哈尔滨地区早产儿母乳营养素含量的调查研究

目的 了解当前哈尔滨地区早产儿母乳中各种营养素的含量，为研制国内早产儿强化母乳提供科学依据，为更加合理喂养早产儿促进其健康成长提供科学依据。方法 收集哈尔滨市四个地区62名产妇的乳汁（早产儿初乳32份、成熟乳28份；足月儿初乳及成熟乳各30份），测定乳汁中蛋白质、脂肪、钙、磷、镁、铜、铁、锌、锰的含量。结果 哈尔滨地区早产儿母乳中蛋白质、磷、锌、镁在成熟乳期下降明显，铁、铜略有下降，但差异无统计学意义，脂肪、锰随泌乳期呈上升趋势，钙无明显变化。早产儿母乳在初乳及成熟乳期蛋白质含量均高于足月儿母乳，其他元素差异两者间无统计学意义。结论 早产儿母乳中蛋白质、锌、脂肪含量在成熟乳阶段含量偏低，建议适当补充，注意喂养。     

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。     

母乳锌,铜含量的研究

随机测定７０名初产妇中的４５份初乳及４２份成熟乳锌，铜含量，并测定相应的母血清含量，结果表明，母乳锌，铜水平随产后时间推移而下降，且母血锌，铜水平与初乳锌，铜水平无相关，提出母乳锌，铜分泌可能既受自身调节控制，又受母乳其他成分分泌的影响。     

早产儿及其母亲体内钙 铁 镁含量的研究

目的：研究早产儿母亲孕前孕期钙、铁、镁摄入情况,早产儿及其母亲体内钙、铁、镁含量,从早产儿的营养影响因素方面初步探讨早产的发病机制,并为预防早产提供依据。方法：选取严格配对的病例和对照共240例作为研究对象,对母亲怀孕前和怀孕期间钙、铁、镁的摄入情况进行膳食调查,ICP-OES法对血浆、羊水、胎盘、母乳、胎粪多种生物样本中钙、铁、镁的水平进行检测和统计分析。结果：怀孕期间,早产儿母亲铁和镁的摄入量亦均显著低于足月儿母亲（P<0.05）,怀孕前铁和钙的摄入量亦均显著低于足月儿母亲（P<0.05）。多元方差分析结果显示早产儿母亲体内的钙、铁含量显著低于足月儿母亲（P<0.05）;早产儿体内铁、镁含量明显低于足月儿（P<0.05）。母亲和新生儿的血浆钙、铁和镁水平都呈显著正相关（P<0.05）。结论：早产儿母亲体内钙、铁含量低于足月儿母亲,早产儿体内的铁、镁含量低于足月儿。有关反映钙、铁和镁含量的指标与母亲在孕前孕期摄入情况的关系还有待进一步研究。     

早产母乳营养成分的分析

目的 探讨早产儿母亲乳汁营养成分的特点及动态变化。方法 收集2012 年11 月至2014 年1月在北京协和医院产科分娩产妇170 人的母乳339 份,用MIRIS 母乳分析仪检测母乳中宏量营养素及能量,比较各组母乳营养成分的差异。结果 （1）早产母乳中蛋白质含量：初乳> 过渡乳> 成熟乳（2.22±0.49 g/dL vs1.83±0.39 g/dL vs 1.40±0.28 g/dL;PPPPP+1~33+6 周组（2.11±0.25 g/dL）和≥ 34 周组（2.22±0.39 g/dL）比较差异有统计学意义（P+1~33+6 周（51±6 kcal/dL vs 58±8 kcal/dL,P+1~33+6 周组和≥ 34 周组（P+1~33+6 周成熟乳蛋白质显著高于≤ 30 周和≥ 34 周组（P结论 （1）早产初乳、过渡乳和成熟乳营养成分差异显著;（2）早产初乳蛋白质显著高于足月初乳,这种差异未能持续到成熟乳阶段;（3）不同孕周早产产妇母乳营养成分亦存在差异,以适应不同胎龄早产儿的营养需要。     

