Department of Neonatology, Baylor Scott and White Health, Temple, TX, USA.
Baylor Research Institute, Temple, TX, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):10025-10029. doi: 10.1080/14767058.2022.2086794. Epub 2022 Jun 15.
Human milk, the ultimate source of nutrition for premature infants, enhances host defense mechanism, gastrointestinal maturation, lowers infection rate, improves neurodevelopmental outcomes, and reduces long-term cardiovascular and metabolic disease. Recently, there has been an increase in donor breast milk (DBM) use for premature infants; however, data are limited on the long-term effects of DBM on the infant's growth and neurodevelopmental outcomes.
To determine if there is an association between type of infant nutrition (maternal breast milk (MBM) or DBM) and neurodevelopmental and growth outcomes in very low birth weight (VLBW) infants.
DESIGN/METHODS: Retrospective cohort study of VLBW (<1500 g) infants admitted to the Baylor Scott & White Memorial Hospital Neonatal Intensive Care Unit from January 2014 to December 2016. Infants with major congenital anomalies, born at an outside hospital, who were nil per os (NPO) for >15 days, or who died before NICU discharge were excluded. Infants were stratified into two groups (MBM or DBM) based on predominant nutrition (>50%) received in the first month of life. Primary outcomes of neurodevelopmental delay(s) between 2 and 4 years of age identified via ICD 9/10 codes. Growth data (weight, length, and head circumference) were obtained from well-check visits at 12-, 18-, 24-, 36-, and 48-months. Severity of illness was determined using the Clinical Risk Index in Babies-II (CRIB-II) score. Generalized linear models were used to assess the relationship between nutrition and neurodevelopmental delay and trends in growth over time.
Two hundred and nine infants were included: 146 MBM; 63 DBM. Median gestational age was 28 weeks (range, 23-35) and median birthweight was 1050 g (range, 410-1470). There were no significant differences in birthweight, gestational age, CRIB-II score, or length of stay between the groups. Infants fed DBM had a significantly larger weight -score (=.005), length -score (=.01), and head circumference -score (=.04), on average from birth to 48 months compared to MBM infants, while controlling for NICU length of stay and number of follow-up months; however, this only equated to DBM infants being 0.5 in taller and 0.9 lbs heavier at 48 months. There were no statistically significant differences among type of infant nutrition and long-term neurodevelopmental outcomes, while controlling for CRIB-II score.
Infants fed DBM have a slightly greater propensity for growth over time compared to infants fed MBM. Longer follow-up is needed to further determine the effect, infant nutrition has on neurodevelopmental outcomes.
母乳是早产儿的最佳营养来源，可增强宿主防御机制、促进胃肠道成熟、降低感染率、改善神经发育结局，并降低长期心血管和代谢疾病风险。最近，使用捐赠母乳（DBM）喂养早产儿的情况有所增加；然而，关于 DBM 对早产儿生长和神经发育结局的长期影响的数据有限。
确定极低出生体重儿（VLBW）中婴儿营养类型（母乳或 DBM）与神经发育和生长结局之间是否存在关联。
这是一项回顾性队列研究，纳入了 2014 年 1 月至 2016 年 12 月在贝勒斯科特-怀特纪念医院新生儿重症监护病房（NICU）住院的 VLBW（<1500g）婴儿。排除了存在主要先天畸形、在院外出生、NPO 时间>15 天或在 NICU 出院前死亡的婴儿。根据生命的第一个月内接受的主要营养物质（>50%），将婴儿分为两组（MBM 或 DBM）。通过 ICD 9/10 编码确定 2 至 4 岁时是否存在神经发育迟缓。通过 12 个月、18 个月、24 个月、36 个月和 48 个月的定期健康检查获取体重、身长和头围的生长数据。采用婴儿临床风险指数 II（CRIB-II）评分评估疾病严重程度。使用广义线性模型评估营养与神经发育迟缓之间的关系以及随时间推移的生长趋势。
共纳入 209 名婴儿：146 名接受 MBM 喂养，63 名接受 DBM 喂养。中位胎龄为 28 周（范围：23-35），中位出生体重为 1050g（范围：410-1470）。两组间的出生体重、胎龄、CRIB-II 评分和 NICU 住院时间均无显著差异。与 MBM 婴儿相比，接受 DBM 喂养的婴儿在出生至 48 个月期间的体重评分（=0.005）、身长评分（=0.01）和头围评分（=0.04）平均显著更大，同时控制了 NICU 住院时间和随访月数；然而，这仅意味着 DBM 婴儿在 48 个月时高 0.5 英寸，重 0.9 磅。控制 CRIB-II 评分后，两组间婴儿营养类型与长期神经发育结局之间无统计学差异。
与接受 MBM 喂养的婴儿相比，接受 DBM 喂养的婴儿在生长方面有略微的增长趋势。需要更长时间的随访来进一步确定婴儿营养对神经发育结局的影响。
