新鲜亲母母乳喂养对极/超早产儿近期临床结局的影响  

Short-term effects of mother’s own fresh milk feeding on very/extremely preterm infants

作　　者：黄静[1] 林新祝 郑直 赵晓燕 高锦华 黄荔涵 王恋 Huang Jing;Lin Xinzhu;Zheng Zhi;Zhao Xiaoyan;Gao Jinhua;Huang Lihan;Wang Lian(Department of Neonatology,Xiamen Maternal and Child Care Hospital,Women and Children's Hospital,School of Medicine,Xiamen University,Xiamen Key Laboratory of Perinatal-Neonatal Infection,Xiamen 361001,China)

机构地区：[1]厦门大学附属妇女儿童医院(厦门市妇幼保健院)新生儿科,厦门市围产-新生儿感染重点实验室,361001

出　　处：《中华新生儿科杂志（中英文）》2020年第3期169-174,共6页Chinese Journal of Neonatology

基　　金：2017厦门市科技计划项目(3502Z20174019);2017年厦门市科技计划重大专项立项(3502Z20171006)。

摘　　要：目的探讨新鲜亲母母乳喂养对极/超早产儿近期临床结局的影响,并评价其安全性及可行性。方法采用前瞻性研究,选择2018年6月至2019年5月厦门大学附属妇女儿童医院新生儿重症监护病房收治的极/超早产儿为研究对象,按照母亲是否愿意进行新鲜母乳喂养(母乳挤出后3 h内使用,不进行冷藏、冷冻、巴氏消毒及温热),分为新鲜母乳组和巴氏消毒组。评价新鲜母乳喂养的安全性及可行性,比较两组死亡率、无严重并发症存活率、早产儿并发症发生率,以及喂养指标和生长指标。采用两独立样本t检验、秩和检验及χ2检验进行统计学分析。结果共纳入120例极/超早产儿,其中新鲜母乳组63例,巴氏消毒组57例。与巴氏消毒组比较,新鲜母乳组平均加奶速度快[(8.3±1.0)ml/(kg·d)比(7.8±0.9)ml/(kg·d)],恢复出生体重日龄小[(6.4±1.8)d比(7.4±2.3)d],达全肠道营养时间和肠外营养时间均缩短[(21.5±3.8)d比(30.0±10.4)d,(21.0±4.9)d比(27.2±9.7)d],晚发型败血症和支气管肺发育不良发生率低[4.8%(3/63)比15.8%(9/57),17.5%(11/63)比35.1%(20/57)],无严重并发症存活率高[60.3%(38/63)比35.1%(20/57)],差异均有统计学意义(P<0.05)。两组住院期间头围、身长和体重增长速率比较差异无统计学意义(P>0.05)。研究期间所有患儿均未出现与新鲜母乳喂养相关的不良事件。结论极/超早产儿每日至少1次新鲜母乳喂养是可行、安全的,可缩短达全肠道营养时间,减少肠外营养时间,有助于降低并发症发生率。Objective To study the effects,feasibility and safety of feeding very/extremely preterm infants with their mothers own fresh milk.Method From June 2018 to May 2019,very/extremely preterm infants admitted to our NICU were enrolled in the prospective cohort study.According to their motherswilling to provide fresh milk or not,the infants were assigned into two groups:fresh human milk group and pasteurized human milk group.The fresh milk was defined as breast milk expressed within 3 hours without cooling,freezing,pasteurizing or heating.The feasibility and safety of mothers own fresh milk were evaluated.The mortality rate,survival without severe complications rate,incidence of preterm-associated complications,as well as feeding and growth index between the two groups were compared.Two independent sample t test,rank-sum test and Chi-square test were used as statistical methods.Result A total of 120 cases were included in the study,63 cases in the fresh human milk group and 57 cases in the pasteurized human milk group.Compared with the pasteurized human milk group,the fresh human milk group increased feeding volume faster[(8.3±1.0)ml/(kg·d)vs.(7.8±0.9)ml/(kg·d)],regaining birth weight earlier[(6.4±1.8)d vs.(7.4±2.3)d],achieving total enteral feeding earlier[(21.5±3.8)d vs.(30.0±10.4)d],had shorter duration of total parenteral nutrition[(21.0±4.9)d vs.(27.2±9.7)d],had lower incidence of late-onset sepsis and bronchopulmonary dysplasia[4.8%(3/63)vs.15.8%(9/57),17.5%(11/63)vs.35.1%(20/57)]and had higher survival rate without severe complications[60.3%(38/63)vs.35.1%(20/57)],the differences were statistically significant(all P<0.05).No significant differences existed in head circumference,body length,and weight growth velocity between the two groups(all P>0.05).No adverse events associated with breastfeeding were reported.Conclusion Feeding mothers own fresh milk at least once a day was safe and feasible.It may shorten the time required achieving total enteral feeding and the duration of total parente

关 键 词：母乳喂养 婴儿 早产 极早产儿 超早产儿 预后 

分 类 号：R722[医药卫生—儿科]