院内不同喂养方式对早产/低出生体质量儿体格生长影响的比较

Comparison of the growth of hospitalized premature/low birth weight infants among different modes of feeding

目的通过前瞻性随机对照研究评价比较不同喂养方式下,早产/低出生体质量儿住院期间的体格生长、血液生化和喂养安全性。方法按照不同喂养方式将出生胎龄<37周、出生体质量≤2500 g的158例早产儿分为早产/低出生体质量婴儿液态配方奶组(早产奶组,58例)、纯母乳喂养组(母乳组,47例)、液态配方奶及纯母乳混合喂养组(混合组,53例),比较各组的体格生长、血液生化指标,喂养不耐受、感染事件发生率,静脉营养使用时间,住院时间及宫外发育迟缓(EUGR)发生率等项目。结果早产奶组、母乳组、混合组婴儿的体质量增长速率分别为(16.46±5.14)g/(kg.d)、(11.56±4.11)g/(kg.d)、(15.19±4.53)g/(kg.d),三组间差异有统计学意义(P<0.01);头围增长速率分别为(0.72±0.34)cm/周、(0.49±0.34)cm/周、(0.71±0.29)cm/周,三组间差异有统计学意义(P<0.01);身长增长速率分别为(0.89±0.41)cm/周、(0.69±0.38)cm/周、(0.89±0.39)cm/周,三组间差异有统计学意义(P<0.05)。早产奶组的出生体质量恢复时间、静脉营养使用时间也短于其余两组,住院时间各组差异无统计学意义;出生3d和2周后各组早产儿组间比较表明血尿素氮、白蛋白水平相似,但组内比较显示入院2周后各组均有尿素氮下降和白蛋白上升;喂养不耐受、感染事件发生率的差异无统计学意义。出院时早产奶组婴儿头围、EUGR发生率低于母乳组(P<0.05)。结论早产儿院内喂养采用早产奶安全,并且在促进早产儿体格生长方面优于单纯母乳喂养。

Objective To Compare the growth velocity, blood biochemical indices and the safety in hospitalized premature/low birth weight infants among different modes of feeding through the prospective randomized study. Methods The 158 infants with a birth weight 〈2 500 g and gestational age 〈37 weeks were enrolled and divided into three groups, preterm formula group （n=58）, breast milk group （n=47） and mixed feeding group （n=53）. The comparison was made of anthropometric data, blood biochemical indices, the duration of intravenous nutrition and hospitalization, the incidence of feeding intolerance, extrauterine growth restriction （EUGR） and infection events among different groups. Results The growth velocities of body weight in the preterm formula group, human milk group and mixed feeding group were （16.46±5.14） g/（kg·d）, （11.56±4.11） g/（kg.d） and （15.19±4.52） g/（kg·d） and the differences between the groups are statistically significant （P〈0.01）; the growth velocities of head circumference were （0.72±0.34） cm/week, （0.49±0.34） cm/week and （0.71±0.29） crrdweek and the differences between the groups are statistically significant （P〈0.01）. The weekly growth velocities of body length were （0.89±0.41） crn/week, （0.69±0.38） cm/week and （0.89±0.39） cm/week and the differences between the groups are statistically significant （P〈0.05）. For the time taken to regain birth weight and the duration of parenteral nutrition, the preterm formula group was shorter than other two groups. In the length of hospital stay, there was no statistical difference among groups. The level of serum urea nitrogen and albumin showed no significant difference among groups. The serum urea nitrogen was decreased and albumin was increased when compared the levels at three days after birth with with at two weeks after birth. There was no significant difference on the incidence of feeding intoler-ance and infection events among groups. The EUGR rate and the head circumference of preterm formula group were lower than those of human milk group （P〈0.05）. Conclusions Preterm formula milk is safe for premature infants, and is more effective thanbreast milk in physical growth during hospital stay.