强化母乳喂养对早产极低出生体质量儿常见合并症及近期神经系统预后的影响

Effects of human milk fortification on complications and recent neurological prognosis in premature very low birth weight infants

目的通过回顾性队列研究评价强化母乳喂养对早产极低出生体质量儿常见合并症及近期神经系统预后的影响。方法选取2015年1月至2020年12月在广东省妇幼保健院新生儿科住院诊断为早产极低出生体质量儿(胎龄小于37周,体质量小于1500 g)且母乳喂养量大于80%的患儿为研究对象,根据病例资料添加母乳强化剂为强化组,未添加强化剂为非强化组,以体质量到达1800 g为观察终点。收集符合条件的患儿一般情况、生长发育指标及常见合并症,并收集神经系统评估结果;比较两组患儿体质量、身高及头围增长速度,宫外发育迟缓(EUGR)、新生儿败血症、颅内感染、支气管肺发育不良(BPD)、Ⅱ级及以上新生儿坏死性小肠结肠炎(NEC)、脑室周围白质软化(PVL)、Ⅲ级以上颅内出血(IVH)、早产儿视网膜病(ROP)等常见合并症发生情况及近期神经系统预后如脑电图、神经行为评分(NBNA)、头颅MRI等结果进行比较。结果完成观察早产极低出生体质量儿共649例,其中男性344例,女性305例,胎龄(29.50±1.60)周,出生体质量(1253.40±131.30)g。强化组306例,非强化组343例。强化组体质量增长速度、身长增长速度更快[(13.40±3.30)g·kg^(-1)·d^(-1)比(11.40±2.10)g·kg^(-1)·d^(-1),P=0.028;(0.81±0.20)cm比(0.72±0.30)cm,P<0.001],强化组EUGR发生率低于非强化组[70.26%(215/306)比81.92%(281/343),P<0.001]。强化组与非强化组喂养不耐受比较[21.57%(66/306)比15.45%(53/343)],差异有统计学意义(P=0.044)。两组败血症、颅内感染、BPD、Ⅱ级及以上NEC、PVL、Ⅲ级以上IVH、ROP等合并症的发生率比较,差异均无统计学意义(均P>0.05)。强化组NBNA评分、脑电图结果、头颅MRI异常率低于非强化组,但差异均无统计学意义(均P>0.05)。结论强化母乳喂养可以加快早产极低出生体质量儿体质量增长,降低EUGR的发生,但是不能完全改善EUGR,而强化母乳喂养对早产极低出生体质量儿其他常见合并症及近期神经系统预后没有影响。

Objective To evaluate the effects of human milk fortification on the common complications and neurological prognosis in premature very low birth weight infants by retrospective cohort study.Methods The premature very low birth weight infants(gestational age<37 weeks and body weight>1500 g)who were diagnosed and hospitalized in Guangdong Maternal and Children Health Care Hospital from January 2015 to December 2020 were selected.Their breastfeeding amounts were over 80%.According to whether breast milk fortifier was added,they were divided into a fortifier group and a non-fortifier group.The observation end point was when their body weights reached 1800 g.The infants'general data,growth indicators,common complications,and evaluation results of neurological system were collected.The growth speeds of body weight,height,and head circumference,the incidences of extrauterine growth restriction/retardation(EUGR),neonatal sepsis,intracranial infection,bronchopulmonary dysplasia(BPD),gradeⅡor above neonatal necrotizing enterocolitis(NEC),periventricular leukomalacia(PVL),gradeⅢor above intracerebral hemorrhage(IVH),and retinopathy of prematurity(ROP),and the results of electroencephalogram,NBNA,and cerebral MRI were compared between these two groups.Results A total of 649 infants were observed,including 344 males and 305 females.Their gestational age was(29.50±1.60)weeks.Their weight was(1253.40±131.30)g.The fortifier group had 306 cases,and the non-fortifier group 343.The weight growth rate and increase of body length of the fortifier group were faster than that of the non-fortifier group[(13.40±3.30)g·kg^(-1)·d^(-1) vs.(11.40±2.10)g·kg^(-1)·d^(-1),P=0.028;(0.81±0.20)cm vs.(0.72±0.30)cm,P<0.001].The incidence of EUGR in the fortifier group was lower than that in the non-fortifier group[70.26%(215/306)vs.81.92%(281/343),P<0.001].The incidence of feeding intolerance in the fortifier group was higher than that in the non-fortifier group[21.57%(66/306)vs.15.45%(53/343),P=0.044].There were no statistical differences in the incidences of sepsis,intracranial infection,BPD,NEC,PVL,gradeⅢor above IVH,and ROP between the two groups(all P>0.05).The NBNA score and abnormal rates of EEG and MRI in the fortifier group were lower than those in the non-fortifier group,but the differences were not statistically significant(all P>0.05).Conclusions Fortifier breastfeeding can accelerate the weight growth of premature very low birth weight infants and reduce EUGR,but it cannot improve EUGR completely.Human milk fortification had no effects on other common complications and neurological prognosis in very low birth weight infants.