Lin Rong, Rong Zhihui, Zhang Rong, Zheng Zhi, Ding Ya, Ning Chao, Cao Yun, Chao Chen, Yang Jie, Lin Xinzhu
Department of Neonatology, Department of Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.
Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China.
BMJ Paediatr Open. 2025 Jul 16;9(1):e003485. doi: 10.1136/bmjpo-2025-003485.
To evaluate the association between the timing of initial breastfeeding and the risk of necrotising enterocolitis (NEC) and other neonatal outcomes in very preterm infants (VPIs, <32 weeks' gestation).
Multicentre observational cohort study.
Data were collected from 102 tertiary neonatal intensive care units (NICUs) in China between 2019 and 2023 through the Chinese Neonatal Network.
A total of 12 679 VPIs admitted to NICUs within 24 hours of birth and initially breastfed within 7 days were included.
Infants were categorised into four groups based on initial breastfeeding timing: within 24 hours (n=2242), 24-48 hours (n=3657), 48-72 hours (n=1870) and after 72 hours (n=4910, reference group).
The primary outcome was NEC (stage ≥2). Secondary outcomes included mortality, bronchopulmonary dysplasia, severe neurological injury, severe retinopathy of prematurity, late-onset sepsis, NICU length of stay and intravenous nutrition duration.
Early breastfeeding initiation (<24 hours) was associated with a higher incidence of NEC (7.5% vs 4.3%, OR 1.92, 95% CI 1.21 to 3.06). No significant NEC risk increase was observed for feeding initiation after 24 hours. Early breastfeeding was linked to a shorter duration of intravenous nutrition (median 15 days (IQR 10-27) vs 22 days (IQR 14-33), mean difference -3.93 days, 95% CI -6.57 to -1.3). Subgroup analysis revealed increased NEC risk in neonates delivered via caesarean section, those receiving blood transfusions and those born <28 weeks' gestation.
While early breastfeeding initiation (<24 hours) reduces intravenous nutrition duration, it may elevate NEC risk in specific high-risk subgroups. Feeding strategies should be individualised based on gestational age, delivery mode and transfusion status. Further randomised trials are needed to optimise early feeding protocols for VPIs.
评估极早产儿（孕周<32周）初次母乳喂养时间与坏死性小肠结肠炎（NEC）风险及其他新生儿结局之间的关联。
多中心观察性队列研究。
2019年至2023年期间，通过中国新生儿网络从中国102家三级新生儿重症监护病房（NICU）收集数据。
共纳入12679例出生后24小时内入住NICU且在7天内开始初次母乳喂养的极早产儿。
根据初次母乳喂养时间将婴儿分为四组：24小时内（n = 2242）、24 - 48小时（n = 3657）、48 - 72小时（n = 1870）和72小时后（n = 4910，参照组）。
主要结局为NEC（≥2期）。次要结局包括死亡率、支气管肺发育不良、严重神经损伤、严重早产儿视网膜病变、晚发性败血症、NICU住院时间和静脉营养持续时间。
早期开始母乳喂养（<24小时）与NEC发生率较高相关（7.5%对4.3%，OR 1.92，95%CI 1.21至3.06）。24小时后开始喂养未观察到NEC风险显著增加。早期母乳喂养与静脉营养持续时间较短相关（中位数15天（IQR 10 - 27）对22天（IQR 14 - 33），平均差值 - 3.93天，95%CI - 6.57至 - 1.3）。亚组分析显示，剖宫产分娩的新生儿、接受输血的新生儿以及孕周<28周出生的新生儿NEC风险增加。
虽然早期开始母乳喂养（<24小时）可缩短静脉营养持续时间，但可能会增加特定高危亚组的NEC风险。应根据孕周、分娩方式和输血状态制定个体化喂养策略。需要进一步的随机试验来优化极早产儿的早期喂养方案。
