母乳喂养对极/超低出生体重早产儿近期临床结局的影响

Effects of human milk on short-term outcomes of very/extremely low birth weight preterm infants

目的探讨母乳喂养对极/超低出生体重(very/ extremely low birth weight,VLBW/ELBW)早产儿住院期间喂养耐受性、生长发育、合并症及住院时间的影响。方法回顾性分析2015年5月至2018年4月中南大学湘雅二医院新生儿科收治并符合入选标准的VLBW/ELBW早产儿,根据是否实施母乳喂养分为母乳组(住院期间母乳喂养总量≥肠道喂养总量的50%)及配方奶组(存在母乳喂养禁忌或无母乳,全部以早产儿配方奶喂养)。比较2组喂养耐受情况、生长发育指标、合并症情况及住院时间。采用两独立样本t检验、非参数检验、χ^2检验(或Fisher精确概率法)对数据进行统计学分析。结果共纳入VLBW/ELBW早产儿113例,其中母乳组52例,配方奶组61例。2组开奶时间、微量喂养时间及喂养不耐受发生率比较差异均无统计学意义(P值均>0.05)。母乳组及配方奶组平均加奶速度分别为(8.4±1.6)与(7.6±1.4)ml/(kg·d);肠外营养支持时间分别为(29.3±7.6)与(33.0±7.9)d;达全肠道喂养时间分别为(30.0±7.8)与(34.9±8.8)d(t值分别为2.853、-2.570和-3.076,P值均<0.05)。2组体重、头围、身长增长速度以及恢复出生体重时间和宫外生长受限发生率比较差异均无统计学意义(P值均>0.05)。母乳组及配方奶组新生儿坏死性小肠结肠炎发生率分别为1.9%(1/52)与11.5%(7/61)(χ2=3.894,P<0.05),但败血症、胆汁淤积症、贫血、支气管肺发育不良、早产儿视网膜病变及脑室周围白质软化发生率比较差异均无统计学意义(P值均>0.05)。母乳组14例支气管肺发育不良患儿中轻度8例、中度6例、重度0例;配方奶组24例中轻度4例、中度18例、重度2例,母乳组严重程度较配方奶组轻(U=-2.645,P<0.05)。母乳组和配方奶组住院时间分别为(47.5±14.8)与(53.9±16.3) d(t=-2.129,P<0.05)。结论母乳喂养有助于VLBW/ELBW早产儿尽早实现全肠道喂养,能够降低新生儿坏死性小肠结肠炎发生率,减轻支气管肺发育不良严重程度,缩短住院时间。强化母乳喂养与配方奶喂养的VLBW/ELBW早产儿体格生长速度相当。

Objective To study the effects of human milk on feeding intolerance,infant growth and development,complications during hospitalization and length of hospital stay in very/extremely low birth weight (VLBW/ELBW) preterm infants.Methods VLBW/ELBW preterm infants admitted to the Division of Neonatology,Children's Medical Center of the Second Xiangya Hospital from May 2015 to April 2018 were enrolled in this retrospective study and were assigned into two groups: human milk group (human milk accounted for at least 50% of total enteral feeding during hospitalization) and formula group (exclusive formula feeding due to breastfeeding contraindication or insufficient human milk supply).Feeding intolerance,neonatal growth,complications and length of hospital stay were compared between the two groups using independent sample t-test,Mann-Whitney U test and Chi-square test (or Fisher's exact probability test).Results A total of 113 VLBW/ELBW infants were enrolled consisting of 52 in the human milk group and 61 in the formula group.The starting time of enteral feeding,duration of minimal enteral feeding and incidence of feeding intolerance were similar between the two groups (all P>0.05).The increasing rate of milk volume was (8.4±1.6) ml/(kg·d) in the human milk group and (7.6±1.4) ml/(kg·d) in the formula group (t=2.853,P<0.05).The length of parenteral nutrition of the human milk group was shorter than that of the formula group [(29.3±7.6) vs (33.0±7.9) d,t=-2.570,P<0.05],so was the time to full enteral feeding [(30.0±7.8) vs (34.9±8.8) d,t=-3.076,P<0.05].No significant difference was found in the average weight gain,increment in head circumference or body length,the length of regaining birth weight,or the incidence of extrauterine growth restriction between the two groups (all P>0.05).The incidence of neonatal necrotizing enterocolitis (NEC) in the human milk group was lower than that of the formula group [1.9%(1/52) vs 11.5%(7/61),χ^2=3.894,P<0.05].No statistical difference in the incidence of sepsis,cholestasis,anemia,bronchopulmonary dysplasia (BPD),retinopathy of prematurity or periventricular leukomalacia was observed between the two groups (all P>0.05).There were 14 cases (26.9%) of BPD in the human milk group,of which eight were mild and six moderate.While in the formula group,24 cases (39.3%) had BPD and among them,four,18 and two infants were mild,moderate and severe BPD,respectively.BPD cases in the human milk group were less severe than those in the formula group (U=-2.645,P<0.05).The length of hospital stay of the human milk group was shorter than that of the formula group [(47.5±14.8) vs (53.9±16.3) d,t=-2.129,P<0.05)].Conclusions Human milk for VLBW/ELBW infants may shorten the time to full enteral feeding and the length of hospital stay,reduce the incidence of NEC,decrease the severity of BPD.VLBW/ELBW infants fed with fortified human milk have similar growth rate as those fed with formula milk.