早产儿胃肠喂养的临床研究

目的探讨早产低体重儿胃肠喂养的体重增长及喂养并发症.方法将出生24h内入院、住院时间≥10天、无喂养禁忌症的早产儿按体重≤2000g或＞2000g分为A组和B组,分别予早产儿配方奶及标准Ⅰ期婴儿配方奶以最大限度的胃肠喂养,比较两组的早期体重下降、平均体重增长和胃肠耐受性.结果两组早期体重下降数(85.7%vs 80.9%)、最大体重下降值(7±4.8%vs 5.5±3.9%)、体重下降＞10%者(17.9%vs 6.4%)均无统计学差异(P均＞0.05);两组晚发性酸中毒发生率(14.3%vs 6.4%)及1～4w胃肠不耐受发生率亦无统计学差异(P均＞0.05);A组第2w后、B组第3w后的平均体重增长均＞10g/(kg.d).结论选择合适的奶方和喂养措施,可以使早产低体重儿达到较好的体重增长.     

早产儿不同喂养方法时血浆胃动素变化的研究

目的比较早产儿生后早期间断鼻十二指肠喂养和鼻胃管喂养对进奶量、生长情况、喂养相关并发症的影响及血浆胃动素的变化.方法将40例早产儿随机分为鼻十二指肠喂养和鼻胃管喂养组,用同一种配方乳喂养.记录喂养1用的入液量、体格生长指标、大便性状、喂养相关并发症.测定喂养前及喂养1w后血浆胃动素水平.结果喂养后1周鼻十二指肠喂养组较鼻胃管喂养组平均进奶量显著增加(P＜0.001);恢复出生体重时间明显缩短(P＜0.05);高胆红素血症发生率显著减少(P＜0.01).两组喂养1w后身长、头围的变化无明显差异(P＞0.05),但两组血浆胃动素水平均较喂养前显著增加(P＜0.001).结论间断鼻十二指肠喂养是早产儿生后早期较适宜的喂养方法.     

早产儿肠道喂养方式对住院期间变应性疾病的影响

目的 评估早产儿不同肠道喂养方式对外周血嗜酸性粒细胞（EOS）水平及住院期间变应性疾病发生的影响。方法 比较早产儿三种喂养方式（母乳、早产奶、部分水解配方奶）下外周血嗜酸性粒细胞的区别及变应性疾病的发生率。结果 病例组中存在家族过敏史的比例高于对照组,差异具有统计学意义（P＜0.05）;达全胃肠道喂养时,病例组的EOS-2水平明显高于对照组,差异具有统计学意义（P＜0.05）;早产奶喂养的外周血EOS-2水平在病例组和对照组中比较差异具有统计学意义（P＜0.05）。结论 除了受家族过敏史影响,早产儿选择母乳或部分水解配方奶喂养可以降低外周血EOS水平,降低变应性疾病的发生。     

配方奶对母乳哺育影响并不大

多年来,医学上一直都认为配方奶会干扰母乳哺育。但最新研究指出,这个问题的答案并不那么绝对。这项研究追踪164名婴儿的喂养情况,这些婴儿在出生后1至3 d进行母乳喂养,并且体质量减轻的幅度大于或等于同年龄婴儿体质量的75%,也就是有严重喂养不足的情况。研究让其中50%的母亲继续纯母乳喂养;另外50%的母亲在每次喂完母乳后,再补充配方奶,并在有较充足母乳时停止使用配方奶。     

谷氨酰胺与无乳糖配方奶喂养治疗坏死性小肠结肠炎患儿疗效观察

目的探讨谷氨酰胺与无乳糖配方奶喂养对坏死性小肠结肠炎早产儿免疫功能、胃肠激素的影响。方法选择56儿坏死性小肠结肠炎患儿为研究对象,采用随机数字表法分为观察组与对照组各28例,两组患儿均给予综合对症治疗,在此基础上,观察组给予谷氨酰胺与无乳糖配方奶喂养,对照组给予谷氨酰胺与早产儿配方奶喂养。喂养14d后,比较两组患儿免疫功能、胃肠激素、体质量变化及治疗效果。结果免疫功能:观察组Ig A、Ig G、Ig M、CD4+、CD4+/CD8+均明显高于对照组,CD8+明显低于对照组,差异有统计学意义(t=5.482~6.271,P0.05);胃肠激素:观察组胃动素、胃泌素水平明显高于对照组(t=7.178~8.211,P0.05);体质量:观察组体质量明显高于对照组(t=2.340,P0.05)。结论谷氨酰胺与无乳糖配方奶喂养有助于改善儿坏死性小肠炎患儿免疫功能及胃肠功能,促进患儿健康成长。     

