强化母乳喂养的不同时机对早产儿体格及神经发育的影响

Effect of different timing of intensive breastfeeding on physical and neurodevelopment of premature infants

目的:探讨强化母乳喂养不同添加时机对早产儿住院期间体格发育、血生化指标、并发症及神经发育的影响。方法:根据强化母乳喂养的时机不同,将122例早产儿分为早期组(当喂养达50 mL·kg^(-1)·d(-1)时开始添加强化剂,60例)和晚期组(当喂养达100 mL·kg^(-1)·d(-1)时开始添加强化剂,62例),比较2组早产儿住院期间生长发育、生化指标、并发症发生率情况及新生儿行为神经测定(NBNA)、头颅核磁共振成像(MRI)、振幅整合脑电图(aEEG)神经系统评估结果。结果:早期组住院期间的体质量增长速度(17.28±3.5)g·kg^(-1)·d(-1)高于晚期组(15.71±3.4)g·kg^(-1)·d(-1),差异有统计学意义(P<0.05),但2组头围、身长增长速度、平均住院时间及恢复至出生体质量时间差异均无统计学意义(P>0.05)。出院时2组白蛋白、前蛋白、尿素氮、碱性磷酸酶、血磷差异均无统计学意义(P>0.05),早期组血钙水平较晚期组高,差异有统计学意义(P<0.05)。早期组早产儿喂养不耐受发生率为16.6%(10/60),高于晚期组的4.8%(3/62)(P<0.05),但2组坏死性小肠结肠炎、医院感染、早产儿视网膜病、贫血、支气管肺发育不良发生率差异均无统计学意义(P>0.05)。早期组头颅MRI异常率低于晚期组(P<0.05),2组NBNA、aEEG异常率差异均无统计学意义(P>0.05)。结论:早期添加母乳强化剂能促进早产儿体质量增长,提高血钙水平,且头颅MRI异常率低于晚期组。

Objective To explore the effects of different timing of intensive breastfeeding on physical development,blood biochemical indicators,complications and neurological development of premature infants during hospitalization.Methods According to different timing of intensive breastfeeding,122 preterm infants were divided into early group(60 cases were added with fortification when feeding up to 50 mL·kg^(-1)·d(-1))and late group(62 cases were added with fortification when feeding up to 100 mL·kg^(-1)·d(-1)).The growth and development,biochemical indicators,incidence of complications,and neonatal behavioral neurological assessment(NBNA),magnetic resonance imaging(MRI)and amplitude integrated electroencephalography(aEEG)were compared between the two groups.Results The weight gain rate during hospitalization in the early group(17.28±3.5)g·kg^(-1)·d(-1) was higher than that in the late group(15.71±3.4)g·kg^(-1)·d(-1),with statistical differences(P<0.05).However,there was no significant difference in head circumference,growth rate of body length,average length of stay and time to return to birth weight between the two groups(P>0.05).There was no significant difference in albumin,preprotein,urea nitrogen,alkaline phosphatase and blood phosphorus between the two groups at discharge(P>0.05),and the blood calcium level in the early group was higher than that in the late group,with statistical significance(P<0.05).The incidence of feeding intolerance(FI)in premature infants in the early group[16.6%(10/60)]was higher than that in the late group[4.8%(3/62)](P<0.05).However,there was no significant difference in the incidence of necrotizing enterocolitis,nosocomial infection,retinopathy of prematurity,anemia and bronchopulmonary dysplasia between the two groups(P>0.05).The abnormal rate of head MRI in the early group was lower than that in the late group(P<0.05),and there was no statistically significant difference in the abnormal rates of NBNA and aEEG between the two groups(P>0.05).Conclusions Early supplementation of breast milk fortifiers can promote weight gain and increase blood calcium levels in premature infants,and the abnormal rate of cranial MRI is lower than that of the late group.