人乳脂肪酸组分与新生儿母乳性黄疸的相关性分析

目的 探讨人乳中不同脂肪酸组分与新生儿母乳性黄疸（BMJ）的相关性。方法 选取2016年10月至2017年10月入住该院新生儿重症监护室,临床诊断为晚发性母乳性黄疸的足月儿作为BMJ组,同期入住月子会所的无黄疸或无病理性黄疸健康新生儿为对照组,每组30例。分别收集两组新生儿的临床资料（包括性别、出生方式、喂养方式、胎龄、出生体重、胎次、产次及总胆红素峰值）及其母亲乳汁,使用MIRIS母乳分析仪检测人乳脂肪、蛋白质、碳水化合物等宏量营养素含量和热卡,采用气相色谱法分析母乳中不同脂肪酸组分含量。结果 对照组人乳各种宏量营养素组分均高于BMJ组,其中脂肪、干物质和热卡差异有统计学意义（P<0.05）。另测得母乳脂肪酸共25种,其中饱和脂肪酸9种,单不饱和脂肪酸6种,多不饱和脂肪酸10种。比较两组不同脂肪酸百分含量发现,BMJ组人乳中C15：0、C16：0、C17：0、C18：0、C20：0、C18：1n9t、C20：1n9、C18：3n6、C22：2、C22：6n3（DHA）等10种长链脂肪酸百分含量均低于对照组,3种脂肪酸C10：0、C12：0、C14：0百分含量均高于对照组（P<0.05）。结论 部分人乳宏量营养素及脂肪酸组分可能与新生儿母乳性黄疸发生机制有关。     

小于胎龄儿(SGA)脐血清脂肪酸成份与母亲产时血清相应成份的分析

通过对小于胎龄儿（SGA）和适于胎龄儿（AGA）脐血清和母亲分娩时血清总脂肪酸（TFA）和游离脂肪酸（FFA）成份的测定，探讨两者间关系以及SGA脂肪酸的特点。两组母亲分娩时血清TFA和FFA浓度显著高于其婴儿。但在百分含量上，两组新生儿C20：4ω6、C22：6ω3和C16：1ω7、C18：0显著增高，前二者增高表明SGA与AGA儿均俱备转化、保留这两种EFA的能力，后二者增高表明SGA儿与AGA儿同样能在宫内自身合成脂肪酸。     

口服金双歧辅助治疗新生儿母乳性黄疸

目的观察口服金双歧对新生儿母乳性黄疸的疗效。方法将符合诊断标准的126例患儿分为观察组和对照组。观察组65例是在常规治疗（服用鲁米那、尼可刹米、维生素C）的基础上口服金双歧，两组均服药5天，治疗前后经皮测定胆红素值。结果两组新生儿的皮肤黄疸均有不同程度的减轻。但治疗组的疗效明显优于对照组（P〈0．001），差异有非常显著性。结论口服金双歧治疗新生儿母乳性黄疸，疗效确切，方法简便，易被家长及新生儿接受。无任何不良反应。     

母乳性黄疸102例临床分析

我院于2000年6月-2006年6月诊治新生儿黄疸200例，其中母乳性黄疸（BMJ）102例，占51％，现报告如下。     

新生儿母乳性黄疸的临床研究

目的　了解母乳性黄疸 (BMJ)患儿胆红素均值及峰值水平 ,探讨BMJ患儿胆红素增高对肝脏及心肌酶的影响 ,寻求最佳干预方案。方法　以 160例确诊为BMJ患儿为研究对象 ,观察黄疸出现及消退时间 ,并行经皮胆红素、血清胆红素测定及心肌酶谱、肝功能等检查 ,并将胆红素 >2 91μmol/L 80例患儿随机分成 4组治疗 ,并评价其疗效。结果　 1.BMJ胆红素高峰期在生后 2～ 4周 ,血清胆红素峰值和均值分别为 3 16μmol/L和 2 3 1μmol/L。黄疸消退时间为 6～ 12周 ;2 .经皮测胆红素与血清总胆红素呈正相关　r =0 .92 ;3 .BMJ患儿心肌酶、肝功能、总蛋白、清蛋白、球蛋白、碱性磷酸酶均在正常范围 ;4.继续母乳组、停止母乳组、光疗暂停母乳组、光疗继续母乳组患儿黄疸消退时间以光疗暂停母乳组与光疗继续母乳组患儿黄疸消退时间快 ,但两组间无显著性差异 (P >0 .0 5)。结论　 1.经皮测胆仪不仅可作为筛查、随访工具 ,且其结果可代替血清总胆红素作为指导治疗的依据 ;2 .BMJ患儿胆红素对肝功能、心肌酶无影响 ;3 .各组中以光疗不停母乳组黄疸消退时间最快 ,疗效最显著 ,故光疗时不必停母乳     

