Chehrazi Mohammad, Lanoue Julia, Ougham Kayleigh, Moss Becky, Uthaya Sabita, Modi Neena
Section of Neonatal Medicine, School of Public Health, Imperial College London, Chelsea and Westminster Hospital campus, 369 Fulham Road, London SW10 9NH, UK.
Section of Neonatal Medicine, School of Public Health, Imperial College London, Chelsea and Westminster Hospital campus, 369 Fulham Road, London SW10 9NH, UK.
Early Hum Dev. 2023 Oct 21;187:105880. doi: 10.1016/j.earlhumdev.2023.105880.
An infant's Own Mother's Milk (OMM) is the mainstay of very preterm nutrition. When a supplement is required, preterm formula and pasteurised human donor milk (pHDM), are options. Which is optimal is unknown.
Comparison of "survival to 34 weeks postmenstrual age (PMA) without surgery for necrotising enterocolitis (NEC)" and other outcomes, in infants receiving OMM supplemented with pHDM without bovine macronutrient fortification (exclusive human milk diet), and infants receiving OMM supplemented with preterm formula.
Cohort analysis of observational data from the National Neonatal Research Database; data-adaptive Super Learner approach with Targeted Maximum Likelihood Estimation to calculate Adjusted Risk Differences (ARD) between the groups.
Infants born below 32 weeks gestation admitted to neonatal units in England and Wales between 01 and 06-2017 and 31-05-2022.
Compared to the formula supplemented group (n = 7133), infants receiving an exclusive human milk diet (n = 1007), had lower survival to 34 weeks PMA without NEC surgery (ARD -98 %, 95%CI -114 to -82), higher all-cause (107 %, 91 to 122) and NEC-related mortality (10 %, 04 to 15), and lower rates of treated retinopathy of prematurity (-28 %, -34 to -23) and bronchopulmonary dysplasia (-121 %, -140 to -101).
The lower survival to 34 weeks PMA without NEC surgery in infants receiving an exclusive human milk diet is unexpected. We adjusted for factors that influence outcomes but cannot exclude the possibility of confounding, hence our data justify a randomised controlled trial to identify optimal supplementary feeds for very preterm infants.
婴儿自身母亲的母乳（OMM）是极早产儿营养的主要来源。当需要补充营养时，早产儿配方奶和巴氏杀菌的人类捐赠母乳（pHDM）是选择。哪种是最佳的尚不清楚。
比较接受不添加牛宏量营养素强化的pHDM补充的OMM（纯人乳饮食）的婴儿和接受添加早产儿配方奶的OMM的婴儿“存活至孕龄34周且无需进行坏死性小肠结肠炎（NEC）手术”及其他结果。
对来自国家新生儿研究数据库的观察数据进行队列分析；采用数据自适应超级学习器方法和靶向最大似然估计来计算两组之间的调整风险差异（ARD）。
2017年1月至6月以及2022年5月31日期间在英格兰和威尔士新生儿病房收治的孕周小于32周的婴儿。
与配方奶补充组（n = 7133）相比，接受纯人乳饮食的婴儿（n = 1007）存活至34周孕龄且无需进行NEC手术的比例较低（ARD -98%，95%CI -114至-82），全因死亡率较高（107%，91至122）以及NEC相关死亡率较高（10%，04至15），早产儿视网膜病变治疗率较低（-28%，-34至-23）和支气管肺发育不良率较低（-121%，-140至-101）。
接受纯人乳饮食的婴儿存活至34周孕龄且无需进行NEC手术的比例较低，这出乎意料。我们对影响结果的因素进行了调整，但不能排除混杂的可能性，因此我们的数据证明有必要进行一项随机对照试验，以确定极早产儿的最佳补充喂养方式。
