早期母乳喂养量对极低出生体重新生儿坏死性小肠结肠炎和喂养不耐受的影响

目的研究早期母乳喂养量对极低出生体重新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)和喂养不耐受的影响。方法回顾性分析2017年6月至2018年5月在南方医科大学附属深圳妇幼保健院产科出生的275例极低出生体重儿(出生体重<1500 g)的临床资料,按照生后2周内是否母乳喂养以及母乳喂养量占总喂养量的比例,分为母乳喂养量占比>50%组(高母乳喂养量组,n=199)、母乳喂养量占比≤50%组(低母乳喂养量组,n=55)、配方奶喂养组(n=21)。3组NEC和喂养不耐受的发生率比较采用χ^2检验(或Fisher精确概率法),采用单因素和多因素logistic回归分析入院后2周内母乳喂养量对NEC和喂养不耐受的影响。结果高母乳喂养量组、低母乳喂养量组和配方奶喂养组NEC的发生率分别为1.5%(3/199)、27.3%(15/55)和9.5%(2/21)(P<0.01);喂养不耐受发生率分别为17.6%(35/199)、56.4%(31/55)和28.6%(6/21)(χ^2=34.826,P<0.01)。单因素logistic回归分析结果显示,与高母乳喂养量组相比,低母乳喂养量组和配方奶喂养组NEC发生风险增加,OR值分别为24.500(95%CI:6.755~85.594)、6.877(95%CI:1.081~43.744);低母乳喂养量组喂养不耐受发生风险增加,OR值为6.316(95%CI:3.293~12.113)。多因素logistic回归分析结果显示,与高母乳喂养量组相比,低母乳喂养量组和配方奶喂养组NEC发生风险增加,OR值分别为28.452(95%CI:7.280~111.195)和8.610(95%CI:1.262~58.766);低母乳喂养量组喂养不耐受发生风险增加,OR值为7.207(95%CI:3.601~14.425)。结论生后2周内母乳喂养量占总喂养量50%以上可能降低极低出生体重儿NEC和喂养不耐受的发生风险。

Effects of early breastfeeding volume on neonatal necrotizing enterocolitis and feeding intolerance in very low birth weight infants

Objective To study the effects of early breastfeeding volume on neonatal necrotizing enterocolitis(NEC)and feeding intolerance in very low birth weight infants.Methods This study retrospectively analyzed the clinical data of 275 cases of very low birth weight infants(birth weight<1500 g)born in Shenzhen Maternity&Child Healthcare Hospital from June 2017 to May 2018.Based on whether breastfeeding or not and the ratio of breast milk intake over the total volume of intake within two weeks after birth,they were divided into three groups:breast milk intake>50%group(>50%group,n=199),breast milk intake≤50%group(≤50%group,n=55)and formula group(n=21).Differences in the incidence of NEC and feeding intolerance among the three groups were analyzed using Chi-square test(or Fisher's exact test).Effects of breast milk intake on the incidence of NEC and feeding intolerance were evaluated using univariate and multivariate logistic regression analysis.Results The incidence of NEC in the>50%group,≤50%group and formula group was 1.5%(3/199),27.3%(15/55)and 9.5%(2/21),respectively(P<0.01),and the incidence of feeding intolerance was 17.6%(35/199),56.4%(31/55)and 28.6%(6/21),respectively(χ^2=34.826,P<0.01).Univariate logistic regression analysis showed that compared with the>50%group,the risk of NEC in the≤50%and formula group increased(OR=24.500,95%CI:6.755-85.594;OR=6.877,95%CI:1.081-43.744);that of feeding intolerance increased in the≤50%group(OR=6.316,95%CI:3.293-12.113).Multivariate logistic regression analysis showed that compared with the>50%group,the risk of NEC in the≤50%and formula groups increased(OR=28.452,95%CI:7.280-111.195;OR=8.610,95%CI:1.262-58.766);that of feeding intolerance increased in the≤50%group(OR=7.207,95%CI:3.601-14.425).Conclusions Breastfeeding accounting for more than half of the total volume of intake within two weeks after birth may reduce the incidence of feeding intolerance and NEC in very low birth weight infants.