母乳强化剂在母乳喂养早产儿中的应用

Application of human milk fortifier in breast-fed preterm infants

目的通过前瞻性对照试验评价强化母乳对住院早产儿短期生长、营养状况的影响。方法出生胎龄≤34周、出生体重≤1800g的24例早产儿分为强化母乳组(试验组,11例)和早产配方奶组(对照组,13例)。试验组早产儿的母乳喂养量均超过总奶量的50%,当喂养量达到100ml/(kg·d)时开始添加FM85母乳强化剂,不够的奶量用早产配方奶补足;对照组全部用早产配方奶喂养。对两组的生长速度、血生化指标、肠内外营养情况、合并症进行比较。结果试验组出生胎龄(30.6±2.9)周,平均出生体重(1280±286)g;对照组出生胎龄(31.6±1.9)周,平均出生体重(1436±201)g。试验组在住院期间,平均母乳量占总喂养量81.6%,母乳强化剂在平均胎龄34.1周、生后24.6d时开始添加。试验组与对照组的体重[18.9vs17.1g/(kg·d),P=0.364]、身长(1.16vs1.00cm/周,P=0.308)、头围(0.79vs0.61cm/周,P=0.057)的增长速度近似,差异无统计学意义。出院时两组血尿素氮水平相似,试验组血清白蛋白、前白蛋白、血磷水平较对照组低,血清碱性磷酸酶和血钙值较对照组高,喂养不耐受、坏死性小肠结肠炎、院内感染的发生率无统计学意义。结论强化母乳喂养与早产配方奶喂养的早产儿在住院期间的生长速度相似。

Objective To evaluate the short term growth velocity, and nutritional status of breast-fed premature infants supplemented with powdered human milk fortifier by a prospective, controlled study. Methods Twenty four infants with a birth weigh ≤ 1 800 g and gestational age ≤36 weeks were enrolled. They were divided into fortified human milk group （FHM group） and preterm formula group （control group）. Premature infants in FHM group received human milk over 50% of total feeding volume and complementary preterm formula. Human milk started to be enriched with human milk fortifier （HMF）（FM85） when the feeding volume reached 100 ml/（kg·d）. Premature infants in control group were fed with only preterm formula. The comparison was made on growth rate, biochemical indices, enteric and parenteral nutrition requirements, and complications between these two groups. Results There were no significant differences in general characteristics or complications between FHM group （n = 11, average birth weight was 1 280 g, gestational age was 30.6 weeks） and control group （n = 13, average birth weight was 1 436 g, gestational age was 31.6 weeks）. The average volume of human milk fed to the infants in FHM group was 81.6% of the total feeding volume during hospital stay. Human milk fortifier was added on 24.6 days of postnatal age, 34.1 weeks of corrected age. The average growth velocity of weight （18.9 vs 17.1 g/（kg.d）, P= 0.364）, length （1.16 vs 1.00 cm/week, P = 0.308） and head circumference （0.79 vs 0.61 cm/week, P = 0.057） were similar in FHM group and control group. Serum urea nitrogen at discharge was comparable between two groups. Serum albumin, prealbumin and phosphate values were lower in the infants of FHM group than those of control group. Serum alkaline phosphatase and calcium levels were higher in FHM group. There was no significant difference in incidence of feeding intolerance, necrotizing enterocolitis （NEC） , and nosocomial infection between two groups. Conclusions Premature infants fed with fortified human milk grew similarly to those premature infants fed with preterm formula during hospital stay.