早产儿喂养不耐受

早产儿喂养不耐受可导致早期营养不良、生长受限,对以后的行为和认知产生影响,是目前新生儿科医生面临的重要问题。喂养不耐受与早产儿胃肠功能不成熟、围生期窒息、感染等疾病因素相关。临床治疗常采用微量喂养,促胃肠动力药、口服益生菌等方法,但目前尚无统一的预防和治疗指南。     

Selenium status of preterm infants fed human milk, preterm formula, or selenium-supplemented preterm formula

The selenium status of 46 orally fed vitamin E-sufficient preterm infants (birth weight less than 1700 gm) was studied longitudinally for 3 weeks to determine the efficacy of selenium supplementation. Infants were fed either human milk (n = 21; 24 ng selenium/ml), preterm formula (n = 13; 7.8 ng selenium/ml), or preterm formula supplemented with sodium selenite (n = 12; 34.8 ng selenium/ml). Plasma and erythrocyte selenium and glutathione peroxidase activity and urinary and dietary selenium content were evaluated on study day 1 (day enteral feeds reached 100 kcal/kg/day) and weekly for 3 weeks. Throughout the study, selenium intakes of infants fed preterm formula plus sodium selenite were greater than those of infants fed human milk, which were greater than those of infants fed preterm formula (p less than 0.001). After 3 weeks no differences were observed among groups for plasma or erythrocyte selenium or glutathione peroxidase. Plasma selenium and glutathione peroxidase values within all groups were low compared with those reported for term infants fed human milk. Whereas urinary selenium levels of infants fed preterm formula plus sodium selenite were greater than those of infants fed preterm formula at weeks 1 and 2 (p less than 0.01), infants fed human milk and preterm formula had lower levels at week 3 than on study day 1 (p less than 0.05). We conclude that blood selenium measurements typically used to monitor selenium status do not reflect dietary selenium intakes of orally fed preterm infants.     

建立喂养不耐受早产儿的肠道喂养:小剂量红霉素随机对照研究

目的 探讨静脉应用小剂量红霉素防治早产儿喂养不耐受的效果并评估其临床应用的相关不良反应.方法 将60例胎龄>32周的早产儿随机分为低剂量红霉素组[5 mg/(kg·d),连用7 d]和对照组.记录并比较两组早产儿喂养不耐受发生率及达到全肠道喂养的时间.监测红霉素潜在的不良反应.结果 60例早产儿中25例出现喂养不耐受,发生率为41.67%(25/60).红霉素组及对照组喂养不耐受的发生率差别无统计学意义(x2=0.231,P=0.631).红霉素组取得完全肠内营养及恢复出生体质量的时间早于对照组,两组差异有统计学意义(P均<0.05).对照组的血清胆汁酸水平高于红霉素组,差异有统计学意义(t=3.202,P=0.003).两组早产儿其他肝功能生化指标差异均无统计学意义(P>0.05).结论 小剂最静脉红霉素对于胎龄>32周的早产儿,不能降低喂养不耐受的发生率,但可以缩短达到全肠道喂养及恢复出生体质量的时间,并能减少长期静脉营养相关的胆汁淤积改变,未发生肝功能损伤等不良反应.     

Establishing enteral feeding in preterm infants with feeding intolerance: a randomized controlled study of low-dose erythromycin

OBJECTIVE: A prospective, double-blind, randomized, controlled trial was conducted to evaluate the effect of low-dose erythromycin on the time taken to attain full enteral feedings in preterm infants with very low birth weight and feeding intolerance. METHODS: Two groups of preterm infants (birth weight 相似文献   

Feeding preterm infants with L-carnitine supplemented formula

A total of 29 preterm infants maintained on mixed enteral nutrition (50% pooled human milk, 50% formula daily) were studied over a 15 days period. 16 of them received L-carnitine supplemented formula during the first seven consecutive days (600 nmol/ml, as added supplement), 13 infants served as controls. In response to enhanced dietary intake, the plasma levels and urinary excretion rates of carnitines were increased by the 7th day of study. The plasma carnitines then returned to the initial values, whilst the urinary excretion remained elevated at the 14th day of study. The elevated daily urinary excretion of carnitines was accompanied by increased clearance and decreased relative reabsorption rates in the supplemented group. In the control group the plasma carnitine levels remained unchanged throughout the observations, while the daily excretion of free carnitine decreased by the end of the study. In the supplemented group statistically significant decrease was found in the daily excreted ammonia and urea with a decrease of plasma alanine and glutamine levels by the 7th day of study. The plasma levels of beta-hydroxybutyrate, glucose and creatinine remained unchanged in both groups.     

