与胎儿编程成人非传染性疾病的发育窗口有关，这些疾病的患病率与早产和性别都有关。越来越多的证据表明，从胎儿期开始，男孩和女孩对母体营养的反应就不同，母体母乳成分也因胎儿性别而异，早期新生儿营养干预对男孩和女孩的影响也不同。这篇综述性文章考察了性别是早产儿营养干预结局的重要调节因素的证据，并描述了在根据婴儿性别为早产儿提供营养干预之前，还需要哪些进一步的知识。影响：本综述检查了越来越多的证据表明，男孩和女孩在出生前对营养应激的反应不同，母体母乳成分因胎儿性别而异，营养干预的反应也因婴儿性别而异。出生前给予标准营养支持的早产儿男孩和女孩并没有考虑到婴儿的性别，而且很少有研究新生儿营养的研究将婴儿性别视为结局的潜在调节因素。通过优化早产儿的早期营养，我们可能会改善两性的结局。我们建议未来的新生儿营养干预研究应考虑婴儿性别。
