Toftlund Line H, Beck-Nielsen Signe Sparre, Agertoft Lone, Halken Susanne, Zachariassen Gitte
Department of Neonatology, Children's Department, Herlev Hospital, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark.
Centre for Rare Diseases, Aarhus University Hospital and Institute for Clinical Research, Aarhus University, Aarhus, Denmark.
Eur J Pediatr. 2025 Jan 30;184(2):160. doi: 10.1007/s00431-024-05935-3.
In very preterm-born infants, nutritional intake is important to reduce the risk of severe metabolic bone disease including the risk of a lower bone mineral density (BMD). The aim of this study was to evaluate bone mineral content (BMC) and BMD (measured as BMC per bone area (BA)) at six years of age in very preterm-born infants fed different diets post-discharge. Data on this topic so far is insufficient, and with this study we aim to supply more useful data. A prospective follow-up study of 281 children born very preterm (gestational age ≤ 32 + 0 weeks) and enrolled in a multicentre RCT on post-discharge nutrition. Infants fed human milk (HM) were randomised respectively to be fed unfortified HM (UHM) or fortified human milk (FHM) from hospital discharge to four months' corrected age. Those not fed HM received a preterm formula (PF). At six years of age, BMD and BMC in all the children were established by means of a dual-energy X-ray absorptiometry (DXA) scan (Lunar Prodigy) and adjusted for sex, age, and anthropometrics. A total of 192 very preterm-born children (59 fed UHM, 67 FHM and 66 PF) had a DXA scan performed at median 6 (5.8-8.3) years of age. No significant difference was found comparing UHM and FHM according to height, weight, BA, BMC, and BMD at six years of age. However, a multiple regression analysis showed significantly improved BMD in breastfed children compared to PF-fed children.
Fortified compared to non-fortified human milk post-discharge did not have an impact on BMD at 6 years of age in very preterm-born infants. Breastfed children demonstrated higher BMD than formula-fed children.
• Adequate nutritional intake is important to improve growth and to reduce the risk of severe bone disease in very preterm born infants. • Bone mineralization is attained later in preterm born infants compared to term born infants.
• Feeding human milk with fortification compared to non-fortified human milk did not improve bone mineral density in children born very preterm in this follow-up study at six years of age. • Feeding human milk compared to formula was associated with increased BMD at six years of age among very preterm born infants.
对于极早早产儿，营养摄入对于降低严重代谢性骨病风险（包括骨矿物质密度（BMD）降低的风险）非常重要。本研究的目的是评估极早早产儿出院后喂养不同饮食至6岁时的骨矿物质含量（BMC）和BMD（以每骨面积（BA）的BMC衡量）。目前关于该主题的数据不足，通过本研究我们旨在提供更多有用数据。对281名极早早产儿（胎龄≤32 + 0周）进行前瞻性随访研究，这些婴儿参加了一项关于出院后营养的多中心随机对照试验（RCT）。喂养母乳（HM）的婴儿从出院至矫正年龄4个月分别随机接受非强化母乳（UHM）或强化母乳（FHM）喂养。未喂养HM的婴儿接受早产配方奶（PF）。在6岁时，通过双能X线吸收测定法（DXA）扫描（Lunar Prodigy）测定所有儿童的BMD和BMC，并根据性别、年龄和人体测量学进行调整。共有192名极早早产儿（59名喂养UHM，67名喂养FHM，66名喂养PF）在中位年龄6（5.8 - 8.3）岁时进行了DXA扫描。在6岁时，比较UHM和FHM的身高、体重、BA、BMC和BMD未发现显著差异。然而，多元回归分析显示，与喂养PF的儿童相比，母乳喂养的儿童BMD显著改善。
出院后强化母乳与非强化母乳相比，对极早早产儿6岁时的BMD没有影响。母乳喂养的儿童BMD高于配方奶喂养的儿童。
• 充足的营养摄入对于改善极早早产儿的生长和降低严重骨病风险很重要。• 与足月儿相比，极早早产儿的骨矿化较晚完成。
• 在这项6岁的随访研究中，与非强化母乳相比，喂养强化母乳并未改善极早早产儿的骨矿物质密度。• 与配方奶相比，母乳喂养与极早早产儿6岁时BMD增加有关。