早产儿/低出生体重儿和足月儿配方粉对住院早产儿生长发育影响的多中心对照研究

目的研究不同组成成分的配方粉对胎龄<34周和（或）出生体重＜2 000 g的住院早产儿早期生长发育的影响,并对早产儿的喂养提出建议 。方法受试对象为上海市3家医院住院的胎龄＜34周或出生体重＜2 000 g的早产儿。分为两组,分别应用Ⅰ号（早产Ⅰ组）和Ⅱ号（早产Ⅱ组 ）配方粉进行喂养。研究采用严格的盲法,试验设计者不参与试验实施,数据整理者为独立的第3方人员,参与试验的医生和患儿家长对两种配 方粉的具体组成成分均不知情。Ⅰ号为适于早产儿的优博早产儿/低出生体重儿配方粉,Ⅱ号为足月儿或胎龄>34周早产儿的优博标准婴儿配方 粉。结果2007年7月至2008年6月,早产Ⅰ组117例,早产Ⅱ组106例进入分析。早产Ⅰ组体重、身长和头围的生长速度均显著快于早产Ⅱ组。试 验期间早产Ⅰ组和早产Ⅱ组的平均体重增加速度分别为12.6 g·kg-1·d-1 和10.6 g·kg-1·d-1（P＜0.001）,头围每周增长分别为0.86 cm 和0.80 cm（P＜0.05）,身长每周增长分别为0.73 cm和0.67 cm（P＜0.05）;按生理性体重下降恢复后计算,早产Ⅰ组和早产Ⅱ组的平均体重 增加速度分别为16.2 g·kg-1·d-1和14.1 g·kg-1·d-1（P＜0.001）,头围每周增长分别为0.96 cm和0.87 cm（P＜0.05）,身长增长分别为 1.08 cm和0.99 cm（P＜0.05）。早产Ⅰ组的宫外发育迟缓（EUGR）发生率（57.3％）低于早产Ⅱ组（72.5％）（P＜0.05）。结论在胎龄＜34 周或出生体重＜2 000 g的早产儿中,应用优博早产儿/低出生体重儿配方粉喂养对早产儿生长发育的影响明显优于优博标准婴儿配方粉,其体 重、身长和头围的生长速度都能够达到理想的宫内生长速度,也可明显降低EUGR的发生率。     

Enhanced weight gain in preterm infants receiving lactase-treated feeds: a randomized,double-blind,controlled trial

OBJECTIVE: To evaluate whether lactase-treated preterm feeds enhance weight gain and feeding tolerance in premature infants. STUDY DESIGN: Prospective, double-blind, randomized, controlled trial involving 130 infants (26-34 weeks postconceptual age). The primary outcome variable was weight gain (g per day). Other outcome measures included gains in length and head circumference, biochemical indexes of nutritional status, feeding intolerance, and incidence of necrotizing enterocolitis. RESULTS: On study day 10, weight gain (mean +/- SEM) of the treatment group was significantly greater (P <.05) than that of the control group (20.4 +/- 1.8 g/day vs 15.5 +/- 1.6 g/day). By study end, no significant difference in weight gain between treatment and control groups was observed. The difference in serum albumin level was significant at study day 14, with a value of 29.3 +/- 0.6 g/L in the treatment group compared with 27.1 +/- 0.4 g/L in the control group (P <.01). There were no significant differences in caloric intakes, length gain, head circumference gain, feeding intolerance, and incidence of necrotizing enterocolitis. CONCLUSIONS: Weight gain may be enhanced during the period of low functional lactase activity of prematurity by addition of lactase to preterm feeds. No adverse effects on feeding tolerance resulted from this treatment.     

Fat absorption in preterm infants fed a taurine-enriched formula

An adapted cow's milk infant formula without or with extra taurine (350 μmol/l) was fed to four and five infants, respectively. The infants, born after 28–32 weeks gestation, and initially fed with a starting formula for preterms, were switched to one of the two above-mentioned formulae at approximately the 16th day of life. Each infant was studied during 4 consecutive weeks. The faecal excretion of fat, energy and total bile acids was determined from 3-day stool collections each week. The addition of taurine to the infant formula neither improved the uptake of fat and energy nor changed the faecal bile acid excretion. Growth velocity was similar in both groups of infants. Based on these results there is no rationale for adding taurine to adapted cow's milk infant formula to obtain a better fat absorption.     