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。     

母发、子发、母乳微量元素配对分析

为了探讨母发、于发、母乳之间的微量元素关系，我们对12名产妇的头发、乳汁及其新生儿的头发作了微量元素锡、锌、铁、钙、镁测定。对象为本院分娩的12名初产妇，孕期体检正常。12例配对的新生儿足月健康，产后1无～7天。每天上午（9～］0）时每名产妇各收集母了L约10ml。海份乳样分别检测微量元素的含量。产后8天内收集产妇及其新生儿头发标本各1价送检。测定方法均采用原子吸收光谱法则C京第二光学仪器厂出品）。结果见表1，表2。讨论一、母乳微量元素锡、锌、铁、钙、镁的含量第1天最高，第2大迅速下降，幼S天以后虽然呈下降趋势，但…     

佝偻病患儿血清微量元素比值的临床意义

目的研究佝偻病患儿血清微量元素的含量及其比值的临床意义。方法采用原子吸收光谱法,测定56例活动期佝偻病患儿、7l例健康小儿血清微量元素锌、铜、铁、锰、钙和镁的含量,并计算它们的比值。结果与健康儿童比较,佝偻病患儿血清Ca／Mg、Cu／Fe、Zn／Fe的比值下降,Cu／Zn比值升高,差异非常显著(P＜0.01)。佝偻病患儿血清钙、锌含量下降,佝偻病与血清钙、锌之间呈负相关关系,相关系数分别为-0.6542和-0.1683;血清铜、铁、镁含量高于正常儿;而锰含量两组之间无显著性差异。结论除低钙外,低锌可能也参与了佝偻病的发生发展。在佝偻病的防治中,应注意微量元素的平衡,适当补充锌制剂。     

早产儿消化系统的特点及喂养

早产儿良好的生存离不开有效的营养 ,而这又有赖于胃肠道消化吸收功能、粘膜屏障功能和动力的成熟与完善 ,早产儿这些功能都不成熟 ,前两方面的缺陷可通过应用特殊的早产儿配方乳或母乳强化剂来克服 ,而胃肠道动力的不成熟只能采用合适的喂养方法来解决。1　早产儿消化系统特点1.1　胃肠道动力的特点[1] 　①尽管孕 15周就可检测到胎儿口部的吸吮动作 ,但协调的吸吮和吞咽要到 34周才成熟 ,因此较小的早产儿易发生乳汁吸入。②协调的食管蠕动存在于孕 32周时 ,然而与足月儿相比 ,其收缩幅度、传播速度及下食管括约肌压力均是降低的 ,因此比…     

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。     

Comparison of the phospholipid classes in human milk in Japanese mothers of term and preterm infants

Background: Phospholipids (PLs) play an essential role in the growth and brain development of infants. Aim: To investigate PL composition in human milk (HM), including lysophosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, phosphatidylserine, phosphatidylcholine (PC) and sphingomyelin (SM), from healthy Japanese mothers. Analyses were performed on colostrum, transitional milk and mature milk from mothers of preterm and term infants. Methods: HM samples were collected from mothers of 15 term infants (term group) and of 19 preterm infants (preterm group). PL composition was determined by two-dimensional thin-layer chromatography in conjunction with phosphorus analysis. Results: In both groups, the PL content (% of total lipid) of mature milk was significantly lower than in colostrum. SM and PC were the main PLs in HM, but in the preterm group, the percentage of SM in mature milk was significantly higher and PC in mature milk was significantly lower than in the term group.

Conclusion: The transition from colostrum to mature milk leads to an increase in SM and a decrease in PC in the HM of preterm infants, along with a decrease in PL content. This is the first report to demonstrate the differences in PL composition in HM between mothers of preterm and term infants.     

Cellular composition including lymphocyte subsets in preterm and full term human colostrum and milk.