双歧三联活菌并哺乳习惯改变干预母乳性黄疸的疗效

目的观察双歧三联活菌并哺乳习惯改变干预母乳性黄疸（BMJ）的效果。方法BMJ患儿50例。随机分为干预和对照组各25例。干预组口服双歧三联活菌,并增加哺乳次数;对照组采用蓝光照射及苯巴比妥口服,按需哺乳;记录每日患儿进乳及排便次数;检测日均胆红素下降值及平均治疗时间。结果干预组大便次数较对照组增加（P〈0.01）,日均胆红素下降、治愈时间无显著性差异（Pa〉0.05）,无不良反应。结论双歧三联活菌口服并增加哺乳次数治疗BMJ安全有效,勿需中断母乳喂养,可作为一种减轻BMJ干预方法。     

β-葡萄糖醛酸苷酶与母乳性黄疸关系的观察

目的动态观察母乳、新生儿粪便中β-葡萄糖醛酸苷酶（β-glucuronidase,β-GD）活性变化的规律及其与血清胆红素浓度的关系。方法以纯母乳喂养的18例母乳性黄疸患儿和12例生理性黄疸儿为观察对象。于生后第1、2、3和4周测定母乳及新生儿粪便中β-GD活性和血清胆红素浓度。结果母乳中β-GD活性在母乳性黄疸组第1、2、3、4周（中位数,M）分别为178、102、134和91kU/L,生理性黄疸组分别为320、128、182、164kU/L,两组各期差异无显著性(P＞0.05);新生儿粪便中β-GD活性在母乳性黄疸组分别为（512±291）、（660±153）、（629±282）和（639±237）U/g,生理性黄疸组分别为（672±118）、（582±270）、（573±211）和（714±153）U/g,两组差异亦无显著性(P＞0.05)。母乳性黄疸组血清胆红素浓度与母乳及粪便中酶活性的相关系数分别为0.224和0.027(P＞0.05);生理性黄疸组分别为0.109及0.140(P＞0.05),两组均无相关性。结论β-GD活性在母乳性黄疸的发病机理中不是唯一的或主要的原因。     

早产儿和足月儿母乳中脂肪酸组成比较研究

为进一步提倡母乳喂养，本研究采用气相色谱法分析了不同泌乳期３８例早产儿和足月儿母乳中脂肪酸的组成。结果：初乳中总饱和脂肪酸百分含量较低，总不饱和脂肪酸百分含量较高，尤其是长链多价不饱和脂肪酸含量丰富，随着泌乳期的延长，母乳中Ｃ８０、Ｃ１００、Ｃ１２０和Ｃ１６１百分含量逐渐升高，而Ｃ１６０、Ｃ１８０、Ｃ２０４ω６和Ｃ２２６ω３百分含量逐渐下降，早产儿母乳成熟乳中总饱和脂肪酸及中链脂肪酸Ｃ８０～Ｃ１４０百分含量明显高于足月儿母乳。结论：初乳，特别是第１、２天的初乳，应尽量哺喂新生儿。对于早产儿，更应鼓励母乳喂养。     