38例极低体重儿部分静脉营养临床探讨

目的观察部分静脉营养对极低体重儿的临床疗效.方法将38例极低体重儿随机分为治疗组18例和对照组20例,治疗组在时照组的基础上,于出生3～5d开始静脉营养,同时根据患儿胃肠耐受情况,鼻饲喂养母乳或早产儿配方奶.结果治疗组18例平均每日体重增加22.6±4.2g,平均住院时间28.5±5.2d,治愈14例,治愈率94.4%,对照组20例平均每日体重增加10.5±5.6g,平均住院时间34.5±3.8d,治愈14例,治愈率70%,两组间平均每日增加体重,治愈时间,治愈率经统计学处理,前两者t检验,t值分别为7.47,4.09,P＜0.05,治愈率经卡方检验,P＜0.05,两者差异有显著性.结论部分静脉营养能保证极低体重儿能量供应,促进体重增长机体康复疗效显著,基本无副作用.     

家庭整合护理对NICU早产儿母乳喂养率及生长发育的影响

目的分析家庭整合护理对NICU早产儿喂养状况及生长发育的影响。方法选择86例NICU早产儿作为研究对象,随机分为观察组与常规组,每组各43例。常规组患儿予以NICU早产儿护理,观察组患儿则采用家庭整合护理。比较两组早产儿护理后的母乳喂养率及经口喂养率,记录日体重增长量、白蛋白值及住院时间。结果护理干预后第6d,观察组早产儿母乳喂养率明显高于常规组,差异具有统计学意义(P0.05),但两组早产儿的经口喂养率比较,差异无统计学意义(P0.05);观察组早产儿日增长体重和白蛋白水平均显著高于常规组,差异具有统计学意义(P0.05);两组早产儿住院时间比较,差异无统计学意义(P0.05)。结论家庭整合护理能更好地改善NICU早产儿的喂养状况,有助于早产儿的生长发育。     

非营养性吸吮在早产儿胃食管返流中的临床应用

目的观察非营养性吸吮治疗早产儿胃食管返流的疗效，评估对胃食管返流早产儿血胃泌素、胃动素及胃排空的影响。方法将早产几胃食管返流惠儿145例随机分为治疗组（74例）和对照组（71例），两组均根据体重和出生日龄计算热卡，用同一种配方乳喂养，喂养不足的部分给予静脉营养补足，治疗组加用非营养性吸吮。通过食管复方泛影葡胺（compound meglumine diatrizoate）造影，观察患儿1至2周后呕吐症状及食管复方泛影葡胺造影返流情况；记录7d、14d胃残留率的变化；同时1至2周后放免法测定血胃泌素、胃动素水平，7d、14d实时超声测定胃排空。结果治疗组7d、14d胃残留发生率低于对照组，差异有统计学意义（P〈0．05）、治疗组7d、14d胃半排空时间快于对照组，差异有统计学意义（P〈0．01）。治疗组1、2周胃泌素水平治疗组为高于对照组，差异有统计学意义（P〈0．05）；出生时胃动素水平差异无统计学意义，治疗组1、2周胃动素水平为高于对照组，且明显增加，差异无统计学意义（P〉0．05）。结论非营养性吸吮治疗早产儿胃食管返流疗效显著，安全、有效，不良反应少，可促进胃泌素分泌，加快胃排空，有利于早产儿生后胃肠功能的发育，值得临床推广应用。     

母乳喂养对比配方奶喂养对足月新生儿组织血氧饱和度、血红蛋白浓度指数及肠道菌群的影响

目的:对比母乳喂养与配方奶喂养对足月新生儿组织血氧饱和度、血红蛋白浓度指数及肠道菌群的影响.方法:选取2020年6月至2020年12月500例于上海市第一妇婴保健院出生的足月新生儿为研究对象,按喂养方式的不同分为母乳喂养组(n=238)与配方奶喂养组(n=262).比较两组新生儿生长发育指标(体重、身长、头围)、组织血...     

