出院后不同强化喂养方式对极早和超早产儿体格发育的影响研究

Effect of different intensive feeding methods on the physical growth of very preterm and extremely preterm infants after discharge

目的研究不同强化喂养方式对极早产儿(VPT)/超早产儿(EPT)追赶生长及体成分(BC)发育的影响,为VPT/EPT群体的出院后保健提供理论支持。方法 2018年4月-2019年10月在复旦大学附属儿科医院早产儿发育随访门诊随访的VPT和EPT91例给予个体化强化喂养指导,校正胎龄40周开始每月行体格测量与BC评估1次。结果与部分母乳喂养组和配方喂养组相比较,纯母乳喂养组在4、5月龄和6月龄时的年龄别体重Z评分更低(4月龄,P=0.042;5月龄,P=0.033;6月龄,P=0.037),6月龄时的身长别体重Z评分也更低(P=0.016);BC方面,4月龄时的体脂百分比纯母乳喂养组明显低于部分母乳喂养组和配方喂养组(25%vs.28.1%vs. 28.8%,P=0.015);6月龄时的去脂组织指数(fat-free mass index,FFMI)纯母乳喂养组明显高于配方喂养组(13.08 vs.11.78,P=0.034)。结论生后早期纯母乳喂养的VPT/EPT有可能出现体重增长和体脂储存的受损。后续有必要进一步增大样本量和延长随访时间,并开展该早期差异对长期健康影响的研究。

Objective To investigate the effects of different intensive feeding methods on catch-up growth of very preterm and extremely preterm infants(VPT/EPT) and body composition(BC) development,in order to provide theoretical support for the post-discharge healthcare of VPT/EPT. Methods Totally 91 VPT and EPTs followed up in the outpatient clinic of Children′s Hospital of Fudan University were enrolled in this study from April 2018 to October 2019,and were given individualized intensive feeding guidance.Physical examination and BC assessment were performed monthly after corrected gestational age of 40 weeks. Results Compared with partial breastfeeding and formula feeding groups,the breastfeeding group had a lower weight-for-age Z score at 4,5 and 6 months(P=0.042,0.033,0.037),a lower weight-for-length Z score at the age of 6 months(P=0.016).In terms of BC,the body fat percentage at the age of 4 months was significantly lower than that of partial breastfeeding and formula feeding groups(25% vs.28.1% vs.28.8%,P=0.015).And the fat-free mass index(FFMI) at the age of 6 months in the breastfeeding group was significantly higher than that in the formula feeding group(13.08 vs.11.78,P=0.034). Conclusions Breastfed VPT/EPT in early life may tend to have an impaired weight gain and body fat deposit.Further studies with larger cohorts and research on the long-term consequences of these early differences are warranted.