人乳喂养与中国极低/超低出生体重儿短期健康结局的关系。

The Association of Human Milk Feeding With Short-Term Health Outcomes Among Chinese Very/Extremely Low Birth Weight Infants.

机构信息

Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.

The Affiliated Shenzhen Maternity and Child Healthcare Hospital of Southern Medical University, Shanghai, China.

出版信息

J Hum Lact. 2022 Nov;38(4):670-677. doi: 10.1177/08903344221078237. Epub 2022 Mar 2.

DOI:10.1177/08903344221078237

PMID:35236170

Abstract

BACKGROUND

There is limited evidence about the influence of human milk feeding on short-term outcomes in a large preterm infant population.

RESEARCH AIMS

To explore the influences of human milk feeding on the primary outcome of necrotizing enterocolitis and secondarily sepsis, bronchial pulmonary dysplasia, severe retinopathy of prematurity, death, and the time to achieve full enteral feeding at discharge in very/extremely low-birth-weight infants.

METHODS

This study was a retrospective, longitudinal, observational two-group comparison cohort study. A total of 4470 very/extremely low-birth-weight infants from 25 neonatal intensive care units in China, between April 2015 and May 2018, were enrolled in this study. Exclusive human milk-fed and formula-fed participants were matched using propensity scores. After matching, human milk-fed participants ( = 1379) and formula-fed participants ( = 1378) were included in the analyses. The likelihood of necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, severe retinopathy of prematurity, death, and the time to achieve full enteral feeding were compared between the two groups.

RESULTS

Exclusive human milk feeding was associated with lower odds of necrotizing enterocolitis (2.90% vs. 8.42%, OR 0.33, 95% CI [0.22, 0.47]), bronchopulmonary dysplasia (15.74% vs. 20.26%, OR 0.69, 95% CI [0.56, 0.86]), severe retinopathy of prematurity (1.45% vs. 2.39%, OR 0.50, 95% CI [0.27, 0.93]), and death (6.02% vs. 10.38%, OR 0.44, 95% CI [0.32, 0.61]) compared with formula feeding. No significant differences in the time to achieve full enteral feeding or the odds of sepsis were found between the two groups.

CONCLUSION

Exclusive human milk feeding is associated with a reduction in necrotizing enterocolitis, bronchopulmonary dysplasia, severe retinopathy of prematurity, and mortality among very/extremely low-birth-weight infants.

TRIAL REGISTRATION

Clinicaltrials.gov on November 9, 2015 (NCT02600195).

摘要

背景

关于母乳喂养对大量早产儿短期结局的影响，证据有限。

目的

探讨母乳喂养对坏死性小肠结肠炎的主要结局以及次要结局（败血症、支气管肺发育不良、重度早产儿视网膜病变、死亡以及出院时达到完全肠内喂养的时间）的影响。

方法

本研究为回顾性、纵向、观察性的两组比较队列研究。共纳入 2015 年 4 月至 2018 年 5 月期间中国 25 个新生儿重症监护病房的 4470 例极低/超低出生体重儿。采用倾向评分匹配法对接受纯母乳喂养和配方奶喂养的患儿进行匹配。匹配后，将纯母乳喂养组（n=1379）和配方奶喂养组（n=1378）纳入分析。比较两组患儿坏死性小肠结肠炎、支气管肺发育不良、败血症、重度早产儿视网膜病变、死亡以及达到完全肠内喂养的时间。

结果

纯母乳喂养与较低的坏死性小肠结肠炎（2.90% vs. 8.42%，OR 0.33，95%CI [0.22, 0.47]）、支气管肺发育不良（15.74% vs. 20.26%，OR 0.69，95%CI [0.56, 0.86]）、重度早产儿视网膜病变（1.45% vs. 2.39%，OR 0.50，95%CI [0.27, 0.93]）和死亡（6.02% vs. 10.38%，OR 0.44，95%CI [0.32, 0.61]）的风险相关。两组患儿达到完全肠内喂养的时间或败血症的风险无显著差异。