出生体重＜1250g 的婴儿喂养人乳及人乳强化剂与牛奶奶源强化剂的短暂性低血糖与生化差异
Transient Hypoglycemia and Biochemical Differences in Infants Less Than 1,250 G at Birth Fed Human Milk with Human Milk-Derived Fortifier versus Cow Milk-Derived Fortifier.
机构信息
Division of Neonatology, CHOC Pediatric Subspecialty Faculty Inc., Orange, California.
Division of Neonatology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of USC, Los Angeles, California.
出版信息
Am J Perinatol. 2024 May;41(S 01):e2824-e2831. doi: 10.1055/a-2164-7957. Epub 2023 Sep 1.
OBJECTIVE
Fortification of human milk (HM) with either human milk-derived fortifier (HMDF) or cow milk-derived fortifier (CMDF) is important in preterm infants. The objective is to compare the incidence of hypoglycemia, and biochemical values in infants less than 1,250 g at birth fed HMDF versus CMDF.
STUDY DESIGN
It is a retrospective cohort study on infants less than 1,250 g at birth who were fed with HMDF or CMDF. Hypoglycemia was defined as blood glucose (BG) level equal to or less than 60 mg/dL within 72 hours of full enteral feeds when off total parenteral nutrition and intravenous fluids.
RESULTS
Ninety infants were enrolled (HMDF = 61, CMDF = 29). HMDF group had a higher rate of hypoglycemia (46 vs. 24%; = 0.048) after achievement of full enteral feeding. The median minimum BG was lower (61 vs. 71; ≤ 0.01), while blood urea nitrogen (12 vs. 6; ≤ 0.01) and albumin (3.1 vs. 2.7; ≤ 0.01) were higher in HMDF group compared with CMDF.
CONCLUSION
At full enteral feedings in infants less than 1,250 g at birth, an HMDF diet may predispose to hypoglycemia needing intervention. Close monitoring of BG levels once off parenteral nutrition is recommended.
KEY POINTS
· Exclusive human milk (EHM) feeding results in better nutritional indices.. · EHM feeding at higher calorie/ounce improves growth.. · Blood glucose needs to be monitored when off TPN during EHM feeding..
目的
对早产儿进行人乳强化（HM），无论是用人乳衍生强化剂（HMDF）还是牛奶衍生强化剂（CMDF）都很重要。本研究旨在比较出生体重小于 1250 克的婴儿在接受 HMDF 或 CMDF 喂养时低血糖的发生率和生化值。
研究设计
这是一项回顾性队列研究，研究对象为出生体重小于 1250 克且接受 HMDF 或 CMDF 喂养的婴儿。低血糖定义为完全肠内喂养后 72 小时内停输全肠外营养和静脉补液时血糖（BG）水平等于或低于 60mg/dL。
结果
共纳入 90 名婴儿（HMDF=61，CMDF=29）。达到完全肠内喂养后，HMDF 组低血糖发生率较高（46%比 24%；=0.048）。中位数最低 BG 较低（61 比 71；≤0.01），而 HMDF 组的血尿素氮（12 比 6；≤0.01）和白蛋白（3.1 比 2.7；≤0.01）较高。
结论
在出生体重小于 1250 克的婴儿完全肠内喂养时，HMDF 饮食可能导致需要干预的低血糖。建议一旦停输肠外营养，密切监测 BG 水平。
关键点
· 纯母乳喂养（EHM）可改善营养指标。· 高能量/盎司的 EHM 喂养可促进生长。· 在 EHM 喂养期间停输 TPN 时需要监测血糖。
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