The cellular composition of colostrum (within 72 hours post partum) and mature milk samples (5th-7th day post partum) from 20 mothers delivering preterm babies and 20 mothers delivering full term babies was examined. Lymphocyte subsets including T cells, B cells, T4 and T8 cells were quantitated by indirect immunoperoxidase staining using specific monoclonal antibodies. The mean total cell count in preterm colostrum (9,338/mm3) was significantly higher than in full term colostrum (5,594/mm3). Similarly, counts for macrophages, neutrophils and lymphocytes were significantly higher in preterm colostrum and milk as compared to full term colostrum and milk. B and T lymphocytes including T4 and T8 cells were identified in both preterm and full term breast milk. The absolute count of T, B, T4 and T8 cells was significantly higher in preterm colostrum compared to term colostrum, though the relative percentage distribution of lymphocyte subsets showed no significant difference between the two groups. T and B cells constituted about 74% and 26% of total lymphocytes, respectively in preterm as well as full term colostrum and about 69% and 31% in preterm and full term milk. The mean T4/T8 ratio was higher in preterm colostrum than term colostrum, being 1.82 and 1.60 respectively. However, this difference was not significant statistically and did not change statistically in the milk sample.     

Cellular Composition Including Lymphocyte Subsets in Preterm and Full Term Human Colostrum and Milk

ABSTRACT. The cellular composition of colostrum (within 72 hours post partum) and mature milk samples (5th–7th day post partum) from 20 mothers delivering preterm babies and 20 mothers delivering full term babies was examined. Lymphocyte subsets including T cells, B cells, T⁴ and T⁸ cells were quantitated by indirect immunoperoxidase staining using specific monoclonal antibodies. The mean total cell count in preterm colostrum (9 338/mm³) was significantly higher than in full term colostrum (5 594/mm³). Similarly, counts for macrophages, neutrophils and lymphocytes were significantly higher in preterm colostrum and milk as compared to full term colostrum and milk. B and T lymphocytes including T⁴ and T⁸ cells were identified in both preterm and full term breast milk. The absolute count of T, B, T⁴ and T⁸ cells was significantly higher in preterm colostrum compared to term colostrum, though the relative percentage distribution of lymphocyte subsets showed no significant difference between the two groups. T and B cells constituted about 74% and 26% of total lymphocytes, respectively in preterm as well as full term colostrum and about 69% and 31% in preterm and full term milk. The mean T⁴/T⁸ ratio was higher in preterm colostrum than term colostrum, being 1.82 and 1.60 respectively. However, this difference was not significant statistically and did not change statistically in the milk sample.     

The impact of gestational length on human milk selenium concentration and glutathione peroxidase activity

Longitudinal changes in selenium (Se) and protein concentrations and glutathione peroxidase (GSH-Px) activity of milk collected from healthy mothers of term (n = 12), preterm (n = 10), and very preterm (n = 12) infants were assessed. All infants were size appropriate for gestational age. Milk samples representative of colostrum (d 3), transitional (d 7), and mature milk (d 21 and 42) were assayed. The content of Se in the colostrum secreted by mothers of preterm infants was significantly greater than the Se content of milk secreted by the same mothers at d 21 and 42 of lactation. Mothers of term and very preterm infants, however, produced colostrum with significantly higher levels of Se than milk produced at d 7 (p less than 0.05), d 21 (p less than 0.01), or d 42 (p less than 0.001). Significant differences between the protein concentrations measured in early lactation and in late lactation were evident in all maternal groups. Protein content did not differ significantly among groups at anytime during lactation. An age-related difference was detected in milk GSH-Px activities of mature milk (d 21). Mature milk produced by mothers of very preterm infants on d 21 of lactation contained significantly greater enzyme activity (p less than 0.05) than milk produced by mothers of term infants at the same stage of lactation. Activity of GSH-Px in milk from mothers of very preterm and preterm infants paralleled previously noted changes in long-chain polyunsaturated fatty acid content in human milk with the progression of lactation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mineral composition of the milk of mothers of premature infants during early lactation

The authors have assessed the concentration of sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), zinc (Zn), copper (Cu), manganese (Mn), lithium (Li), cadmium (Cd) and lead (Pb) in the milk of mothers with premature births, during the first month of lactation. The levels of Na, Cu and Mn were decreased and those of K, Ca, Mg, Zn and Li were unchanged. The needs of Na, Ca and Mn for the premature infants are insufficient. Li, present in all the milk samples at a constant level, seems to be a common component. The incidence of Cd in the milk of 7 mothers and of Pb in 4 milk samples indicates their clearance from the mothers' organism.     