早产儿母乳宏量营养素和总能量横断面调查

背景：中国早产儿母乳成分的报告不多,早产儿母乳成分可能受遗传、饮食习惯等影响。 目的探索不同孕周、不同分娩方式的早产儿母亲在不同泌乳阶段乳汁的宏量营养素含量及其变化情况。 设计：横断面调查。 方法：纳入NICU收治的出生体重<2 500 g、孕周<37周的早产儿母亲,母亲年龄＞18岁、无严重先天畸形,未使用免疫抑制剂,无母乳喂养禁忌证,自愿提供新鲜母乳,以双侧电动吸奶器收集早上4～5时双侧乳房全乳至一次性储奶瓶,冷链运送,从母亲采集母乳至上机行成分分析的过程在4 h内完成,采用 MIRIS HMA 母乳分析仪（瑞典 Miris AB 公司）,检测时用超声技术进行匀化。通过婴儿病例资料获取临床信息,根据纳入母亲分娩孕周分为<28周组、～32周组和～＜37周组;根据纳入母亲分娩年龄分为适龄产妇（≤34岁）和高龄产妇（＞35岁）;根据采集母乳发生于产后时间分为产后初乳（1～7 d）、过渡乳(～14 d)、成熟乳(～42 d)。 主要结局指标：早产儿母亲不同泌乳阶段乳汁的宏量营养素含量。 结果：符合本文纳入标准的早产儿母亲191例,阴道分娩79例（41.4%）,分娩年龄18～44（31.1±4.5）岁,分娩时孕周为（29.2±2.2)周;分娩191例婴儿,男婴102例（53.4%）,女婴89例,出生体重 (1 286±344)g。共收集到母乳305份,其中初乳55份,过渡乳72份,成熟乳178份。初乳、过渡乳和成熟乳的脂肪含量呈递增趋势,蛋白质呈递减趋势,差异均有统计学意义;初乳、过渡乳和成熟乳多重比较结果显示,碳水化合物和总能量差异有统计学意义,但过渡乳和成熟乳的碳水化合物、总能量差异无统计学意义。不同孕周的早产儿母亲的母乳中宏量营养素及总能量多重分析差异均无统计学意义。过渡乳中的蛋白质含量＜28周高于～32周和～＜37周,过渡乳中的碳水化合物含量~28周和～32周高于～＜37周,差异均有统计学意义。初乳中的脂肪含量阴道分娩低于剖宫产,过渡乳和成熟乳中的蛋白质含量阴道分娩均低于剖宫产,成熟乳中的碳水化合物含量阴道分娩高于剖宫产,差异均有统计学意义。成熟乳中的脂肪含量和总能量适龄产妇低于高龄产妇,差异均有统计学意义。 结论：不同泌乳阶段早产儿母乳中的宏量营养元素和总能量有明显差别,未来可考虑开展母乳成分分析以指导早产儿个体化母乳喂养。     

不同加热方法对人乳中脂肪酸成份的影响

目的 了解不同的加热方法对人乳中脂肪酸含量的影响.方法 对人乳采取三种不同的加热方法:①冷藏人乳放在37℃水浴中加温;②冷藏人乳取出后进行巴氏灭菌(63℃水浴加热30 min);③冷藏人乳取出后在100℃水浴中加热5 min.观察这三种处理方式对人乳中总脂肪酸含量和各脂肪酸成份的影响.结果 三种加热方法中常温处理的人乳中总脂肪酸的含量最高,其次是巴氏火菌法,高温煮沸的人乳中的总脂肪酸含量最低,但三种结果比较,差异无统计学意义(P=0.9);各脂肪酸的百分含量比较,差异也无统计学意义(P0.05).结论 对人乳进行巴氏火菌消毒和短时间煮沸消毒,对其中的脂肪酸成份无明显影响.     

Free fatty acids in the development of breast milk jaundice

The incubation of milk, at 4 degrees C, from mothers of infants with breast milk jaundice (BMJ) is reported to result in significantly higher levels of free fatty acids (FFA) compared with milk from controls. Single milk samples collected under standard conditions were obtained from four mothers of infants with BMJ and 14 control donors matched for stage of lactation. Milk samples were analyzed for the concentrations of FFA, using thin-layer gas chromatographic techniques. In addition, serum total fatty acids were measured in mothers and infants. The concentrations of FFA increased after storage of the milk from both the jaundiced and control groups. No differences were observed in the composition of milk FFA before or after incubation, when respective values were compared between these two groups. Similarly, no differences were detected in serum total fatty acids in either infants or mothers. The observation that increased levels of FFA in milk are associated with BMJ was not confirmed.     

