The Coombe Hospital, Dublin, Ireland.
Royal College of Surgeons Ireland, Dublin, Ireland.
Eur J Clin Nutr. 2024 Oct;78(10):825-829. doi: 10.1038/s41430-024-01471-3. Epub 2024 Jul 9.
Breastmilk confers empirical benefits for preterm infants, however direct breastfeeding rates in this population remain low. For preterm infants, it may be useful to assess the volume of breastmilk transferred from mother to baby when breastfeeding, particularly during transition to oral feeding when breastfeeding attrition is high. Establishing breastfeeding in preterm infants is complex and without knowledge of milk intake during breastfeeds there is risk of inaccurate feed supplementation with subsequent effects on growth and nutrition. Here we review the evidence for clinical assessments of breastfeeding in preterm infants including test weighing, use of isotope labelled water and clinical observation tools designed to estimate adequacy of breastfeeds. Test weighing is a validated measurement, however requires rigorous protocols and further investigation in small infants. Use of isotope labelled water is a validated technique but, due to sampling requirements, reflects intake over days and weeks instead of individual feeds. Clinical observation tools assessed in preterm infants, have not been shown to reflect volumes of breastmilk intake. While current methods have limitations, the goal is to identify measurement tools to be used as temporary aids to facilitate transition to direct breastfeeding while minimising risk of inaccurate supplementation.
母乳为早产儿提供了经验性益处，但该人群中的直接母乳喂养率仍然很低。对于早产儿，当母乳喂养时，评估母乳从母亲转移到婴儿的量可能是有用的，特别是在向口服喂养过渡时，因为此时母乳喂养的流失率很高。在早产儿中建立母乳喂养很复杂，如果不知道母乳喂养期间的牛奶摄入量，就有可能不准确地补充喂养，从而对生长和营养产生影响。在这里，我们回顾了早产儿母乳喂养的临床评估证据，包括测试称重、使用同位素标记水和旨在估计母乳喂养充足性的临床观察工具。测试称重是一种经过验证的测量方法，但需要严格的方案，并且需要在小婴儿中进一步研究。同位素标记水的使用是一种经过验证的技术，但由于采样要求，它反映的是几天到几周的摄入量，而不是单个喂养量。在早产儿中评估的临床观察工具并不能反映母乳摄入量。虽然目前的方法有其局限性，但目标是确定测量工具，作为临时辅助手段，帮助早产儿过渡到直接母乳喂养，同时最大限度地减少不准确补充的风险。