小剂量红霉素与吗丁啉治疗早产儿喂养困难疗效比较

目的探讨小剂量红霉素对早产儿喂养困难的疗效.方法将两年间于住院期间出现喂养困难的早产儿随机分成两组,治疗组38例用小剂量红霉素3～5mg(g.d)治疗,对照组36例用吗丁啉治疗.结果两组显效率分别为76.32%和72.22%,υ=0.40(<1.96),P>0.05;总有效率分别为96.74%和91.67%,υ=0.53(<1.96),P>0.05,均无显著差异.两组呕吐、奶量不增和胃潴留的症状缓解天数亦无显著性差异(P<0.05).结论临床上对喂养困难的早产儿可以采用小剂量红霉素治疗,以促进胃肠动力,提高喂养的耐受性.     

Improved use of the [13C]octanoic acid breath test as intra-individual parameter to study the effect of a prokinetic drug on gastric emptying in preterm infants with oral feeding intolerance

The [13C]octanoic acid breath test was used for the measurement of differences in gastric emptying in preterm infants for the evaluation of pharmacological therapy. In order to perform a good intra-individual comparison of the gastric emptying in preterm infants under non-standardisable test conditions, we adjusted t1/2 for variations in non-recovered label (=label retention) and introduced an "effective half 13CO2 breath excretion time" t1/2eff = t1/2/m expressed as min per percentage of the cumulative dose recovered. In a pilot study, we investigated the action of the gastrointestinal prokinetic drug cisapride on gastric emptying in seven premature infants, of whom four suffered from gastric stasis and three had constipation. The postnatal age and weight at the start of treatment ranged from 15 to 64 days and from 815 to 1635 g, respectively. All infants received the standard formula for premature infants (Nenatal, Nutricia). Cisapride was administered orally 0.2 mg/kg, four times daily. The changes in gastrointestinal motility were studied using the total bowel transit time of carmine red. After 7 days of treatment in all children, the gastric emptying coefficient and the half 13CO2 breath excretion time adjusted for label retention were improved (n=7, the gastric emptying coefficient range before treatment was 1.69-3.34 (mean 2.59 +/- 0.80) and after treatment it was 2.79-3.76 (mean 3.28 +/- 0.30); the half 13CO2 breath excretion time adjusted for label retention range before treatment was 3.0-14.7 min/% dose (mean 7.0 +/- 5.0) and after treatment 2.6-4.0 min/% dose (mean 3.1 +/- 0.6). The total bowel transit time was only slightly improved in two patients (n=7, mean total bowel transit time before: 23.7 h compared to mean total bowel transit time after 7 days of treatment: 35.5 h). Side effects during cisapride treatment were not seen. We conclude that in premature infants cisapride is effective in shortening gastric emptying time and reducing gastric stasis; the therapeutic role in constipation has to be further investigated.     

喂养方式与新生儿高胆红素血症的关系

将229例足月健康新生儿(Apgar评分8～10分)按照喂养的方式分为母婴同室和混合喂养两组,观察在两种喂养方式下高胆红素血症的发病率和血清胆红素的水平。结果表明,两组新生儿的高胆红素血症发病率没有显著性差异,母婴同室的高胆红素血症发病率并没有高于混合喂养组,但母婴同室组的血清胆红素水平却明显低于混合组(P<0.02)。尤其在不明原因黄疸的新生儿中,两种喂养方式下的血清胆红素水平有非常显著的差异(P<0.001)。喂养方式在ABO血型不合、G-6-PD缺陷、母HBsAg阳性等因素组的新生儿高胆红素血症的发病率和血清胆红素水平中影响不大。母婴同室可降低新生儿血清胆红素水平,提高新生儿的机体状态。     

Serum IgE in healthy infants fed breast milk or cow's milk-based formulas

A group of ninety-five infants was followed from birth to one year of age, and the total serum IgE concentration was studied. The infants were fed on breast milk, home-prepared cow's milk formula, or proprietary infant milk formula. Solid foods were introduced at 3.5 months of age. The breast milk group had lower IgE than the cow's milk group up to 4 months of age, i.e. until the end of exclusive milk feeding. The formula group had intermediate IgE values. The difference was not due to the presence of IgE antibodies to cow's milk in the bottle-fed infants, since no such antibodies could be detected. After the introduction of solid foods the differences between the groups disappeared. Our data suggest that exclusive breast milk feeding can reduce total serum IgE concentration in early infancy. Reference values for unselected infants and for infants with no atopic manifestations are reported.     

