Salas Ariel A, Gunawan Emily, Jeffcoat Seabrook, Nguyen Kelly
Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Am J Clin Nutr. 2025 May;121(5):1117-1123. doi: 10.1016/j.ajcnut.2025.02.019. Epub 2025 Feb 21.
In preterm infants, the timing of human milk fortification when maternal or donor milk is offered at volumes of 60-80 mL/kg/d within the first 36 h after birth remains a matter of debate.
This trial assessed the impact of early human milk fortification (<7 d postnatal age) on fat-free mass (FFM) z-scores.
This was an unmasked clinical trial involving preterm infants with birthweight <1800 g and gestational ages ranging from 29 0/7 to 33 6/7 weeks of gestation. Human milk-fed infants receiving feeding volumes of 60-80 mL/kg/d within the first 36 h after birth were randomly assigned to receive either early (between days 4 and 7) or delayed (between days 10 and 14) fortification using a bovine-derived fortifier. FFM was assessed at postnatal day 21 using air-displacement plethysmography.
A total of 80 infants were randomly assigned. The mean birthweight was 1488 g (SD: 233). Baseline characteristics did not differ between groups. Of 80 infants randomly assigned shortly after birth, 74 had the primary outcome measured at ∼35 wk of postmenstrual age (interquartile range: 34-36). No statistically significant differences in FFM z-scores were observed between the 2 groups (-1.7 ± 0.9 compared with -1.8 ± 0.9; P = 0.64), but the early fortification group had higher weight [median difference: +131 g; 95% confidence interval (CI): 12, 236; P = 0.03], higher FFM (median difference: +103 g; 95% CI: 1, 193; P = 0.03), and higher length (mean difference: +0.9 cm; 95% CI: 0.1, 1.8; P = 0.04) at the time of body composition assessment.
In very preterm infants receiving early full enteral nutrition, providing early human milk fortification does not result in higher than usual FFM z-scores. This feeding strategy may, however, lead to a sustained increase in length, and transient increases in weight and FFM in grams. This study was registered at clinicaltrials.gov as NCT05525585.
对于早产婴儿，在出生后36小时内以60 - 80毫升/千克/天的量提供母乳或捐赠母乳时，母乳强化的时机仍存在争议。
本试验评估早期母乳强化（出生后年龄<7天）对去脂体重（FFM）z评分的影响。
这是一项非盲临床试验，纳入出生体重<1800克、胎龄在29 0/7至33 6/7周的早产婴儿。在出生后36小时内接受60 - 80毫升/千克/天喂养量的母乳喂养婴儿被随机分配接受早期（第4至7天之间）或延迟（第10至14天之间）强化，使用牛源性强化剂。在出生后第21天使用空气置换体积描记法评估FFM。
共80名婴儿被随机分配。平均出生体重为1488克（标准差：233）。两组间基线特征无差异。在出生后不久随机分配的80名婴儿中，74名在月经后年龄约35周时测量了主要结局（四分位间距：34 - 36）。两组间FFM z评分无统计学显著差异（-1.7±0.9与-1.8±0.9相比；P = 0.64），但在身体成分评估时，早期强化组体重更高[中位数差异：+131克；95%置信区间（CI）：12，236；P = 0.03]，FFM更高（中位数差异：+103克；95% CI：1，193；P = 0.03），身长更高（平均差异：+0.9厘米；95% CI：0.1，1.8；P = 0.04）。
在接受早期完全肠内营养的极早产婴儿中，提供早期母乳强化并不会导致高于正常的FFM z评分。然而，这种喂养策略可能会导致身长持续增加，以及体重和FFM克数的短暂增加。本研究在clinicaltrials.gov注册，注册号为NCT05525585。
