Lin Rong, Shen Wei, Wu Fan, Mao Jian, Liu Ling, Chang Yanmei, Zhang Rong, Ye Xiuzhen, Qiu Yinping, Ma Li, Cheng Rui, Wu Hui, Chen Dongmei, Zheng Zhi, Lin Xinzhu, Tong Xiaomei
Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.
Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China.
Front Pediatr. 2022 Feb 23;10:795222. doi: 10.3389/fped.2022.795222. eCollection 2022.
To investigate the use of human milk fortifier (HMF) for very preterm infants (VPIs) and complications and nutritional status of VPIs due to various breast milk enhancement strategies among the Chinese population.
VPIs with birth weight < 1,800 g and wholly or predominantly breastfed were assigned to the following fortification groups: no HMF, early HMF (adding HMF at an enteral volume of ≤ 80 ml·kg·day), middle HMF (adding HMF at an enteral volume of 80-100 ml·kg·day), and late HMF (adding HMF at an enteral volume of ≥100 ml·kg·day). The growth status and complications for various groups were evaluated.
We enrolled 985 VPIs, of which 847 VPIs (86.0%) received HMF, whereas 138 VPIs (14.0%) did not. The number of VPIs in the early, middle, and late fortification groups were 89 (9.0%), 252 (25.6%), and 506 (51.4%), respectively. The complete fortification of the early, middle, and late fortification groups was achieved in 13.2 ± 11.0, 13.8 ± 11.7, and 12.3 ± 13.0 days, respectively, without significant differences ( > 0.05). The groups did not exhibit significant differences in the incidence of feeding intolerance, necrotizing enterocolitis (Bell stage ≥ 2), late-onset sepsis, and metabolic bone diseases ( > 0.05). The middle fortification groups exhibited the fastest growth velocity and the least dramatic decrease in the -score of weight and length, and the lowest incidence of EUGR (35.7%), whereas the "no HMF" groups exhibited the slowest growth velocity and the largest decline in the -score, and the highest incidence of EUGR (61.6%).
The usage rate of HMF was relatively low among Chinese VPIs, fortification often occurred in the late feeding stage, and the time to reach complete fortification was long. Adding HMF and different breast milk enhancement strategies did not increase the incidence of feeding intolerance and necrotizing enterocolitis. The enteral volume of 80-100 ml·kg·day with HMF addition led to increased growth in the weight and length and lower EUGR incidence, indicating that the addition of HMF at the specific feeding volume might be the best practice for promoting growth.
探讨人乳强化剂（HMF）在中国极低出生体重儿（VPI）中的使用情况，以及不同母乳强化策略对VPI并发症和营养状况的影响。
将出生体重<1800g且完全或主要母乳喂养的VPI分为以下强化组：不使用HMF组、早期HMF组（肠内摄入量≤80ml·kg·天·时添加HMF）、中期HMF组（肠内摄入量为80-100ml·kg·天·时添加HMF）和晚期HMF组（肠内摄入量≥100ml·kg·天·时添加HMF）。评估各组的生长状况和并发症情况。
共纳入985例VPI，其中847例（86.0%）使用了HMF，138例（14.0%）未使用。早期、中期和晚期强化组的VPI数量分别为89例（9.0%）、252例（25.6%）和506例（51.4%）。早期、中期和晚期强化组分别在13.2±11.0天、13.8±11.7天和12.3±13.0天实现完全强化，差异无统计学意义（>0.05）。各组在喂养不耐受、坏死性小肠结肠炎（Bell分期≥2期）、晚发性败血症和代谢性骨病的发生率方面差异无统计学意义（>0.05）。中期强化组生长速度最快，体重和身长Z评分下降幅度最小，宫外生长迟缓（EUGR）发生率最低（35.7%）；“不使用HMF”组生长速度最慢，Z评分下降幅度最大，EUGR发生率最高（61.6%）。
中国VPI中HMF使用率相对较低，强化多在喂养后期进行，达到完全强化的时间较长。添加HMF及不同母乳强化策略未增加喂养不耐受和坏死性小肠结肠炎的发生率。添加HMF且肠内摄入量为80-100ml·kg·天可使体重和身长增长加快，EUGR发生率降低，提示在特定喂养量时添加HMF可能是促进生长的最佳做法。