Bile salt-stimulated lipase activity in human colostrum from mothers of infants of different gestational age and birthweight

The bile salt-stimulated lipase (BSSL) activity was measured in milk collected at 3-4 days postpartum (colostrum) from 36 mothers divided into three groups according to gestational age and birthweight of their infants. BSSL activity changed with the length of gestation. Preterm colostrum presented a mean activity significantly higher than the term groups (small-for-gestational age and appropriate-for-gestational age) which had similar values. The ratio of BSSL activity to the estimated fat content was 6.33 in colostrum of mothers who delivered preterm and 4.20 in colostrum of both groups of term mothers. These data suggest that preterm colostrum has a higher fat digesting potential than term colostrum and that it is the gestational age rather than the adequacy or non-adequacy of birthweight to gestational age that may influence the BSSL activity.     

Bile Salt-Stimulated Lipase Activity in Human Colostrum from Mothers of Infants of Different Gestational Age and Birthweight

ABSTRACT. The bile salt-stimulated lipase (BSSL) activity was measured in milk collected at 3–4 days postpartum (colostrum) from 36 mothers divided into three groups according to gestational age and birthweight of their infants. BSSL activity changed with the length of gestation. Preterm colostrum presented a mean activity significantly higher than the term groups (small-for-gestational age and appropriate-for-gestational age) which had similar values. The ratio of BSSL activity to the estimated fat content was 6.33 in colostrum of mothers who delivered preterm and 4.20 in colostrum of both groups of term mothers. These data suggest that preterm colostrum has a higher fat digesting potential than term colostrum and that it is the gestational age rather than the adequacy or non-adequacy of birthweight to gestational age that may influence the BSSL activity.     

Anti-Infective Factors in Preterm Human Colostrum

ABSTRACT. Feeding of the infection prone preterm neonate with concentrated immunologically active ingredients in the form of colostrum may have even more significant clinical implications than in the full term infants. The scarcity of knowledge on anti-infective factors in colostrum of mothers delivering prematurely prompted us to carry out this study. Colostrum was collected and analysed from 25 mothers delivering prematurely (Study group) and 10 delivering at term (Control group). Major anti-infective factors namely IgA, IgG, IgM, lactoferrin and lysozyme were quantitated and total cell, macrophage, lymphocyte and neutrophil counts were performed. The mean concentrations of IgA, lysozyme and lactoferrin of preterm colostrum were significantly higher than in full term colostrum (p <0.001). IgG and IgM were found to be similar in both groups. The absolute counts of total cells, macrophages, lymphocytes and neutrophils were found to be significantly higher in the preterm colostrum as compared to the full term colostrum (p < 0.001). Though in both the groups IgA was the predominant immunoglobulin, the mean percentage of IgA in the study group was significantly higher as compared to the control group. Degree of prematurity did not have any influence on the anti-infective protein levels in colostrum. However total cells and macrophages were significantly higher in colostrum of mothers delivering severely preterm babies.     

Bacterial growth in expressed breast-milk

We determined the degree of bacterial contamination and the rate of bacterial growth in expressed breast-milk stored in a tropical environment with high ambient temperatures and humidity. Colostrum or mature milk obtained from mothers who were delivered preterm or at term was stored at room temperature (27-32 degrees C) and in a refrigerator (4 degrees C) over a 24-h period. Bacterial isolates represented normal skin flora. Our study showed that colostrum was more inhibitory than mature milk, and term colostrum more so than preterm colostrum. At room temperature, mature milk from term mothers could be stored for 6 h without a significant increase in bacterial counts. Term colostrum could be stored for 12 h without significant bacterial growth. Preterm milk could be stored for 4 hr. Our findings should be of practical value to lactating mothers without access to refrigerators.