采集母乳与母乳库母乳喂养对早产儿生长发育的影响

采集母乳与母乳库母乳可以作为早产儿在无法获得直接母乳喂养时可选择的一种喂养方式.目前文献提示,单纯以采集母乳与母乳库母乳喂养的早产儿生后短期内生长要慢于早产儿配方乳喂养,对早产儿远期生长的影响尚不明确;但采集母乳与母乳库母乳喂养可供给早产儿一定量的人乳特有成分,有利于早产儿神经发育,并减少坏死性小肠结肠炎、喂养不耐受等喂养相关并发症的发生.采集母乳与母乳库母乳的临床广泛应用还面临一些亟待解决的问题,将来的研究应更多关注于对早产儿远期生长发育的影响.     

母乳喂养的研究进展

母乳是婴儿最天然的理想食品,母乳喂养的好处涉及母婴健康、婴儿免疫与生长发育以及社会等多方面。母乳库的建立与应用无疑为无法母乳喂养的早产儿以及其他疾病患儿提供了营养与治疗的新途径。目前母乳成分的研究围绕着母乳中的蛋白质种类与数量、生物活性成分、益生菌以及细胞群等多个方面。今后的研究将可能集中在母乳生物活性成分及细胞群的调控与作用机制、益生菌产品开发以及捐赠母乳的临床应用上。     

早产儿和低出生体重儿使用捐赠母乳与配方奶喂养的荟萃分析

目的探讨不同喂养对新生儿坏死性小肠结肠炎(NEC)发病率的影响,并分析其对新生儿生长发育的不同作用。方法应用Donor human milk、formula milk、premature、low birth weight等关键词检索Pubmed、EMBASE、Ovid、the Cochrane Library和中国生物医学文献数据库发表的文章,并同时检索相关参考文献,对资料进行Meta分析。结果不同国家的7项研究共16篇文献被纳入此研究。共纳入病例1012例,其中单纯使用捐赠母乳或配方奶者669例,同时进行母乳喂养者343例,荟萃分析发现应用捐赠母乳可降低NEC的发病风险,合并的相对风险度RR=0.34,95%CI(0.16～0.71)。但是其对早产儿和低出生体重儿生长发育的作用弱于配方奶。结论捐赠母乳应该得推广,从而在降低NEC和胃肠不耐受的同时使早产儿和低出生体重儿更快地成长。     

早产儿和低出生体重儿使用捐赠母乳与配方奶喂养的荟萃分析

目的 探讨不同喂养对新生儿坏死性小肠结肠炎(NEC)发病率的影响,并分析其对新生儿生长发育的不同作用.方法 应用Donor human milk、formula milk、premature、low birth weight等关键词检索Pubmed、EMBASE、Ovid、the Cochrane Library和中国生物医学文献数据库发表的文章,并同时检索相关参考文献,对资料进行Meta分析.结果 不同国家的7项研究共16篇文献被纳入此研究.共纳入病例1012例,其中单纯使用捐赠母乳或配方奶者669例,同时进行母乳喂养者343例,荟萃分析发现应用捐赠母乳可降低NEC的发病风险,合并的相对风险度RR:0.34,95%CI(0.16～0.71).但是其对早产儿和低出生体重儿生长发育的作用弱于配方奶.结论 捐赠母乳应该得推广,从而在降低NEC和胃肠不耐受的同时使早产儿和低出生体重儿更快地成长.     

