标准强化捐赠人乳与早产儿配方奶补充喂养极低/超低出生体重儿短期结局比较  

Comparison of the short-term outcomes in very/extremely low birth weight infants supplemented with fortified donor human milk or preterm formula

作　　者：王琳[1] 苑静[1] 张玉[1] 全美盈[1] 唐晓艳[1] 李正红[1,2] Wang Lin;Yuan Jing;Zhang Yu;Quan Meiying;Tang Xiaoyan;Li Zhenghong(Department of Pediatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Complex,Severe,and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院儿科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院疑难重症及罕见病国家重点实验室,北京100730

出　　处：《中华围产医学杂志》2024年第1期62-67,共6页Chinese Journal of Perinatal Medicine

基　　金：北京市卫生健康科技成果和适宜技术推广项目(BHTPP2022010)。

摘　　要：目的比较在亲母母乳(mother's own milk,MOM)不足时分别应用标准强化捐赠人乳(donor human milk,DHM)或早产儿配方奶(preterm formula,PF)补充喂养极低出生体重儿(very low birth weight infant,VLBWI)和超低出生体重儿(extremely low birth weight infant,ELBWI)对其短期结局的影响。方法本研究为回顾性队列研究,选择2017年10月1日至2020年9月30日在北京协和医院住院的91例出生体重<1500 g的VLBWI或ELBWI,根据MOM不足时早产儿补充喂养方式,分为DHM组(51例)和PF组(40例),采用t检验、Mann-WhitneyU检验、χ^(2)检验比较2组早产儿住院期间的短期临床结局。结果DHM组与PF组早产儿的出生胎龄、出生体重、性别比例、出生方式、母亲分娩年龄及小于胎龄儿比例差异均无统计学意义(P值均>0.05)。DHM组生后第14天喂养量显著大于PF组[(108.2±53.1)与(81.0±47.8)ml/(kg·d),t=0.78,P=0.020],但喂养量达120和150 ml/(kg·d)时间显著短于PF组[分别为(17.5±10.2)与(30.0±12.0)d和(22.1±13.3)与(32.3±11.9)d,t值分别为4.38和0.02,P值均<0.05]。与PF组相较,DHM组应用经外周中心静脉置管(peripherally inserted central catheter,PICC)比例较低[58.8%(30/51)与100%(40/40),χ^(2)=21.88],PICC时间短[10.0(0.0~19.0)与29.0(17.0~40.5)d,Z=5.56;P值均<0.05]。DHM组输红细胞次数[0.0(0.0~2.0)与2.0(1.0~3.0)次,Z=4.44,P<0.001]、晚发败血症发生率[23.5%(12/51)与50.0%(20/40),χ^(2)=6.39,P=0.011]均低于PF组。2组支气管肺发育不良、新生儿坏死性小肠结肠炎、早产儿视网膜病变发生率及住院时长差异均无统计学意义(P值均>0.05)。结论在MOM不足时应用标准强化DHM进行补充喂养VLBWI或ELBWI可以更快实现全胃肠道内营养,降低PICC使用率并缩短置管时间,降低晚发败血症发生风险,减少红细胞输注次数。Objective To compare the short-term outcomes of very low birth weight(VLBW)and extremely low birth weight(ELBW)infants supplementarily fed with fortified donor human milk(DHM)or preterm formula(PF)when the mother's own milk(MOM)is insufficient.Methods This retrospective cohort study included 91 VLBW or ELBW preterm infants with birth weight<1500 g who were hospitalized in Peking Union Medical College Hospital from October 1,2017,to September 30,2020.Based on the supplemental feeding method when MOM was insufficient,these infants were divided into the DHM group(n=51)and PF group(n=40).Mann-Whitney U,t-test,Chi-square test,or Fisher's exact test were used to compare the short-term clinical outcomes during hospitalization between the two groups.Results(1)There were no statistically significant differences between the 91 preterm infants in the DHM group and PF group in their gestational age,birth weight,sex ratio,birth mode,mothers'age at delivery,or the proportion of infants of small gestational age(all P>0.05).(2)The feeding volume in the DHM group was significantly greater than that in the PF group on the 14th day after birth[(108.2±53.1)vs.(81.0±47.8)ml/(kg·d),t=0.78,P=0.020].Moreover,the time to achieve the feeding amounts up to 120 ml/(kg·d)and 150 ml/(kg·d)for infants in the DHM group were significantly shorter than those in the PF group[(17.5±10.2)vs.(30.0±12.0)d,t=4.38;(22.1±13.3)vs.(32.3±11.9)d,t=0.02;both P<0.05];(3)Lower proportion of peripherally inserted central catheter(PICC)[58.8%(30/51)vs.100%(40/40),χ^(2)=21.88,P<0.001]and shorter PICC duration were observed in the DHM group[10.0(0.0-19.0)vs.29.0(17.0-40.5)d,Z=5.56,P<0.001]compared to the PF group.The times of red blood cell transfusions and the incidence of late sepsis in the DHM group were less than those in the PF group[0.0(0.0-2.0)vs.2.0(1.0-3.0)times,Z=4.44,P<0.001;23.5%(12/51)vs.50.0%(20/40),χ^(2)=6.39,P=0.011].There were no statistically significant differences observed in the incidence of bronchopulmonary dysplasia,neonatal necrot

关 键 词：乳 人 人奶库 婴儿配方 母乳喂养 肠道营养 婴儿 极低出生体重 婴儿 超低出生体重 

分 类 号：R722.6[医药卫生—儿科]