强化巴氏消毒捐赠人乳与标准强化巴氏消毒捐赠人乳对极低出生体重儿生长的影响：一项随机对照试验
Enhanced versus standard fortification of pasteurized donor human milk for growth in very low birth weight infants: a randomized controlled trial.
作者信息
Ong Chengsi, Wong Anng Anng, Wong Siew Tin, Zheng Ying, Pang Cynthia Pui Chan, Jayagobi Pooja Agarwal, Yeo Joo Guan, Yeo Kee Thai, Chua Mei Chien
机构信息
Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore, Singapore.
KK Human Milk Bank, Singapore, Singapore.
出版信息
Front Nutr. 2025 Aug 18;12:1582519. doi: 10.3389/fnut.2025.1582519. eCollection 2025.
INTRODUCTION
Very-low-birthweight (VLBW) infants on pasteurized donor human milk (PDHM) have poorer growth compared to infants on fortified mother's milk, suggesting that standard fortification methods for PDHM are inadequate.
METHODS
We designed a randomized controlled trial to determine whether an enhanced method of fortification (EF) improved growth in VLBW infants compared to standard fortification (SF). VLBW infants admitted to our tertiary-level neonatal intensive care unit were randomized to receive a bovine powdered human milk fortifier (HMF) added to PDHM (SF), or specially selected high-fat PDHM (fat concentration ≥3.8 g/dL) with bovine powdered HMF and a liquid protein fortifier providing an additional 0.67 g/dL protein (EF). Primary outcome was impaired weight gain defined as weight z-score drop of ≥0.8 from birth at 37 weeks or hospital discharge, whichever earlier. Secondary outcomes included change in length and head circumference (HC) z-scores from birth, requirement for high calorie formula, and rates of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP).
RESULTS
A total of 61 infants were randomized (31 SF, 30 EF). Impaired weight gain was not significantly different (SF 83.9% vs. EF 73.3%, p = 0.347), with similar declines in weight z-scores from birth in both groups SF -1.27 [interquartile range (IQR) -1.71, -0.87] vs. EF -1.13 (IQR -1.46, -0.78), = 0.403. However, the EF group had a smaller decline in length and HC z-scores from birth to discharge compared to the SF group [Length z-score change: -0.92 (IQR -1.64, -0.48) vs. -1.64 (IQR -2.21, -0.89), = 0.007; HC z-score change: -0.08 (IQR -0.74,0.58) vs. -0.86 (IQR -1.81, -0.21), = 0.014]. The EF group also required less high calorie formula supplementation [0% (IQR 0-4.1) vs. 3.8% (IQR 0 -16.9), = 0.032]. Rates of BPD and ROP were not significantly different between groups.
CONCLUSION
Among VLBW infants, EF did not improve weight gain, but reduced declines in HC and linear growth compared to SF.
引言
与食用强化母乳的婴儿相比，食用巴氏消毒捐赠人乳（PDHM）的极低出生体重（VLBW）婴儿生长较差，这表明PDHM的标准强化方法并不充分。
方法
我们设计了一项随机对照试验，以确定与标准强化（SF）相比，强化方法（EF）是否能改善VLBW婴儿的生长情况。入住我们三级新生儿重症监护病房的VLBW婴儿被随机分为两组，一组接受添加到PDHM中的牛粉状人乳强化剂（HMF）（SF），另一组接受特别挑选的高脂肪PDHM（脂肪浓度≥3.8g/dL），并添加牛粉状HMF和一种液体蛋白质强化剂，额外提供0.67g/dL蛋白质（EF）。主要结局是体重增加受损，定义为在37周或出院时（以较早者为准）体重Z评分较出生时下降≥0.8。次要结局包括出生后身长和头围（HC）Z评分的变化、高热量配方奶的需求、支气管肺发育不良（BPD）和早产儿视网膜病变（ROP）的发生率。
结果
共有61名婴儿被随机分组（31名SF组，30名EF组）。体重增加受损情况无显著差异（SF组83.9% vs. EF组73.3%，p = 0.347），两组出生时体重Z评分下降相似，SF组为-1.27[四分位间距（IQR）-1.71，-0.87]，EF组为-1.13（IQR -1.46，-0.78），p = 0.403。然而，与SF组相比，EF组从出生到出院时身长和HC Z评分的下降幅度较小[身长Z评分变化：-0.92（IQR -1.64，-0.48） vs. -1.64（IQR -2.21，-0.89），p = 0.007；HC Z评分变化：-0.08（IQR -0.74，0.58） vs. -0.86（IQR -1.81，-0.21），p = 0.014]。EF组对高热量配方奶的补充需求也较少[0%（IQR 0 - 4.1） vs. 3.8%（IQR 0 - 16.9），p = 0.032]。两组之间BPD和ROP的发生率无显著差异。
结论
在VLBW婴儿中，与SF相比，EF并未改善体重增加，但减少了HC和线性生长的下降。
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