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母乳喂养与适于胎龄早产儿支气管肺发育不良。

Mother's own milk and bronchopulmonary dysplasia in appropriate for gestational age preterm infants.

机构信息

Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy.

Division of Neonatology, Mother and Child Department, G. Salesi Children's Hospital, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy.

出版信息

Eur J Clin Nutr. 2024 Aug;78(8):703-708. doi: 10.1038/s41430-024-01455-3. Epub 2024 May 30.

Abstract

OBJECTIVE

To evaluate the association between mother's own milk (MOM) and bronchopulmonary dysplasia (BPD) in appropriate for gestational age (AGA) preterm infants <32 weeks.

METHODS

Clinical data of AGA preterm infants (24-31 weeks) were reviewed. Infants with ≥66% of cumulative prescribed enteral volumes as MOM from birth to 36 weeks were allocated to the high provision of MOM group (H-MOM), whereas those with <66% were assigned to the low provision of MOM group (L-MOM). Multiple regressions were used to assess the association of H-MOM with BPD and oxygen saturation to fraction inspired oxygen ratio (SFR) at 36 weeks.

RESULTS

A total of 1041 infants met the inclusion criteria, with a median provision of cumulative enteral nutrition volumes of 5721 (IQR 2616) mL/kg. Among them, 517 (49.7%) were H-MOM and 524 (50.3%) L-MOM infants. H-MOM showed a reduction in the incidence of BPD to 31.6% compared to L-MOM infants. H-MOM had a lower risk of BPD than L-MOM infants after the adjustment for gestational age, sex, cesarean section, mean SFR at the first hours of life, surfactant administration, patent ductus arteriosus, sepsis, prolonged ventilatory supports/oxygen exposure, and cumulative energy intakes from birth to 36 weeks [aOR: 0.613, p = 0.047]. H-MOM was also associated with a lower risk of SFR in the first quartile at 36 weeks [aOR: 0.616, p = 0.028] than L-MOM.

CONCLUSION

A high provision (≥66%) of enteral volume as MOM from birth to 36 weeks is associated with a reduced risk of both BPD and low SFR at 36 weeks in AGA preterm infants <32 weeks.

摘要

目的

评估适合胎龄(AGA)早产儿<32 周时,母亲的初乳(MOM)与支气管肺发育不良(BPD)之间的关联。

方法

回顾 AGA 早产儿(24-31 周)的临床数据。从出生到 36 周,累积规定肠内喂养量≥66%为 MOM 的婴儿被分配到高 MOM 供应组(H-MOM),而累积规定肠内喂养量<66%的婴儿被分配到低 MOM 供应组(L-MOM)。采用多元回归评估 H-MOM 与 BPD 以及 36 周时氧饱和度与吸入氧分数比(SFR)的关系。

结果

共有 1041 名婴儿符合纳入标准,累积肠内营养量中位数为 5721(IQR 2616)mL/kg。其中,517 名(49.7%)为 H-MOM 婴儿,524 名(50.3%)为 L-MOM 婴儿。与 L-MOM 婴儿相比,H-MOM 婴儿的 BPD 发生率降低至 31.6%。在调整胎龄、性别、剖宫产、出生后前几小时的平均 SFR、表面活性剂应用、动脉导管未闭、败血症、延长通气支持/氧暴露以及出生至 36 周的累积能量摄入后,H-MOM 婴儿发生 BPD 的风险低于 L-MOM 婴儿[比值比:0.613,p=0.047]。与 L-MOM 婴儿相比,H-MOM 婴儿在 36 周时 SFR 处于第一四分位数的风险也较低[aOR:0.616,p=0.028]。

结论

在出生至 36 周期间,肠内喂养量以 MOM 形式提供≥66%与 AGA 早产儿<32 周时 BPD 和 36 周时低 SFR 的风险降低有关。

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