Cytokines in human milk and late‐onset breast milk jaundice

Background: Maternal milk plays an important role in the development of late‐onset breast milk jaundice (BMJ), possibly due to the unique characteristics of breast milk. The aim of this study was to investigate whether there is a relation between cytokine concentrations in the milk of nursing mothers and BMJ. Methods: Breast milk samples were collected from breast‐feeding mothers of healthy full‐term neonates, 40 with BMJ and 40 without jaundice. Milk samples were taken between the second and the fourth postpartum week. The concentrations of interleukin (IL)‐1 β, IL‐6, IL‐8, IL‐10, and tumor necrosis factor‐α were measured by flow cytometric bead array. Results: There were significant differences between the study groups in terms of IL‐1 β concentrations (P= 0.013). Not statistically significant but similar trends were also seen for IL‐10 (P= 0.067) and tumor necrosis factor‐α (P= 0.053) concentrations. However, no significant differences were noted in IL‐6 (P= 0.174) and IL‐8 (P= 0.285) concentrations. Conclusions: IL‐1 β concentration seems to be increased in milk of mothers whose infants had BMJ. Although the effect of these cytokines on BMJ is unknown, it may cause prolonged jaundice via hepatic uptake, hepatic excretion, conjugation and intestinal absorption.     

Fatty acid balance studies in term infants fed formula milk containing long-chain polyunsaturated fatty acids

Long-chain polyunsaturated fatty acids (LCP) are thought to be required for optimal nervous system development in the newborn. A commercial milk formula containing LCP (Aptamil-LCP) with a fatty acid profile closely resembling breast milk, has recently been introduced for term infants. The absorption of fatty acids in term infants was examined in a double-blind randomized controlled trial comparing Aptamil-LCP ( n = 20) and standard Aptamil ( n = 20). Formula-fed newborn infants were studied from birth for 14 d. Fat balances (3 d) were performed from d 10. A 3-d stool collection was performed from d 10 in a parallel breastfed group ( n = 21). Plasma samples were taken on d 6. Median fat excretion (mg kg⁻¹) was 897.1, 615.0 and 355.2 with Aptamil, Aptamil-LCP and breastfeeding, respectively. The median total fat absorption coefficient in Aptamil-LCP-fed infants was higher than in those fed standard Aptamil ( p < 0:01). These findings were accounted for by differences in the excretion and absorption of long-chain saturated fatty acids (C14:0, C16:0 and C18:0). Higher fat excretion was associated with bulkier and firmer stools. Only trace amounts of LCP were detected in the stools of all groups. This accounted for less than 4% of dietary intake in Aptamil-LCP-fed infants. No differences in the utilization of LCP from Aptamil-LCP and breast milk feeding were apparent. Plasma phospholipid fatty acid composition data reflected differences in dietary LCP intake. Thus, PL LCP levels were highest in the breastfed infants and lowest in the Aptamil-fed infants, with values for the Aptamil-LCP-fed group falling in between.     

Absence of serum-stimulated lipase activity and altered lipid content in milk from a patient with type I hyperlipoproteinaemia

We measured the serum-stimulated lipase activity, fatty acid content, and various biochemical parameters in the breast milk of a lactating mother suffering from familial lipoprotein lipase deficiency and of healthy control subjects. Serum-stimulated lipase activity was virtually undetectable in milk from our patient and the total fatty acid content was low. The fatty acid composition differed from normal showing a marked absolute and relative increase in the content of lauric (C12:0) and myristic (C14:0) fatty acids and considerably reduced levels of oleic (C18:1) and especially linoleic (C18:2) acids. Other fatty acid species showed lesser changes in concentration. Besides a reduced calcium concentration in the milk from our patient, other biochemical parameters were not significantly different from control subjects.     

Fatty acid balance studies in preterm infants fed formula milk containing long-chain polyunsaturated fatty acids (LCP) II

A milk formula (Prematil-LCP) containing long-chain polyunsaturated fatty acids (LCP) and with a fatty acid profile closely resembling breast milk has recently been introduced for preterm infants. A double-blind randomized controlled trial was performed comparing fatty acid absorption from Prematil-LCP (n = 10) and standard Prematil (n = 10). Formula-fed preterm infants underwent 3 d fat balances (once full enteral feeds were established) along with a parallel human milk fed group (n = 11). Plasma samples were taken on the last day. Median total fat excretion (absorption, %) was 2.34 g kg (82.0), 2.64 g kg (82.9) and 1.65 g kg (87.8) with Prematil, Prematil-LCP and human milk feeding, respectively. This reflected differences in the excretion and absorption of long-chain saturated fatty acids. All groups excreted detectable LCP. LCP disappearance was higher in infants fed human milk than in those fed Prematil-LCP, particularly for n -6 LCP (p <0:01). Nevertheless, excreted LCP equated to <30% dietary intake, with Prematil-LCP feeding. Plasma lipid fatty acid composition reflected differences in dietary LCP intake.     