A study of serum bilirubin in neonates in relation to the maternal age

A comparative study of neonatal serum bilirubin levels was done in neonates of different age groups of mothers. A total 122 healthy, new borns were selected for the study, born at Queen Mary's Hospital, Lucknow. Mothers were divided into two groups i.e. < 30 years and > 30 years of age. Samples of blood were collected thrice, first on day 1 from cord blood, 2nd and 3rd on days three and five of life from neonates by heel prick method, using small bore capillaries for blood collection, serum bilirubin estimation were done by the method of Malloy & Evelyn and Mean +/- SD were calculated. P-Value was observed between different age groups. In both the groups of mothers i.e. < 30 years and > 30 years serum bilirubin levels in their neonates raised to highly significant levels on day 3 (P-Value < 0.001) as compared to their cord blood serum bilirubin levels. On comparing serum bilirubin levels in neonates of both the maternal groups, it was observed that there is no significant difference between two groups on day of birth and day day 5 but statistically significant difference was observed on day 3 (P < 0.05), serum bilirubin levels were higher in neonates of younger age group mothers.     

Prevention of Cytomegalovirus Transmission via Breast Milk in Extremely Low Birth Weight Infants

Purpose

Extremely low birth weight infants (ELBWIs) have a high risk of acquiring cytomegalovirus (CMV) infection via breast milk and consequently developing serious symptoms. We evaluated whether freeze-thawing or pasteurization could prevent postnatal CMV infection transmitted through breast milk in ELBWIs.

Materials and Methods

Medical records of 385 ELBWIs with whole milk feeding, and freeze-thawed or pasteurized breast milk feeding were reviewed retrospectively. Postnatally acquired CMV infection was defined as an initial negative and a subsequent positive on follow-up urine CMV DNA polymerase chain reaction screening tests. The incidence, clinical characteristics, symptoms, sequelae, and long-term outcome at corrected age [(CA): 2 years of CMV infection] were analyzed.

Results

While no infant developed CMV infection with whole milk (0/22) or pasteurized breast milk (0/62) feeding, postnatal CMV infection was diagnosed in 8% (27/301) of ELBWIs who were fed freeze-thawed breast milk. Gestational age in the CMV group was significantly lower than the control group. In 82% (22/27) of cases, CMV infection was symptomatic and was associated with increased ventilator days and ≥moderate bronchopulmonary dysplasia (BPD). Neurodevelopmental outcome and growth status at CA 2 years were not different between the study groups. Lower gestational age and freeze-thawed breast milk feeding >60% of total oral intake during the first 8 postnatal weeks were independent risk factors for acquiring postnatal CMV infection. BPD (≥moderate) was the only significant adverse outcome associated with this CMV infection.

Conclusion

Pasteurization but not freeze-thawing of breast milk eradicated the postnatal acquisition of CMV infection through breast milk.     

Examining the side effects of sucrose for pain relief in preterm infants: a case-control study

Sucrose solution is recommended as relevant pain relief management in neonates during acute painful procedures; however, only a few studies have analyzed the potentially adverse effects of sucrose administration to preterm neonates. The goal of this study was to examine the potential side effects of sucrose for pain relief in preterm infants, assessing feeding and weight gain during hospitalization and their feeding patterns postdischarge. The study sample consisted of 43 preterm neonates divided into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which no sucrose was administered. The SG received 0.5 mL/kg 25% oral sucrose for 2 min prior to all acute painful procedures during three consecutive days. A prospective review of medical charts was performed for all samples. The study was done prior to implementation of the institutional sucrose guidelines as a routine service, and followed all ethical requirements. There were no statistically significant differences between groups in terms of weight gain, length of stay with orogastric tubes, and parenteral feeding. Postdischarge, infant nutritional intake included feeding human milk to 67% of the SG and 74% of the CG. There were no statistically significant differences between groups regarding human milk feeding patterns postdischarge. Neonate feeding patterns and weight gain were unaffected following the short-term use of sucrose for pain relief.     

