住院早产超低和极低出生体重儿强化母乳喂养的前瞻性对照研究

目的：通过前瞻性部分随机分组对照研究分析强化母乳喂养对住院早产超低和极低出生体重儿生长发育和内环境的影响，评估其有效性及安全性。方法：将符合研究条件的122例早产超低和极低出生体重儿分为强化母乳组（human milk fortification, HMF组，62例）和早产儿配方奶组（premature formula feeding, PF组，60例），比较两组早产儿体格发育指标（体重、身长、头围、上臂围）、宫外生长迟缓发生率、血红蛋白水平、骨代谢情况及合并症发生率。结果：（1）HMF组周平均身长增长率高于PF组［(0.89±0.23) cm/week vs. (0.79±0.34) cm/week，P=0.04］，两组日平均体重增长率、周平均头围增长率和周平均上臂围增长率组间差异无统计学意义（P>0.05）；（2）HMF组最低体重出现时间［(5.58±2.48) d vs. (4.37±2.06) d, P=0.004］、恢复出生体重时间［(10.13±4.03) d vs. (8.03±3.28) d, P=0.002］和静脉营养使用时间［(16.77±6.63) d vs. (14.23±4.15) d, P=0.01］均明显长于PF组，总住院时间和开始喂养时间比较两组间差异无统计学意义（P>0.05）；（3）两组患儿出院时体重、头围、身长、宫外生长迟缓发生率相比较差异无统计学意义（P>0.05）；（4）入院时和出院时两组患儿血红蛋白水平相比较差异均无统计学意义（P>0.05）；（5）入院时HMF组钙水平明显低于PF组［(2.19±0.22) mmol/L vs. (2.32±0.27) mmol/L, P=0.005］,出院时HMF组碱性磷酸酶水平明显高于PF组［(363.98±122.49) mmol/L vs. (299.73±117.39) mmol/L, P=0.004］；（6）HMF组喂养不耐受发生率（6.5% vs. 18.3%，P=0.04）、败血症发生率（4.8% vs. 16.7%，P=0.03）明显低于PF组，早产儿视网膜病变、慢性肺疾病、坏死性小肠结肠炎发生率两组比较差异无统计学意义（P>0.05）。结论：早产超低和极低出生体重儿住院期间强化母乳喂养可以获得与早产配方奶喂养相似的体格生长速率且更有利于钙吸收，强化母乳喂养可以减少早产超低和极低出生体重儿败血症、喂养不耐受的发生，同时不增加坏死性小肠结肠炎的发生率。

Prospective and controlled study on effect of fortified human milk feeding on infants with extremely and very low birth weight during hospital stay

Objective:To explore the effect of fortified human milk feeding on growth and complica-tions of infants with extremely and very low birth weight (ELBW/VLBW)during hospital stay by a pro-spective,random and controlled study.Methods:In the study,1 22 ELBW/VLBW infants were enrolled and divided into two groups.The infants fed with human breast milk,combined with human milk fortifi-cation (HMF)during hospital stay were named HMF group (n=62),and those fed exclusively with pre-mature formula were named premature formula feeding group (PF group,n=60 ).The data of the in-fants’growth (the velocity of increase on the weight,length,head circumference and upper arm circum-ference),the time of rebounding to birth weight,the time of needing intravenous nutrition,the time of hospitalizing,the proportion of extrauterine growth retardation (EUGR)during hospital stay,the level of hemoglobin,bone metabolism and incidence of complications were compared between the two groups. Results:Among the 1 22 infants included,(1 )the length increment in HMF group was higher than PF group [(0.89 ±0.23)cm/week vs.(0.79 ±0.34)cm/week,P=0.04];there were no significant differences in the weight gain,head circumference increment and upper arm circumference increment (P>0.05);(2)the age of rebounding to birth weight [(1 0.1 3 ±4.03)d vs.(8.03 ±3.28)d,P=0.002]and the duration of intravenous nutrition [(1 6.77 ±6.63)d vs.(1 4.23 ±4.1 5)d,P=0.01 ] in HMF group were longer than that in PF group,there were no significant differences between the two groups in the hospital stay and age achieved feeding;(3 )there were no significant differences between the two groups in the incidence rate of EUGR during hospital stay (P>0.05);(4)the level of calcium at birth in HMF group was lower than that in PF group [(2.1 9 ±0.22)mmol/L vs.(2.32 ±0.27) mmol/L,P=0.005 ],and the level of alkaline phosphatase (AKP)in HMF group at discharge was higher than in PF group [(363.98 ±1 22.49)mmol/L vs.(299.73 ±1 1 7.39)mmol/L,P=0.004];(5)the incidence of the feeding intolerance (6.5% vs.1 8.3%,P=0.04)and sepsis (4.8% vs. 1 6.7%,P=0.03)in HMF group were less than in PF group,there were no significant differences be-tween the two groups on the morbidity of necrotizing enterocditis,retinopathy of prematurity (ROP),and bronchopulmonary dysplasia (BPD)(P>0.05).Conclusion:HMF for premature infants may ensure the same growth pattern as those fed by premature formula,promote the calcium absorption,decrease the inci-dence of sepsis and feeding intolerance,and does not increase the incidence of necrotizing enterocolitis.