Effect of dietary omega-3 fatty acids on retinal function of very-low-birth-weight neonates

Retinal function was assessed by electroretinogram in 32 neonates randomly assigned to formulas of different omega-3 fatty acid content and in 10 infants fed human milk. All neonates had a birth weight of 1000-1500 g and were fed study diets from d 10 to 45 or discharge. Group A received formula containing predominantly 18:2 omega-6. Group B received a balanced mix of 18:2 omega-6 and 18:3 omega-3. Group C was given a formula containing both essential fatty acids and supplemented with marine oil to provide 22:6 omega-3 content similar to that of human milk. The fatty acid composition of plasma and red blood cell (RBC) lipids were similar for all groups on entry but marked diet-induced differences were found after feeding the study diets. Group C was comparable to the human milk-fed group, but group A had lower 22:6 omega-3 and omega-3 long-chain polyunsaturated fatty acids (LCPUFA) in plasma and RBC membranes. Cone function was not affected by dietary essential fatty acids. Rod electroretinogram thresholds were significantly higher for group A relative to the human milk-fed group and group C and significantly correlated with RBC omega-3 LCPUFA (r = -0.63, p less than 0.0001); 44% of the variance could be explained by RBC and plasma omega-3 LCPUFA content.(ABSTRACT TRUNCATED AT 250 WORDS)     

Influences of maternal dietary intake and suckling on breast milk lipid and fatty acid composition in low-income women from Brasilia, Brazil

Diet has a strong effect, while suckling stimulus is believed not to influence breast milk fatty acids. The effect of dietary pattern and suckling on the fatty acid composition of Brazilian women's breast milk was studied. A cross-sectional study was conducted with low-income women living in the central region of Brazil, where dietary DHA is not readily available. Fore and hind milk fatty acids were collected from 77 women on day 15+/-1 postpartum, and information on maternal characteristics and dietary habit was taken. The effect of suckling stimulus was measured by the changes between fore and hind milk. The mean body mass index (BMI) of volunteers was 23.7+/-3.2 kg/m(2), and the milk lipid concentration was 4.8+/-1.2 g/dl. A mixture of traditional and western type of dietary habit, high in fat and sugar was observed. The fatty acids of the subject's milk were 41.93+/-1.42% saturated, 33.31+/-1.67% monounsaturated and 25.03+/-5.23% polyunsaturated (wt/wt). The DHA level in the milk was 0.34+/-0.19%, similar to the values found in milk of many western societies. DHA and 18:3n-3 levels increased from fore to hind milk (p<0.05). Correlation existed mostly between dietary components and milk 16:0 and oleic acid (18:0). An analysis of classes of fatty acids in milk showed oleic acid (18:0) to present a negative correlation with all milk fatty acid classes. The results suggest that breast milk fatty acids of Brazilian women reflect a western maternal dietary pattern and are influenced by the suckling.     

Neonatal Jaundice and Fatty Acid Composition of the Maternal Diet

ABSTRACT. The role of serum fatty acid composition in neonatal jaundice was studied by comparing the incidence of jaundice among 332 newborn infants receiving breast milk from mothers on a diet with either a low (0.1, n =145) or a high (1.5, n =187) polyunsaturated to saturated fatty acid (P/S) ratio. The diet was started immediately after delivery. The composition of fatty acids in the breast milk and sera of the mothers and in the sera of the newborns was evaluated from a random sample of 15 mother-newborn pairs on the control diet (low P/S ratio) and 19 pairs on the experimental diet. Five days after delivery the relative amounts of fatty acids, especially that of linoleate, in the sera of the mothers differed significantly depending on the diet. Differences were also observed in breast milk samples taken three, four or five days after delivery and in the sera of the newborns sampled at the age of four or five days. Nine of the 145 newborn infants (6.2 %) in the control group had to be treated with light therapy compared with 12 out of 187 (6.4 %) of the newborn infants in the experimental group (high P/S ratio). Serum bilirubin concentrations were 142.5 μmol/l (SD 65.8) and 140.7 μmol/l (SD 73.5) in the experimental and control groups, respectively, at the age of five days. It appears that the changes in the composition of serum fatty acids reached in this study had no effect on the neonatal jaundice.