早产母乳中淀粉酶活性观察

目的观察不同哺乳阶段早产儿母乳中淀粉酶活性变化,并与足月儿母乳作比较。方法测定36例早产儿乳母和40名足月儿乳母不同泌乳期母乳中淀粉酶活性。结果早产儿乳母其初乳淀粉酶活性较高,为10232.93±1·48IU/L,随着泌乳期的延长,淀粉酶活性逐渐下降。与足月儿母乳相似,早产儿母乳淀粉酶98%为唾液型淀粉酶。不同胎龄早产儿其母乳淀粉酶活性均值较接近,差异无统计学意义。分别比较早产和足月母乳在各泌乳阶段的淀粉酶活性显示,在任何一阶段,早产母乳淀粉酶活性的绝对值略高于足月母乳,但差异无统计学意义,P均>0·05。结论早产儿母乳含有较高活性的淀粉酶,对早产儿的淀粉消化和潜在的抗感染作用具有重要意义,应鼓励对早产儿进行母乳喂养。     

早产母乳中淀粉酶活性观察

目的 观察不同哺乳阶段早产儿母乳中淀粉酶活性变化,并与足月儿母乳作比较.方法 测定36例早产儿乳母和40名足月儿乳母不同泌乳期母乳中淀粉酶活性.结果 早产儿乳母其初乳淀粉酶活性较高,为10232.93±1.48 IU/L,随着泌乳期的延长,淀粉酶活性逐渐下降.与足月儿母乳相似,早产儿母乳淀粉酶98%为唾液型淀粉酶.不同胎龄早产儿其母乳淀粉酶活性均值较接近,差异无统计学意义.分别比较早产和足月母乳在各泌乳阶段的淀粉酶活性显示,在任何一阶段,早产母乳淀粉酶活性的绝对值略高于足月母乳,但差异无统计学意义,P均＞0.05.结论 早产儿母乳含有较高活性的淀粉酶,对早产儿的淀粉消化和潜在的抗感染作用具有重要意义,应鼓励对早产儿进行母乳喂养.     

早产儿母乳喂养的益处和挑战(摘译)

尽管母乳喂养的益处众所周知,但早产儿的母乳喂养率和持续时间一直低于足月儿。本文汇总了目前关于早产儿母乳喂养方面的研究,并对相关文献进行了综述。一、早产儿母乳喂养的益处 1．营养方面的益处母乳中的一些物质是配方奶所不能提供的。蛋白质组成成分独特,乳清蛋白比配方奶中的含量更多,且母乳中的乳清蛋白更利于早产儿消化和加速胃排空。母乳中的低聚糖可以阻止细菌粘附于宿主的消化道黏膜,可减少低出生体重儿的坏死性小肠结肠炎(NEC)的发生。母乳     

早产儿母乳喂养有哪些益处？为什么早产儿母乳需要强化？

答：早产母乳中的成分与足月母乳不同,其营养价值和生物学功能更适合早产儿的需求。如早产母乳中蛋白质含量高,利于早产儿快速生长的需求;乳清蛋白与酪蛋白的比例达70：30,而且主要是仅一乳清蛋白,利于消化和加速胃排空;脂肪和乳糖量较低,易于吸收;钠盐较高,利于补充早产儿的丢失。母乳中的某些成分,包括激素、肽类、氨基酸、糖蛋白,对小肠的成熟起一定作用。而且母乳喂养为早产儿提供最理想的免疫防御,这是其最值得推荐的原因之一。母乳不仅提供保护性物质,还对早产儿免疫功能的发育起调节作用。     

母乳营养成分与早产儿脑发育的研究进展

母乳是早产儿的首选食品。近年来，母乳在早产儿脑发育中的作用越来越多地受到学者重视。研究表明，母乳喂养对早产儿神经发育、远期认知结果的影响可能一直持续到儿童、青少年，甚至成人时期。母乳中的营养成分在其中起着决定性作用，涉及低聚糖、多不饱和脂肪酸、乳铁蛋白等。该文将母乳中营养成分在早产儿脑发育中的最新研究进展作一综述，具体阐述每种营养成分的概念和作用。     

呵护早产儿从母乳喂养开始

母乳喂养是降低新生儿死亡率的重要干预手段之一,对早产儿尤其如此。早产母乳中的成分与足月母乳不同,其营养价值和生物学功能更适合早产儿的需求。在NICU积极推进母乳喂养能降低早产相关疾病的发生率,改善神经行为发育,降低成年慢性非传染性疾病的发病风险。对低出生体质量早产儿,强化母乳喂养是最佳的喂养方式,能优化蛋白质摄入,促进早产儿体格增长和骨骼矿化。应当以积极的支持策略来保证早产儿母乳喂养的顺利实施。     

