Kazmi Sadaf H, Berman Sarah, Caprio Martha, Wachtel Elena V
Division of Neonatology, Department of Pediatrics, New York University School of Medicine, New York, USA.
JPEN J Parenter Enteral Nutr. 2022 Mar;46(3):600-607. doi: 10.1002/jpen.2132. Epub 2021 Jun 29.
Preterm infants are at risk for metabolic bone disease (MBD). Analysis of donor breast milk (DBM) shows lower levels of macronutrients compared with mother's own milk (MOM). The purpose of this study was to investigate the prevalence of MBD, rate of postnatal growth, and long-term neurodevelopmental outcomes in infants fed predominantly MOM vs DBM.
Retrospective observational study of infants born <1500g and <32 weeks at New York University Langone Health or Bellevue Hospital from January 2014 to January 2018. Infants were divided into two groups: those who received >70% of feeds with either MOM or DBM by 34 weeks' corrected age (CA). MBD was assessed using alkaline phosphatase (AlkPO4) levels and radiographic findings. Data was also collected on growth, feeding tolerance, and long-term neurodevelopmental outcomes.
A total of 210 infants were included (MOM =156 and DBM =54). The DBM group had higher AlkPO4 levels for the first 3 weeks of life (P < .01). Growth was similar between the groups, and both groups demonstrated catch-up growth after discharge. No difference was seen in feeding intolerance, incidence of necrotizing enterocolitis, or sepsis. The DBM group had lower cognitive (odds ratio [OR], 0.93 [0.88-0.98]; P < .01) and language (OR, 0.95 [0.90-0.99]; P < .01) scores at 18 months' CA.
Infants fed predominantly DBM had elevated AlkPO4 levels suggestive of MBD but did not develop osteopenia. Despite appropriate growth and comparable short-term outcomes, infants fed DBM had lower cognitive and language scores at 18 months' CA.
早产儿有患代谢性骨病（MBD）的风险。对捐赠母乳（DBM）的分析显示，与母亲自身母乳（MOM）相比，其宏量营养素水平较低。本研究的目的是调查以MOM为主喂养与以DBM为主喂养的婴儿中MBD的患病率、出生后生长速率以及长期神经发育结局。
对2014年1月至2018年1月在纽约大学朗格尼健康中心或贝尔维尤医院出生体重<1500g且孕周<32周的婴儿进行回顾性观察研究。婴儿被分为两组：在矫正年龄（CA）34周时，接受MOM或DBM喂养且喂养量>70%的婴儿。使用碱性磷酸酶（AlkPO4）水平和影像学检查结果评估MBD。还收集了生长、喂养耐受性和长期神经发育结局的数据。
共纳入210名婴儿（MOM组=156名，DBM组=54名）。DBM组在出生后的前3周AlkPO4水平较高（P<.01）。两组生长情况相似，且两组在出院后均出现追赶生长。在喂养不耐受、坏死性小肠结肠炎或败血症的发生率方面未观察到差异。DBM组在矫正年龄18个月时认知（优势比[OR]，0.93[0.88 - 0.98]；P<.01）和语言（OR，0.95[0.90 - 0.99]；P<.01）得分较低。
以DBM为主喂养的婴儿AlkPO4水平升高提示患有MBD，但未发生骨质减少。尽管生长正常且短期结局相当，但以DBM喂养的婴儿在矫正年龄18个月时认知和语言得分较低。
