Department of Pediatrics, New York Presbyterian-Columbia University, New York, New York, USA.
Department of Medical Sciences, Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.
J Pediatr Gastroenterol Nutr. 2024 Nov;79(5):1047-1055. doi: 10.1002/jpn3.12341. Epub 2024 Aug 21.
Breast milk (BM) enhancement is often used to meet the nutritional needs of preterm infants after hospital discharge to achieve optimal growth. This study compared growth at 18-28 months corrected age (CA) among very preterm (VP) and very low birth weight (VLBW) infants discharged from the neonatal intensive care units (NICUs) on two BM enhancements.
We conducted a retrospective chart review study of infants born between January 1, 2013 and December 31, 2017, with gestational age < 32 weeks or birthweight < 1500 g, discharged from the NICU on BM enhancements; fortification of BM with infant formula additives (BM-F) or unfortified BM supplemented with bottle feeds of infant formula (BM-S). BM enhancements were nonrandomized and determined by the medical team. A linear mixed model regression analysis with propensity score matching was used to estimate the adjusted associations between the nutrition plan at discharge and growth outcomes at 18-28 months CA follow-up.
Two hundred and fifty-one VLBW/VP infants were included. Compared with BM-S, infants discharged on BM-F were more likely to continue receiving BM at 8-12 months CA, and had lower head circumference, weight-for-length z scores, and higher incidence of moderate malnutrition (p ≤ 0.01). After adjusting for confounders, discharge on BM-F was associated with a lower incidence of overweight/obesity at 18-28 months CA (odds interval: 0.45; confidence interval: 0.21-0.96; p = 0.04).
This retrospective study suggests that VLBW/VP infants discharged on BM-F received BM longer, had lower growth parameter and were less likely to be overweight/obese at 18-28 months CA. Further studies are needed to evaluate the role of postdischarge nutrition on preterm born children's growth, metabolic disease, and neurodevelopmental outcomes.
母乳强化通常用于满足早产儿出院后的营养需求，以实现最佳生长。本研究比较了通过两种母乳强化方法出院的极低出生体重/极低出生体重（VLBW/VP）早产儿在矫正月龄 18-28 个月时的生长情况。
我们对 2013 年 1 月 1 日至 2017 年 12 月 31 日期间出生的胎龄<32 周或出生体重<1500g 的婴儿进行了回顾性图表审查研究，这些婴儿在新生儿重症监护病房（NICU）中通过添加婴儿配方添加剂的母乳强化（BM-F）或未强化的母乳补充婴儿配方奶瓶喂养（BM-S）出院。母乳强化是非随机的，由医疗团队决定。使用线性混合模型回归分析和倾向评分匹配来估计出院时营养计划与矫正月龄 18-28 个月随访时生长结果之间的调整关联。
共纳入 251 名 VLBW/VP 婴儿。与 BM-S 相比，出院时接受 BM-F 的婴儿在 8-12 个月时更有可能继续接受母乳喂养，头围、体重长度 z 分数较低，中度营养不良的发生率较高（p≤0.01）。在调整混杂因素后，出院时接受 BM-F 与矫正月龄 18-28 个月时超重/肥胖的发生率较低相关（优势比：0.45；置信区间：0.21-0.96；p=0.04）。
这项回顾性研究表明，出院时接受 BM-F 的 VLBW/VP 婴儿接受母乳喂养的时间更长，生长参数较低，在矫正月龄 18-28 个月时超重/肥胖的可能性较小。需要进一步的研究来评估出院后营养对早产儿生长、代谢疾病和神经发育结局的作用。
