不同喂养方式对极低/超低出生体重儿生长发育的影响

Effects of different feeding patterns on the growth and development of infants with very/extremely low birth weight

目的探讨极低/超低出生体重(VLBW/ELBW)早产儿纠正年龄6个月内生长发育情况及不同喂养方式对其生长发育的影响。方法对2016年1月至2017年4月出院并按时完成随访的VLBW/ELBW早产儿109例进行纠正年龄6个月内的生长发育监测。采用Z评分法评价体格指标,并分析不同喂养方式(母乳喂养组:母乳+母乳强化剂;混合喂养组:母乳+早产儿配方奶;人工喂养组:早产儿配方奶)对其生长发育的影响。结果年龄别体重Z积分、年龄别身长Z积分、身长别体重Z积分、体重指数Z积分的追赶高峰发生于纠正年龄3个月内;年龄别头围Z积分的追赶高峰发生于纠正年龄5个月。VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内。母乳喂养组体重、身长、头围的生长在纠正年龄3个月时均优于混合喂养组和/或人工喂养组(P<0.05);母乳喂养组头围、身长的生长在纠正年龄6个月时均优于混合喂养组和/或人工喂养组(P<0.05)。结论 VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内,提示应加强早期个体化随访及营养指导以减少生长偏离的发生。亲母母乳喂养并添加母乳强化剂是VLBW/ELBW早产儿的最佳喂养方式。

Objective To investigate the growth and development of very low birth weight（VLBW）/extremely low birth weight（ELBW） preterm infants within the corrected age of 6 months and the effect of different feeding patterns on growth and development. Methods A total of 109 VLBW/ELBW preterm infants who were discharged from January 2016 to April 2017 and who had completed regular follow-up were enrolled, and their growth and development within the corrected age of 6 months were monitored. The Z-score method was used to evaluate physical indices and analyze the effect of different feeding patterns（breastfeeding group： breast milk ＋ human milk fortifier; mixed feeding group： breast milk ＋ preterm formula milk; artificial feeding： preterm formula milk） on growth and development. Results The peaks of weight-for-age Z-score, height-for-age Z-score, weight-for-height Z-score, and BMI-for-age Z-score occurred within the corrected age of 3 months, and the peak of head circumference-for-age Z-score occurred at the corrected age of 5 months. Growth deviation of the infants often occurred within the corrected age of 1-3 months. At the corrected age of 3 months, the breastfeeding group had significantly better body weight, height and head circumference growth than the mixed feeding group and/or the artificial feeding group（P〈0.05）. At the corrected age of 6 months, the breastfeeding group had significantly better head circumference and body length growth than the mixed feeding group and/or the artificial feeding group（P〈0.05）. Conclusions Growth deviation of VLBW/ELBW preterm infants often occurs within the corrected age of 1-3 months, suggesting that early individualized follow-up and nutritional guidance should be strengthened to reduce growth deviation. Maternal breastfeeding with the addition of human milk fortifier is the best feeding pattern for VLBW/ELBW preterm infants.