Human milk banking; current evidence and future challenges

Human milk banks systematically collect, pasteurize, store, and distribute donated breast milk. In situations when a mother's own milk is insufficient or unavailable donor milk may be used as an alternative. There are a number of clinical groups who may benefit from donor milk; due to limitations in supply and evidence of benefit in term infants, most commonly donor milk is administered to preterm infants. Guidelines regarding the management of milk banks recommend potential donors are screened and tested and that milk is heat treated to minimize risk of transmission of infectious agents. Although essential to safety, pasteurization alters bioactive and nutritional properties of human milk. Pasteurized donor milk is lower in protein, calories and bioactive molecules compared with mother's own preterm milk produced in the first few weeks after delivery.Current evidence suggests that there are some health advantages for preterm infants to being fed pasteurized donor milk over preterm formula. There are challenges with regard to providing adequate nutrition with donor milk as well as logistical and ethical concerns. Formation of a national milk-bank network within the UK combined with standardized data collection would assist in the distribution and further evaluation of the potential benefits of this precious resource.     

捐献母乳喂养对极低出生体重儿院内感染发生的影响

目的 探讨捐献母乳在预防极低出生体重儿院内感染中的作用。方法 将105例极低出生体重住院早产儿纳入研究,根据其所接受的喂养方式分为亲母母乳、捐献母乳、早产儿配方奶喂养组,每组各35例。比较3组院内感染发生率、坏死性小肠结肠炎发生率、喂养不耐受发生率以及达到全肠道喂养时间、早期生长指标。结果 与配方奶组比较,捐献母乳组和亲母母乳组患儿院内感染及坏死性小肠结肠发生率明显降低,且捐献母乳组和亲母母乳组达到全肠道喂养的时间短于配方奶组,差异均有统计学意义（P < 0.05）。3组患儿头围、身长、体重增长速率比较差异无统计学意义。结论 极低出生体重儿在亲母母乳不足时可以采用捐献母乳替代喂养,有助于降低院内感染的发生。     

Policy statement of enteral nutrition for preterm and very low birthweight infants

1. For preterm and very low birthweight infants, the mother’s own milk is the best nutrition. Based on the latest information for mothers who give birth to preterm and very low birthweight infants, medical staff should encourage and assist mothers to pump or express and provide their own milk whenever possible.
2. If the supply of maternal milk is insufficient even though they receive adequate support, or the mother’s own milk cannot be given to her infant for any reason, donor human milk should be used.
3. Donors who donate their breast milk need to meet the Guideline of the Japan Human Milk Bank Association.
4. Donor human milk should be provided according to the medical needs of preterm and very low birthweight infants, regardless of their family’s financial status.
5. In the future, it will be necessary to create a system to supply an exclusive human milk‐based diet (EHMD), consisting of human milk with the addition of a human milk‐derived human milk fortifier, to preterm and very low birthweight infants.

     

Early diet in preterm babies and developmental status in infancy.

Few data from randomised prospective studies address whether early diet influences later neurodevelopment in man. As part of a larger multicentre trial, 502 low birthweight infants were assigned randomly, for a median of 30 days, to receive a preterm formula or unfortified donor breast milk as sole diets or as supplements to their mothers'' expressed milk. Surviving infants were assessed at nine months after their expected date of delivery without knowledge of their feeding regimen. The mean developmental quotient was 0.25 standard deviations lower in those fed donor breast milk rather than preterm formula. In infants fed their mother''s expressed milk, however, the disadvantage of receiving banked milk compared with preterm formula as a supplement, was greater when the supplement was over half the total intake, and approached five points, representing 0.5 standard deviations for developmental quotient. Infants fed donor breast milk were at particular disadvantage following fetal growth retardation, with developmental quotients 5.3 points lower. We suggest that the diet used for low birthweight babies over a brief, but perhaps critical, postnatal period has developmental consequences that persist into infancy; infants who are small for gestational age are especially vulnerable to suboptimal postnatal nutrition.     

