Department of Human Nutrition, School of Medicine, Dentistry and Nursing, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Department of Clinical Nutrition, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Neonatology. 2023;120(1):71-80. doi: 10.1159/000527522. Epub 2023 Jan 5.
Mother's own milk (MOM) is the optimal feed for premature infants but may not always be sufficiently available. Alternative feeding includes donor human milk (DONOR), with or without fortification and preterm formula. This study evaluated the association between early feeding with exclusively and predominantly MOM (MAINLY-MOM) versus MOM supplemented with fortified DONOR (MOM + DONOR) or preterm formula (MOM + FORMULA) and in-hospital growth and neonatal morbidities.
This was a multicentre (n = 13 units) cohort study of infants born at <32 weeks' gestation. Data captured at the point of care were extracted from the UK National Neonatal Research Database. The study groups were defined based on feeding patterns within the first 2 weeks of life using predefined cut-offs. The primary outcome was the in-hospital growth rate.
Data from 1,272 infants were analysed. Infants fell into two groups: extremely preterm (EPT) infants and very preterm (VPT) infants, born after <28 weeks and 28 to <32 weeks of gestation, respectively. Only 11 of 365 EPT infants received formula supplements, precluding a useful comparison of MOM + DONOR and MOM + FORMULA. There was no difference in median (25th-75th centile) growth velocity over the first 30 days of life between the MAINLY-MOM (n = 248) and MOM + DONOR (n = 106) groups: 10 (8-13) versus 10 (7-13) g/kg/day. Similarly, for VPT infants, there was no difference in growth velocities between MAINLY-MOM (n = 407), MOM + DONOR (N = 196), and MOM + FORMULA (N = 304): 11 (8-14) versus 11 (8-14) versus 11 (8-14) g/kg/day. Head growth did not differ (p value = 0.670). Cox regression analysis showed no difference in time to discharge between feeding types or any difference in major neonatal morbidities. In both EPT and VPT infants, growth velocity from the time of regaining birth weight to discharge was significantly lower in the MAINLY-MOM group compared to the MOM-DONOR group (EPT: 12.5 [11-14.2] vs. 14 [12.3-15.9] p = 0.45, VPT 13.5 [11-15.7] vs. 14.5 [12.6-16.8] p = 0.015).
Early feeding with fortified DONOR, in comparison to formula, to supplement MOM was not associated with any differences in short-term growth, length of stay, and neonatal morbidities. However, early feeding with mainly maternal milk, compared to maternal milk supplemented with DONOR, was associated with significantly lower overall weight gain.
母乳是早产儿的最佳食物，但可能并不总是足够供应。替代喂养包括人乳捐赠（DONOR），可与强化剂和早产儿配方奶一起使用或不使用。本研究评估了主要采用母乳喂养（MAINLY-MOM）与添加强化 DONOR（MOM + DONOR）或早产儿配方奶（MOM + FORMULA）喂养与住院期间生长和新生儿发病率之间的关系。
这是一项在 13 个中心（n = 13 个单位）进行的胎龄<32 周的婴儿队列研究。在护理点采集的数据从英国国家新生儿研究数据库中提取。研究组根据出生后 2 周内的喂养模式，使用预设的截止值进行定义。主要结局是住院期间的生长速度。
对 1272 名婴儿的数据进行了分析。婴儿分为两组：极早产儿（EPT）和非常早产儿（VPT），分别出生于<28 周和 28-32 周。只有 365 名 EPT 婴儿中的 11 名接受了配方奶补充，这使得 MOM + DONOR 和 MOM + FORMULA 之间无法进行有用的比较。在生命的前 30 天内，MAINLY-MOM（n = 248）和 MOM + DONOR（n = 106）组的中位（25-75 百分位数）生长速度没有差异：10（8-13）与 10（7-13）g/kg/天。同样，对于 VPT 婴儿，MAINLY-MOM（n = 407）、MOM + DONOR（N = 196）和 MOM + FORMULA（N = 304）之间的生长速度也没有差异：11（8-14）与 11（8-14）与 11（8-14）g/kg/天。头围生长无差异（p 值=0.670）。Cox 回归分析显示，喂养方式与出院时间之间无差异，主要新生儿发病率也无差异。在 EPT 和 VPT 婴儿中，与 MOM-DONOR 组相比，MAINLY-MOM 组从恢复出生体重到出院的体重增长速度明显较低（EPT：12.5[11-14.2]与 14[12.3-15.9]，p =0.45，VPT 13.5[11-15.7]与 14.5[12.6-16.8]，p =0.015）。
与配方奶相比，早期添加强化 DONOR 补充 MOM 喂养与短期生长、住院时间和新生儿发病率无差异。然而，与添加 DONOR 的母乳相比，主要采用母乳喂养与总体体重增长明显较低有关。
