Lucas A, Fewtrell M S, Morley R, Lucas P J, Baker B A, Lister G, Bishop N J
Medical Research Council Childhood Nutrition Research Center, Institute of Child Health, London, United Kingdom.
Am J Clin Nutr. 1996 Aug;64(2):142-51. doi: 10.1093/ajcn/64.2.142.
Despite potential benefits, human milk may fail to meet preterm infants' nutrient requirements. We tested the hypothesis that fortified breast milk, fed alone or with preterm formula, would improve neurodevelopment and growth at 18-mo follow-up without adverse short-term clinical or biochemical consequences. Two hundred seventy-five preterm infants from two medical centers (birth weight < 1850 g; mean gestation 29.8 +/- 2.7 wk) whose mothers chose to provide breast milk were randomly assigned to receive for a mean of 39 d a multinutrient fortifier or control supplement containing phosphate and vitamins. Breast milk comprised 47.6% and 46.4% of enteral intake in fortified and control groups, respectively; preterm formula supplements were used when insufficient breast milk was available. Overall, there were no significant growth advantages with fortification; although, when breast milk exceeded 50% of intake, fortification promoted faster weight gain (an advantage of 1.6 g.kg-1.d-1; 95% CI: 0.1, 3.1; P < 0.05). Compared with control infants, the fortified group showed 1) higher plasma urea from week 2 (P = 0.04), 2) higher plasma calcium (mean 2.34 +/- 0.01 compared with 2.27 +/- 0.02 mmol/L; P = 0.003), 3) a greater rise in alkaline phosphatase by week 6 (P = 0.04), 4) more clinical infections (suspected plus proven; 43% compared with 31%, P = 0.04), 5) a nonsignificantly increased incidence of necrotizing enterocolitis (5.8% compared with 2.2%, P = 0.12), and 6) higher white cell and platelet counts. Developmental scores at 18 mo were slightly but not significantly higher in the fortified group. This study confirmed that breast milk fortifiers can improve short-term growth (when breast milk intakes are high); but beneficial effects on long-term development remained unproven. Future research is required to evaluate potential adverse consequences and explore more optimal fortification strategies.
尽管母乳有潜在益处，但可能无法满足早产儿的营养需求。我们检验了这样一个假设：单独喂养强化母乳或与早产儿配方奶一起喂养，在18个月随访时可改善神经发育和生长，且不会产生不良的短期临床或生化后果。来自两个医疗中心的275名早产儿（出生体重<1850克；平均孕周29.8±2.7周），其母亲选择提供母乳，这些婴儿被随机分配接受平均39天的多种营养素强化剂或含磷酸盐和维生素的对照补充剂。强化组和对照组中，母乳分别占肠内摄入量的47.6%和46.4%；当母乳量不足时使用早产儿配方奶补充剂。总体而言，强化并没有显著的生长优势；不过，当母乳摄入量超过摄入量的50%时，强化可促进体重更快增加（优势为1.6克·千克⁻¹·天⁻¹；95%置信区间：0.1，3.1；P<0.0）。与对照婴儿相比，强化组表现为：1）从第2周起血浆尿素更高（P = 0.04），2）血浆钙更高（平均值为2.34±0.01，而对照组为2.27±0.02毫摩尔/升；P = 0.003），3）到第6周碱性磷酸酶升高幅度更大（P = 0.04），4）临床感染更多（疑似加确诊；43%比31%，P = 0.04），5）坏死性小肠结肠炎发病率无显著增加（5.8%比2.2%，P = 0.12），6）白细胞和血小板计数更高。强化组18个月时的发育评分略高，但无显著差异。本研究证实，母乳强化剂可改善短期生长（当母乳摄入量高时）；但对长期发育的有益作用仍未得到证实。需要未来的研究来评估潜在的不良后果并探索更优化的强化策略。
