Division of Newborn Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Semin Perinatol. 2021 Mar;45(2):151383. doi: 10.1016/j.semperi.2020.151383. Epub 2020 Dec 31.
Human milk is the preferred enteral diet for preterm infants. It provides macronutrients, micronutrients, and bioactive factors that support physical growth and neurodevelopment. Challenges of the human milk diet include the variability in its composition and a need for fortification to mirror placental nutrient delivery and prevent extrauterine growth restriction. Various strategies exist to attain target nutrient provision and optimize growth, including leveraging new technology for point-of-care human milk analysis. When maternal milk is unavailable or in short supply, pasteurized donor human milk is the preferred alternative. Infants fed donor milk may have slower weight gain than those fed exclusively maternal milk or formula, whereas infants fed fortified maternal milk have similar weight gain to preterm formula-fed infants. Future directions include more rigorous characterization of the variation in human milk, further investigation of the clinical benefits of non-nutrient bioactive factors in milk, and novel approaches to optimize fortification.
母乳是早产儿首选的肠内营养。它提供宏量营养素、微量营养素和生物活性因子，支持身体生长和神经发育。母乳饮食的挑战包括其成分的可变性和需要强化以反映胎盘营养输送和预防宫外生长受限。存在各种策略来达到目标营养供给和优化生长，包括利用新技术进行即时母乳分析。当母乳不可用时或供应不足时，巴氏消毒的捐赠母乳是首选的替代物。接受捐赠母乳的婴儿体重增加可能比仅接受母乳或配方奶喂养的婴儿慢，而接受强化母乳喂养的婴儿体重增加与早产儿配方奶喂养的婴儿相似。未来的方向包括更严格地描述母乳中的变化，进一步研究牛奶中非营养生物活性因子的临床益处，以及优化强化的新方法。
