Nantes Université, INRAE, UMR1280 PhAN, CRNH-OUEST, IMAD, 1 Place Alexis Ricordeau, 44000, Nantes, France.
Department of Neonatalogy, CHU, Nantes University Hospital, 44000, Nantes, France.
Eur J Nutr. 2021 Oct;60(7):3959-3969. doi: 10.1007/s00394-021-02562-8. Epub 2021 Apr 30.
Feeding supplemented mother milk during hospital stay improves neurodevelopment in preterm infants. Yet the composition of mother milk varies widely between subjects. The relationship between this variation and outcome is unknown.
To determine whether the protein content in native breast milk (BM) correlates with 2-year infant outcome.
In a monocentric prospective observational study, LACTACOL, preterm infants born between 28 and 34 weeks of gestation, whose mothers decided to exclusively breastfeed, were enrolled during the first week of life. Samples of expressed breast milk obtained at several times of the day were pooled over a 24-h period, and such pool was used for macronutrient analysis, using mid-infrared analyzer. Age and Stages questionnaire (ASQ) was used to assess 2-year neurodevelopmental outcome. We analyzed the relationship between protein content in BM, and (i) infant neurodevelopment at 2-year (primary outcome), and (ii) growth until 2-year (secondary outcome).
138 infants were enrolled. The main analysis concerned 130 infants (including 40 twin infants) and 110 mothers with BM samples collected at week 3 after birth. Native BM samples were ranked in three tertiles of protein content (g/100 ml): 0.91 ± 0.09 (lower), 1.14 ± 0.05 (middle) and 1.40 ± 0.15 (upper); 48, 47 and 35 infants were ranked, respectively, in these three tertiles. Infants in the upper tertile were more often singleton (P = 0.012) and were born with lower birth weight and head circumference Z-scores (P = 0.005 and 0.002, respectively). Differences in weight and head circumference were no longer observed at 2-year. ASQ score at age 2 did not differ between the three tertiles (P = 0.780). Sensitivity analyses with imputations, including all 138 infants, confirmed the main analysis as well as analyses based on fortified BM as exposure.
Protein content of BM (native or fortified) is not associated with preterm infant neurodevelopment at 2-year. Higher protein content was associated with a lower birth weight.
在住院期间喂养添加了补充物的母乳可改善早产儿的神经发育。然而，母乳的成分在个体之间差异很大。这种差异与结果之间的关系尚不清楚。
确定天然母乳（BM）中的蛋白质含量是否与 2 岁婴儿的结局相关。
在一项单中心前瞻性观察研究中，LACTACOL 纳入了胎龄为 28 至 34 周且其母亲决定纯母乳喂养的早产儿，在生命的第一周进行研究。在一天的多个时间点采集的母乳样本在 24 小时内混合，然后使用中红外分析仪对混合样本进行宏量营养素分析。使用年龄和阶段问卷（ASQ）评估 2 岁时的神经发育结局。我们分析了 BM 中的蛋白质含量与（i）2 岁时婴儿的神经发育（主要结局），以及（ii）2 岁时的生长情况（次要结局）之间的关系。
共纳入了 138 名婴儿。主要分析涉及 130 名婴儿（包括 40 对双胞胎）和 110 名 BM 样本采集于出生后第 3 周的母亲。天然 BM 样本按蛋白质含量（g/100ml）分为三个三分位数：0.91±0.09（低）、1.14±0.05（中）和 1.40±0.15（高）；48、47 和 35 名婴儿分别处于这三个三分位数。处于高分位的婴儿更常为单胎（P=0.012），且出生体重和头围 Z 评分较低（P=0.005 和 0.002）。2 岁时体重和头围的差异不再存在。三个三分位数之间的 ASQ 评分在 2 岁时无差异（P=0.780）。使用插补法进行包括所有 138 名婴儿的敏感性分析，结果与主要分析以及基于强化 BM 作为暴露的分析一致。
BM（天然或强化）中的蛋白质含量与 2 岁时早产儿的神经发育无关。较高的蛋白质含量与较低的出生体重有关。