母乳中生物活性物质对婴儿生长发育影响的研究进展

母乳中存在多种生物活性物质,如活性蛋白、生长因子、细胞因子、寡聚糖、益生菌和细胞等。大量研究表明,母乳中的生物活性成分对于婴儿生长发育有着多种保护作用,如抗菌、抗病毒、促进婴儿生长发育和机体免疫成熟等。它们还能降低婴儿感染性疾病的发病率,改善早产儿的神经系统发育结局,并能降低婴儿未来发生肥胖、糖尿病的风险等。但目前对于母乳中某些活性物质的作用仍缺乏一定的临床证据支持,其免疫调节的机制尚未明确,需进一步研究来阐明。     

Best practice guidelines for the operation of a donor human milk bank in an Australian NICU

Until the establishment of the PREM Bank (Perron Rotary Express Milk Bank) donor human milk banking had not occurred in Australia for the past 20 years. In re-establishing donor human milk banking in Australia, the focus of the PREM Bank has been to develop a formal and consistent approach to safety and quality in processing during the operation of the human milk bank. There is currently no existing legislation in Australia that specifically regulates the operation of donor human milk banks. For this reason the PREM Bank has utilised existing and internationally recognised management practices for managing hazards during food production. These tools (specifically HACCP) have been used to guide the development of Standard Operating Procedures and Good Manufacturing Practice for the screening of donors and processing of donor human milk. Donor screening procedures are consistent with those recommended by other human milk banks operating internationally, and also consistent with the requirements for blood and tissue donation in Australia. Controlled documentation and record keep requirements have also been developed that allow complete traceability from individual donation to individual feed dispensed to recipient and maintain a record of all processing and storage conditions. These operational requirements have been developed to reduce any risk associated with feeding pasteurised donor human milk to hospitalised preterm or ill infants to acceptable levels.     

Human milk banking guidelines

Justification

WHO and UNICEF state that the use of human milk from other sources should be the first alternative when it is not possible for the mother to breastfeed. Human milk banks should be made available in appropriate situations. The IYCF Chapter is actively concerned about the compelling use of formula feeds in the infants because of the non availability of human breast milk banks.

Process

A National Consultative Meet for framing guidelines was summoned by the IYCF Chapter and the Ministry of Health and Family Welfare, Government of India on 30th June, 2013, with representations from various stakeholders. The guidelines were drafted after an extensive literature review and discussions. Though these guidelines are based on the experiences and guidelines from other countries, changes have been made to suit the Indian setup, culture and needs, without compromising scientific evidence.

Objectives

To ensure quality of donated breast milk as a safe end product.

Recommendations

Human Milk Banking Association should be constituted, and human milk banks should be established across the country. National coordination mechanism should be developed with a secretariat and technical support to follow-up on action in States. Budgetary provisions should be made available for the activities.     

Metabolic and endocrine events at the time of the first feed of human milk in preterm and term infants.

The first feed of breast milk given to a group of 12 term infants was previously shown to increase the levels of blood glucose and plasma insulin, growth hormone (GH), gastrin, and enteroglucagon. We have now studied the effects of the first feed of breast milk in two similar groups of preterm infants, to compare the results with those obtained for the term infant. One group of 8 preterm infants received a bolus (2.5 ml/kg) of breast milk via a nasogastric tube; the other group of 5 infants received a continuous intragastric infusion (2.5 ml/kg per hour) of breast milk. No change occurred in the concentrations of blood glucose, lactate, pyruvate, or ketone bodies, or in plasma insulin, GH, pancreatic glucagon, or enteroglucagon in either the ''bolus fed'' or the ''infusion fed'' group of preterm infants. Thus the marked metabolic and endocrine changes in term infants after the first feed do not occur in preterm infants with standard methods of feeding.