强化母乳喂养对住院早产儿生长代谢的影响

Effect of fortified human milk feeding on growth and metabolism of premature infants during hospital stay

目的回顾性研究强化母乳喂养对早产儿住院期间生长代谢及合并症的影响。方法收集中国医学科学院北京协和医院2009年1月1日至2012年12月31日胎龄≤36周且出生体重≤1800g符合人选条件的早产儿148例，根据喂养方式不同分为强化母乳喂养组（73例）与早产儿配方奶喂养组（75例）。比较2组早产儿的生长发育、代谢指标和合并症发生情况。数据采用均数±标准差或中位数和四分位数[M（P25，P75）]表示。采用t检验、x2检验或非参数检验进行统计学分析。结果强化母乳喂养组和配方奶喂养组早产儿的胎龄、出生体重、出生身长、出生头围、恢复出生体重的日龄及出生时小于胎龄儿、新生儿呼吸窘迫综合征、≥Ⅲ级脑室内出血、窒息的比例差异均无统计学意义（P均〉0．05）。强化母乳喂养组早产儿住院期间肠外营养时间为18d（14d，25d），短于配方奶喂养组[24d（18d，31d．），Z=-2．950，P=0．003]；奶量达120ml／（kg·d）日龄为16d（12d，23d），小于配方奶喂养组[22d（16d，30d），Z=-2．895，P=0．004]；总热卡达120kcal／（kg·d）日龄为11d（8d，15d），小于配方奶喂养组[14d（10d，18d），Z=-2．392，P=0．017]。强化母乳喂养组住院费用为47078元（30802元，67039元），低于配方奶喂养组[58400元（38166元，82737元）]，差异有统计学意义（Z=-1．970，P=0．049）。2组早产儿开奶时间、喂养不耐受发生率、恢复出生体重后平均每日体重增长速度、每周身长增长速度、每周头围增长速度、出院时小于胎龄儿发生率、出生体重z评分、出院体重z评分、出院体重、出院身长及出院头围差异均无统计学意义（P均〉0．05）。强化母乳喂养组出院前血碱性磷酸酶为（347．7±149．4）U／L，高于配方奶喂养组[（288．6±108．8）U／L，t=2．570，P=0．011]，其余生化指标人院时及出院前差异均无统计学意义。强化母乳喂养组败血症的发生率为11．0Yo（8／73），低于配方奶喂养组[20．0％（15／75）]，但差异无统计学意义（x2=2．30，P〉0．05），视网膜病、支气管肺发育不良及坏死性小肠结肠炎发生率差异均无统计学意义（P均〉0．05）。结论早产儿强化母乳喂养不仅可达到与配方奶喂养相似的生长速率，且可加速肠内喂养进程，缩短肠外营养时间，减少败血症发生率，降低住院费用。

Objective To explore the effect of fortified human milk feeding on growth, metabolism and complications of premature infants during hospital stay. Methods Totally, 148 premature infants of gestational age ≤36 weeks and birth weight ≤ 1800 g, admitted to NICU of Peking Union Medical College Hospital between January 1st, 2009 and December 31st, 2012, were retrospectively enrolled and divided into two groups. Infants fed predominantly （〉50%） with human breast milk, combined with human milk fortification （HMF） formula when breast milk was insufficient during hospital stay, were named HMF group （n = 73）, and those fed exclusively with premature formula were called premature formula feeding group （PF group, n= 75）. Data of infants on growth, metabolism and incidence of various complications were compared between the two groups. Clinical data were expressed with mean_＋ standard deviation or median and quartiles [M（P25,P75）]. Statistical analysis was performed with t-test, Z2 test or non-parameter test. Results Among the 148 infants included, there was no significant difference in gestational age, birth weight, head circumference, length at birth, time for regaining birth weight, SGA at birth, neonatal respiratory distress symdrome, intraventricular hemorrhage （over grade Ⅲ ） and asphyxia rate between HMF and PF group（all P〉0.05）. Infants of the HMF group showed shorter duration of parenteral nutrition [18 d（14 d,25 d） vs 24 d （18 d,31 d）, Z=-2. 950,P=0. 0031, smaller age to achieve 120 ml/（kg, d） through enteral feeding [-16 d（12 d,23 d） vs22 d（16 d,30d）, Z= 2. 895, P=0. 0041, smaller age to achieve total energy intake of 120 kcal/（kg · d） Ell d（8 d,15 d） vs 14 d （10 d, 18 d）, Z=-2. 392,P=0. 0171 than those of the PF group. Medical cost during hospital stay in the HMF group was significantly less than in the PF group [RMB： 47 078 yuan（30 802 yuan, 67 039 yuan） vs 58 400 yuan （38 166 yuan, 82 737 yuan）, Z=-1. 970,P=0.049%. The time for initial feeding, rate of feeding intolerance, daily weight gain after regaining birth weight, weekly increase of body length and head circumference, weight, body length and head circumference at discharge, proportion of small for gestational age infants at discharge, z scores of both birth weight and weight at discharge showed no significant difference（all P〉0.05）. The level of blood alkaline phosphates before discharge in HMF group was significantly higher than that of the PF group [（347.7±149.4） U/Lvs （288.6±108.8） U/L,t=2.570,P=0.0111. None of the other biochemical indicator showed any statistical difference. The incidence of sepsis in the HMF group was slightly lower than that in the PF group [11. 0% （8/73） vs 20. 0% （15/75）1 without significant difference （Z2 =2.30, P 〉0.05）, neither the morbidity of retinopathy of premature, chronic lung disease, necrotizing enterocditis of newborns （all P〉 0.05）. Conclusions HMF for premature infants may ensure the same growth pattern as those fed by premature formula, and it also can accelerate the enteral feeding process, reduce the incidence of sepsis and decrease the medical cost during hospital stay.