Sorce Lauren R, Asaro Lisa A, Curley Martha A Q
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Nurs Crit Care. 2025 Mar;30(2):e13103. doi: 10.1111/nicc.13103. Epub 2024 Jun 26.
Data support the protective effects of human breast milk (HBM) feeding in acute illness but little is known about the impact of HBM feeding on the criticality of infants.
To explore the relationship between early HBM feeding and severity of illness and recovery in critically ill children requiring intubation and mechanical ventilation for acute respiratory failure (ARF).
Prospective cohort study of mothers of patients aged 1-36 months who participated in the acute and follow-up phases of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) clinical trial. Participants completed a survey describing HBM dose fed during their infant's first month of life.
Of 138 patients, 70 (51%) received exclusive HBM feedings (90%-100% total feeds) and 68 (49%) did not. We found no group differences in severity of illness on paediatric intensive care unit (PICU) admission or severity of paediatric acute respiratory distress syndrome (PARDS) within the first 24-48 h of intubation/mechanical ventilation (Pediatric Risk of Mortality [PRISM] III-12 score median: 5 vs. 5, p = .88; moderate/severe PARDS: 53% vs. 54%, p = .63). While median time to recovery from ARF was reduced by 1 day in patients who received exclusive HBM feedings, the difference between groups was not statistically significant (median 1.5 vs. 2.6 days, hazard ratio 1.40 [95% confidence interval, 0.99-1.97], p = .06).
Human breast milk dose was not associated with severity of illness on PICU admission in children requiring mechanical ventilation for ARF.
Data support the protective effects of HBM during acute illness and data from this study support a clinically important reduction in time to recovery of ARF. Paediatric nurses should continue to champion HBM feeding to advance improvements in infant health.
数据支持母乳喂养对急性疾病具有保护作用，但关于母乳喂养对婴儿病情危急程度的影响却知之甚少。
探讨早期母乳喂养与因急性呼吸衰竭（ARF）需要插管和机械通气的危重症儿童的疾病严重程度及康复之间的关系。
对年龄在1至36个月患者的母亲进行前瞻性队列研究，这些母亲参与了呼吸衰竭镇静滴定随机评估（RESTORE）临床试验的急性期和随访期。参与者完成了一项调查，描述其婴儿出生后第一个月内母乳喂养的量。
138名患者中，70名（51%）接受了纯母乳喂养（占总喂养量的90%-100%），68名（49%）未接受。我们发现，在儿科重症监护病房（PICU）入院时的疾病严重程度或插管/机械通气后的最初24至48小时内的儿科急性呼吸窘迫综合征（PARDS）严重程度方面，两组之间没有差异（儿科死亡风险[PRISM]III-12评分中位数：5对5，p = 0.88；中度/重度PARDS：53%对54%，p = 0.63）。虽然接受纯母乳喂养的患者从ARF恢复的中位时间缩短了1天，但两组之间的差异无统计学意义（中位数1.5天对2.6天，风险比1.40[95%置信区间，0.99-1.97]，p = 0.06）。
对于因ARF需要机械通气的儿童，母乳喂养量与PICU入院时的疾病严重程度无关。
数据支持母乳喂养在急性疾病期间的保护作用，本研究的数据支持ARF恢复时间在临床上有重要缩短。儿科护士应继续倡导母乳喂养，以促进婴儿健康的改善。
