早产儿不同喂养量状态下添加母乳强化剂的效果观察

Analysis of the effect of added human milk fortifier applied to preterm infants in different feeding status

目的探讨2种不同喂养量状态下添加母乳强化剂(human milk fortifier,HMF)对住院早产儿早期生长发育和消化道并发症的影响。方法回顾性分析2019年1月1日至2021年4月1日浙江省金华市中心医院收治的102例早产儿的临床资料,按照开始使用母乳强化剂时经口喂养量的不同,将102例早产儿分为早强化组[46例,经口喂养量达50~75 mL/(kg·d)时开始强化]和晚强化组[56例,经口喂养量达76~100 mL/(kg·d)时开始强化],每次喂养前按照比例在母乳中添加母乳强化剂。比较两组早产儿早期生长发育和消化道并发症发生率。结果早强化组早产儿住院期间体重增长速率高于晚强化组早产儿[(16.89±2.81)g/(kg·d)vs.(15.23±3.12)g/(kg·d)],出院时宫外生长迟缓(extrauterine growth retardation,EUGR)的发生率低于晚强化组早产儿(28.3%vs.48.2%),其差异均具有统计学意义(均P<0.05);两组早产儿喂养不耐受(feeding intolerance,FI)、≥ⅡB期坏死性小肠结肠炎(necrotizing enterocolitis,NEC)发生率比较,其差异均无统计学意义(均P>0.05)。结论早产儿经口喂养量达50~75 mL/(kg·d)开始使用母乳强化剂可以加快住院期间体重增长速率,降低出院时EUGR的发生率,且不增加早产儿早期消化道并发症的发生率,进一步研究后具有在临床推广的价值。

Objective To investigate the effect of human milk fortifier(HMF)on early growth and development and complications of preterm infants under two different feeding status.Methods Retrospectively analyzed the clinical data of 102 preterm infants in Zhejiang Jinhua Central Hospital from January 1,2019 to April 1,2021.HMF was added to breast milk before each feeding.According to the volume of oral feeding at the time of starting HMF,the early fortification group[fortification by oral feeding up to 50~75 mL/(kg·d)]and the late fortification group[fortification by oral feeding up to 76~100 mL/(kg·d)]were divided to compare the early growth and development and complication rate of preterm infants.Results The rate of weight gain during hospitalization was higher in the early fortification group than in the late fortification group[(16.89±2.81)g/(kg·d)vs.(15.23±3.12)g/(kg·d)],and the incidence of extrauterine growth retardation(EUGR)at discharge was lower(28.3%vs.48.2%),with statistically significant differences(P<0.05).While preterm infants with feeding intolerance(FI)and≥stage IIB necrotizing enterocolitis(NEC)in both groups were not statistically significant(all P>0.05).Conclusions Early breast feeding intensification[fortification by oral feeding up to 50~75 mL/(kg·d)]for preterm infants accelerates the rate of weight gain during hospitalization and reduces the incidence of EUGR at discharge,which does not increase the incidence of early complications.Early breast feeding intensification after further research should be promoted in the clinic.