早产儿不同母乳强化策略的临床研究  

Clinical study on different breast milk enhancement strategies in premature infants

作　　者：陈文超[1] 蔡成[2] 王义乾 许云波[1] 王定成 程红斌[1] Chen Wenchao;Cai Cheng;Wang Yiqian;Xu Yunbo;Wang Dingcheng;Cheng Hongbin(Department of Neonatology, Huangshi Maternal and Child Health-Care Hospital, Huangshi 435000, China;Department of Neonatology, Shanghai Children′s Hospital, Shanghai 200062, China)

机构地区：[1]湖北省黄石市妇幼保健院新生儿科,435000 [2]上海市儿童医院新生儿科,200062

出　　处：《中华新生儿科杂志（中英文）》2019年第3期167-171,共5页Chinese Journal of Neonatology

基　　金：湖北省卫生计生委基金项目(WJ2017M210)。

摘　　要：目的探讨早产儿不同母乳强化策略效果及并发症发生率。方法前瞻性选取2017年1月至2018年2月黄石市妇幼保健院新生儿科收治的胎龄<34周且出生体重<2 000 g的早产儿,根据住院号末尾数字奇偶数分为50~<70 ml/(kg·d)组和70~<90 ml/(kg·d)组,分别在达到相应母乳喂养量时添加母乳强化剂。采用χ2检验、t检验比较两组早产儿基本情况、并发症发生率、体重增长速率、出院时宫外生长迟缓(extrauterine growth retardation,EUGR)比例及出院时Z评分下降值。结果共纳入早产儿140例,胎龄(31.4±1.9)周,出生体重(1 402±213)g。50~<70 ml/(kg·d)组67例,70~<90 ml/(kg·d)组73例。两组性别、胎龄、出生体重、身长、头围、窒息史、宫内生长受限比例、出生时Z评分、开始使用母乳强化剂时日龄、达全肠道喂养时间、肠外营养时间、平均住院时间、恢复出生体重时间等差异均无统计学意义(P>0.05)。50~<70 ml/(kg·d)组喂养不耐受比例高于70~<90 ml/(kg·d)组(11.9%比4.1%),差异有统计学意义(P=0.013),两组其他并发症发生率差异均无统计学意义(P>0.05)。50~<70 ml/(kg·d)组早产儿体重增长速率高于70~<90 ml/(kg·d)组,出院时Z评分下降值、EUGR发生率低于70~<90 ml/(kg·d)组,差异有统计学意义(P<0.05)。结论母乳喂养量达到50~<70 ml/(kg·d)时添加母乳强化剂更有利于早产儿生长发育,减少出院时EUGR发生率,但喂养过程中需警惕并发症发生情况。Objective To study the effect of different breast milk enhancement strategies and the incidence of complications in premature infants. Method Premature infants whose gestational age less than 34 weeks and birth weight less than 2 000 g were prospectively enrolled from January 2017 to February 2018 at the Department of Neonatology of Huangshi Maternal and Child Health-Care Hospital. According to the odd even number at the end of the hospitalization admission number, participants were assigned into 50~<70 ml/(kg·d) group and 70~<90 ml/(kg·d) group, When the children reached the corresponding amount of breast-feeding to be given breast milk fortifier. The demographic information, incidence of complications, rate of weight gain, percentage of extrauterine growth retardation (EUGR) and decrease of Z score at discharge were compared between groups. Result A total of 140 cases were included, with gestational age (31.4±1.9) weeks and birth weight (1 402±213) grams. Among the participants, 67 infants were assigned to 50~<70 ml/(kg·d) group, and 73 infants were assigned to 70~<90 ml/(kg·d) group. There was no statistical difference between two groups in gender, gestational age, birth weight, length, head circumference, rates of asphyxia, ratio of intrauterine growth retardation, Z score of weight at birth, age at which breast milk fortifiers were added, full enteral feeding time, duration of parenteral nutrition, average length of hospital stay and the time of restoration of birth weight (P>0.05). The proportion of feeding intolerance in 50~<70 ml/(kg·d) group was higher than that in 70~<90 ml/(kg·d) group (11.9% vs. 4.1%), the difference was statistical significant (P=0.013). There was no statistical difference in other complications between the two groups (P>0.05). The body weight increase rate of premature infants in 50~<70 ml/(kg·d) group was higher than that in 70~<90 ml/(kg·d) group, and decrease of Z score at discharge in 50~<70 ml/(kg·d) group was lower than that of 70~<90 ml/(kg·d), the difference was

关 键 词：婴儿 早产 母乳喂养 母乳强化剂 肠道营养 宫外生长迟缓 

分 类 号：R722.6[医药卫生—儿科]