Serum lipids in preterm infants fed a formula supplemented with nucleotides

BACKGROUND: The effect of dietary nucleotides on lipid metabolism has been the subject of clinical studies with conflicting results. We measured serum triglycerides, total cholesterol (total-C), and lipoprotein cholesterol levels (HDL-C, LDL-C, and VLDL-C) in preterm neonates fed formula with and without nucleotide supplements. METHODS: This prospective, randomized, controlled study included 150 healthy preterm neonates (gestational age, 33.0 +/- 1.9 weeks) matched for gestational age, birth weight, and gender. Subjects were assigned at birth to receive either a standard milk formula supplemented with nucleotides (group F-NT) or the same formula without nucleotides (group F). Serum was obtained before discharge (29.1 +/- 10.0 days of life) and triglycerides, total-C, and HDL-C were determined enzymatically. LDL-C and VLDL-C were estimated by the Friedewald formula. For statistical analysis t test, Mann Whitney-U test, two-way ANOVA, and chi2 test were used, as appropriate. The influence of several factors on serum lipid levels was evaluated by linear regression analysis. RESULTS: Serum triglycerides, total-C, and VLDL-C levels did not differ between groups. HDL-C levels (median; 25th-75th percentiles) were significantly higher (P < 0.001) in group F-NT (48.0 mg/dL; 40.5-57.0 mg/dL) than in group F (34.5 mg/dL; 27.2-44.0 mg/dL). On the contrary, LDL-C levels (median; 25th-75th percentiles) were significantly lower (P < 0.001) in group F-NT (39.0 mg/dL; 26.0-54.0 mg/dL) than in group F (65.0 mg/dL; 41.0-73.0 mg/dL). In the multiple regression analysis, nucleotide supplementation was identified as one of the controlled independent factors influencing serum HDL-C and LDL-C levels. CONCLUSIONS: Preterm neonates fed from birth with formula supplemented with nucleotides have significantly higher HDL-C and lower LDL-C serum levels than do neonates fed unsupplemented formula. The clinical relevance of these results remains to be elucidated.     

乳糖酶添加剂对早产儿乳糖不耐受有效性及安全性：一项前瞻性、多中心、随机对照研究

目的 探讨乳糖酶添加剂对早产儿乳糖不耐受改善的有效性以及安全性。方法 2018年1月至2019年12月对上海交通大学医学院附属新华医院、上海市第一妇婴保健院、浙江大学医学院附属儿童医院和苏州大学附属儿童医院收治的有乳糖不耐受症状并符合入组标准的早产儿进行研究,将研究对象随机分为乳糖酶治疗组及对照组,各80例。乳糖酶治疗组患儿每顿母乳或早产儿配方奶中加入4滴（180mg）乳糖酶,同时予双歧杆菌三联活菌散口服及腹部按摩作为辅助治疗。对照组患儿则在每顿奶中加入同等剂量的安慰剂,并予与治疗组相同的益生菌和腹部按摩进行辅助治疗。在干预后第1周末和第2周末比较两组患儿临床症状、体重、粪便pH值、粪便还原糖等指标。结果 乳糖酶治疗组和对照组分别有78例、77例完成研究。干预后第1周末,乳糖酶治疗组还原糖阳性率较对照组低（P<0.05）;干预后第2周末,乳糖酶治疗组患儿腹胀发生率较对照组低（P<0.05）,还原糖阳性率低于对照组（P<0.05）,同时乳糖酶治疗组患儿喂养增加量高于对照组（P<0.05）。研究过程中两组均未发现患儿对乳糖酶添加剂或益生菌产生不良反应。结论 外源性乳...     

乳糖酶添加剂对早产儿乳糖不耐受有效性和安全性的前瞻性随机对照研究

目的 探讨乳糖酶添加剂对改善早产儿乳糖不耐受的有效性和安全性.方法 选取上海交通大学医学院附属新华医院2018年1月至2019年12月收治的有乳糖不耐受症状的早产儿60例纳入研究,随机分为乳糖酶治疗组和对照组,每组30例.乳糖酶治疗组给予乳糖酶添加剂4滴(180 mg)加入早产儿配方奶或母乳中;对照组给予安慰剂,同时予...     

Nitrogen and mineral balance in preterm infants fed human milks or formula

Growth as well as nitrogen, calcium, sodium, and potassium balances were evaluated in 16 preterm infants weighing less than 1,600 g at birth, who were fed either their mother's milk, donated mature human milk, or standard commercial formula. Birthweight, gestational age, age of balance, and energy and fluid intakes were similar between groups. There were no differences between groups in the rate of growth. The infants fed their mother's milk (obtained 11-30 days into lactation) demonstrated nutrient balance similar to infants fed mature human milk. Infants fed standard commercial formula demonstrated significantly greater intake and retention of calcium compared to either human milk group. Infants fed either their mother's milk or mature human milk demonstrated net nitrogen and calcium retention below estimates of fetal nitrogen and calcium accretion. Infants fed standard formula demonstrated retentions that more closely approach the fetal estimates. This study did not demonstrate an advantage to feeding premature infants their mother's milk when compared to the feeding of mature donor milk.     

