Umasekar Urmila, Amboiram Prakash, Balakrishnan Umamaheswari, Sirala Jagadeesh Nalini
Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamilnadu, India.
Neonatology, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamil Nadu, India.
BMJ Paediatr Open. 2025 Jan 7;9(1):e002931. doi: 10.1136/bmjpo-2024-002931.
Human milk, especially the mother's own milk (MOM), is highly recommended for preterm babies considering its numerous benefits. Prioritising the use of exclusive MOM in enteral feeding plans is essential for maximising the health and development of preterm babies. This study evaluated the effect of early establishment of full enteral feed (FEF) with exclusive MOM on feeding rate and neonatal nutritional outcomes at discharge among preterm babies.
A retrospective cohort study was conducted using medical records of single preterm babies born between 27 and 33 weeks of gestational age and admitted to a single tertiary care hospital in South India between June 2019 and May 2022. The primary exposure was the establishment of FEF with exclusive MOM. The outcomes assessed were the exclusive MOM feeding rate and neonatal nutritional outcomes at discharge.
A total of 160 preterm babies met the inclusion criteria. Among these 104 (65%) achieved FEF with exclusive MOM. The exclusive MOM feeding rate at discharge was significantly higher among preterm babies who achieved FEF with exclusive MOM, 91.3% vs 62.5% (RR: 1.46 (95% CI: 1.18 to 1.81)). Preterm babies who achieved FEF with exclusive MOM were five times more likely to continue exclusive MOM feeding at discharge (aOR: 5.37, 95% CI: 2.04 to 14.16). The median time taken to achieve exclusive MOM among the exposure group was 6 days (95% CI: 5.6 to 6.3) compared with 12 days (95% CI: 10.2 to 13.8) for the unexposed group (HR: 0.26 (95% CI: 0.17 to 0.38; p<0.001)). There was no significant difference in growth and neonatal complications between the groups. Availability of MOM within 48 hours was strongly associated with achieving FEF with exclusive MOM, with an adjusted OR of 6.12 (95% CI: 2.81 to 13.30).
Early establishment of FEF with exclusive MOM increases the exclusive MOM feeding rate at discharge. Early access to MOM within 48 hours significantly enhances the likelihood of achieving FEF with exclusive MOM.
考虑到母乳，尤其是母亲自己的母乳（MOM）有诸多益处，强烈推荐用于喂养早产儿。在肠内喂养计划中优先使用纯MOM对于使早产儿的健康和发育最大化至关重要。本研究评估了早期以纯MOM建立完全肠内喂养（FEF）对早产儿出院时喂养率和新生儿营养结局的影响。
采用回顾性队列研究，使用2019年6月至2022年5月期间在印度南部一家三级医疗中心收治的孕周为27至33周的单胎早产儿的病历。主要暴露因素是以纯MOM建立FEF。评估的结局为纯MOM喂养率和出院时的新生儿营养结局。
共有160名早产儿符合纳入标准。其中104名（65%）以纯MOM实现了FEF。以纯MOM实现FEF的早产儿出院时的纯MOM喂养率显著更高，分别为91.3%和62.5%（相对危险度：1.46（95%置信区间：1.18至1.81））。以纯MOM实现FEF的早产儿出院时继续纯MOM喂养的可能性高出五倍（校正比值比：5.37，95%置信区间：2.04至14.16）。暴露组实现纯MOM喂养的中位时间为6天（95%置信区间：5.6至6.3），未暴露组为12天（95%置信区间：10.2至13.8）（风险比：0.26（95%置信区间：0.17至0.38；p<0.001））。两组之间在生长和新生儿并发症方面无显著差异。48小时内可获得MOM与以纯MOM实现FEF密切相关，校正后的比值比为6.12（95%置信区间：2.81至13.30）。
早期以纯MOM建立FEF可提高出院时的纯MOM喂养率。48小时内尽早获得MOM可显著提高以纯MOM实现FEF的可能性。