The relationship between ghrelin and adiponectin levels in breast milk and infant serum and growth of infants during early postnatal life

Ghrelin and adiponectin have been found in breast milk and are considered to take part in the regulation of growth and energy metabolism of infants. Our aims were to determine ghrelin and adiponectin levels in breast milk and serum samples of mothers and their infants, and to investigate the relationship between their levels and anthropometry of newborn infants during early postnatal life. Total and active ghrelin and adiponectin levels were studied in breast milk, and the serum samples of 25 healthy lactating women and their healthy fullterm infants were taken at the 1st and 4th months of life. Anthropometric measurements of infants were also performed during the study period. Breast milk and infant serum active ghrelin levels were found to be significantly increased at the 4th month of life compared with 1st month levels (p < 0.05). Maternal serum total ghrelin and infant serum adiponectin levels were found to be significantly reduced at the 4th month of life (p < 0.05). Breast milk active ghrelin levels were higher than the infant and maternal serum active ghrelin at the 1st and 4th months (p < 0.05). There was a negative significant correlation between the level of infant serum active ghrelin levels and BMI of infants at the 1st month. A positive significant correlation was found between the level of 1st month infant serum adiponectin levels and weight gain of infants during the study period. Fourth month infant serum adiponectin were also positively correlated with weight and BMI of infants at the 4th month and the weight gain during study period. There was a positive significant correlation between the level of 4th month breast milk active ghrelin and weight gain of infants during the study period. Ghrelin and adiponectin are involved in postnatal growth of infants. Ghrelin in breast milk also seems to be related to the growth of infants during early postnatal life. The sources of these peptides in breast milk are probably both maternal serum and breast tissue itself.     

IgG and IgA antibody levels to cow's milk are low at age 10 years in children born preterm

BACKGROUND: Both innate and specific defenses of the preterm infant are even less developed than those of term infants, and the immune systems of preterm infants might be skewed differently at birth. Their immune responses to food antigens started early in life might therefore differ from those of term infants. OBJECTIVE: We sought to compare antibody levels to cow's milk, ovalbumin, and gliadin at age 10 years in children who had been born either preterm or at term. METHODS: IgG and IgA isotype antibodies to whole cow's milk, beta-lactoglobulin, alpha-casein, and ovalbumin, as well as IgG antibody levels to gliadin and to tetanus and diphtheria toxoids, were measured for a group of 62 children born preterm and 61 control subjects born at term. These children were studied at the same time for atopy. RESULTS: Children born preterm had markedly lower levels of antibodies to cow's milk and to its protein fractions (P <.0001 for IgA and IgG antibodies to cow's milk and alpha-casein and IgG beta-lactoglobulin antibodies). IgG gliadin antibodies were also significantly lower in the preterm group (P =.03), although the difference was not significant for IgG ovalbumin antibodies. In the preterm group both those born before gestational week 30 and those given cow's milk-based formula early (before day 50) had the lowest levels of cow's milk antibodies. In the preterm group atopy was associated with low levels of IgG cow's milk antibodies but with high levels of IgG ovalbumin antibodies. CONCLUSIONS: Early introduction of food antigens into the immature gastrointestinal tract of preterm infants might result in tolerance. The presence of less atopy in these children might also be a result of tolerance development.     

Triple antiretroviral prophylaxis administered during pregnancy and after delivery significantly reduces breast milk viral load: a study within the Drug Resource Enhancement Against AIDS and Malnutrition Program

BACKGROUND: The administration of antiretroviral therapy to lactating women could represent a possible strategy to reduce postnatal HIV transmission. In this study, we assessed the effect of antiretroviral treatment on breast milk viral load and determined plasma and breast milk drug concentrations in pregnant women receiving highly active antiretroviral therapy (HAART). METHODS: We studied 40 women receiving zidovudine, lamivudine, and nevirapine from 28 weeks of gestation to 1 month postpartum (group A) and 40 untreated pregnant women (group B). Blood and breast milk samples were collected at delivery and 7 days postpartum. RESULTS: Women in group A had received a median of 85 days of therapy before delivery. Median breast milk concentrations of nevirapine, lamivudine, and zidovudine were 0.6, 1.8, and 1.1 times, respectively, those in maternal plasma. HIV RNA levels in breast milk were significantly lower in group A than in group B (median of 2.3 vs. 3.4 log at delivery and 1.9 vs. 3.6 log at day 7; P < 0.001 for both comparisons). CONCLUSIONS: Antiretroviral drugs administered during the last trimester of pregnancy and after delivery reach levels similar to or higher than plasma concentrations in breast milk and can significantly reduce HIV RNA levels. Our data support the potential role of maternal HAART prophylaxis in reducing the risk of breast-feeding-associated transmission.