Vitamin E status in preterm infants fed human milk or infant formula

Vitamin E status was assessed in 36 infants with birth weights less than 1500 gm who were assigned randomly to receive one of three sources of nutrition: milk obtained from mothers of preterm infants (preterm milk), mature human milk, or infant formula. Infants in each dietary group were further assigned randomly to receive iron supplementation (2 mg/kg/day) beginning at 2 weeks or to receive no iron supplementation. All infants received a standard multivitamin, providing 4.1 mg alpha-tocopherol daily. Serum vitamin E concentrations at 6 weeks were significantly related both to type of milk (P less than 0.0001) and to iron supplementation (P less than 0.05). Infants fed preterm milk had significantly higher serum vitamin E levels than did infants fed mature human milk, and both groups had significantly higher levels than did those fed formula. Ratios of serum vitamin E/total lipid were also significantly greater for infants fed human milks than for those fed formula. The addition of iron to all three diets resulted in significantly lower serum vitamin E levels at 6 weeks (P less than 0.05); however, only in the group fed formula was there evidence of vitamin E deficiency. Preterm milk with routine multivitamin supplementation uniformly resulted in vitamin E sufficiency in VLBW infants whether or not iron was administered.     

Fecal cholesterol excretion in preterm infants fed breast milk or formula with different cholesterol contents

In 44 very low-birth-weight infants, fecal cholesterol excretion was measured and in 29 other infants serum total cholesterol concentrations in response to different cholesterol intakes were studied. The infants received fortified breast milk (mean cholesterol content 15.3mg/dl) or were fed either a standard preterm formula (cholesterol content 5.5mg/dl) or the same formula but with a modified lipid composition (long chain polyunsaturated fatty acid concentration closely related to breast milk fat) and 30 mg of cholesterol/dl. In the group fed the high cholesterol formula, fecal cholesterol excretion was significantly higher (35.5mmol/kg/day) than in the groups fed breast milk or the standard formula (20.1 and 18.2mmol/kg/day). Cholesterol balance in the group fed the high cholesterol formula (21.8mg/kg/day) was significantly higher than in the group fed breast milk (+8.6mg/kg/day). In the infants fed the low cholesterol formula the balance was negative (-7.7 mg/ kg/day). Serum concentrations of total cholesterol were similar in the groups fed breast milk or the high cholesterol formula (3.47 and 3.51 mmol/1), but significantly higher than in the group fed the low cholesterol formula (3.15 mmol/1). The data suggest that preterm infants are able to regulate a higher cholesterol intake than during breast feeding by increasing fecal cholesterol excretion as well as decreasing endogenous synthesis.     

Nutritional efficacy of preterm formula with a partially hydrolyzed protein source: a randomized pilot study.

BACKGROUND: Decreased nitrogen levels, calcium intestinal absorption rates, and plasma amino acid imbalances were reported for preterm infants who were fed partially hydrolyzed preterm formulas. In this pilot study, we evaluated a new formula with modified nitrogen and calcium sources. METHODS: During their second week of life, 16 preterm infants were randomly assigned to one of two groups: 9 were fed the new partially hydrolyzed formula and 7 were fed a conventional formula. Nutrient balance was performed at the end of the first month of life. Amino acid concentrations and anthropometric parameters were measured at theoretical term. RESULTS: Birth weight and gestational age (mean +/- SD) were similar in the two groups (28.9 +/- 7.0 weeks and 1183 +/- 242 g vs. 27.7 +/- 1.0 weeks and 1139 +/- 162 g). Median nitrogen absorption rates (85% vs. 89%; P = 0.03) and biological values (59% vs. 69%; P = 0.13) were lower for infants who were fed the new formula than for those fed the conventional formula. After correction for difference in nitrogen intake, there was no significant difference in nitrogen retained between the two groups (P = 0.11). Plasma amino acid concentrations were also similar in the two groups. Median calcium absorption tended to be higher in the new-formula group than in the conventional-formula group (54% vs. 45%, P = 0.19). At theoretical term, infants fed the conventional formula were heavier than infants fed the new formula (3559 +/- 362 g vs. 3193 +/- 384 g, P = 0.04). CONCLUSIONS: Because nitrogen content is 10% higher in hydrolyzed-protein formula than in entire-protein formula, appropriate nitrogen retention, plasma amino acid profile, and mineral use can be achieved with the new partially hydrolyzed formula. Further studies with larger groups are needed to evaluate the effect on growth.