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目的通过回顾性队列研究评价早产儿母乳喂养强化时机对早产儿住院期间生长的影响,探讨早产儿母乳喂养强化的最佳时机和进程。方法选择2009年11月至2011年3月在4家三甲医院新生儿重症监护病房住院治疗、住院期间母乳喂养量大于总喂养量50%并应用母乳强化剂的早产儿为研究对象。根据开始添加母乳强化剂的时间分为早强化组[奶量<90ml/(kg·d)即开始强化]和晚强化组[奶量≥90 ml/(kg·d)开始强化],再根据从开始添加母乳强化剂至足量强化的时间分为快强化组(1~3天完成足量强化)和慢强化组(≥4天完成足量强化)。对不同组间早产儿的合并症、肠内营养情况及生长情况进行比较。结果符合入选标准的早产儿共67例。早强化组32例,晚强化组35例,两组基本情况、坏死性小肠结肠炎(NEC)等合并症发生率、住院期间体重增长速率差异均无统计学意义(P>0.05)。早强化组出院时小于胎龄儿(SGA)比例与出生时比较差异无统计学意义(P>0.05),晚强化组出院时SGA比例较出生时增多(72.7%比42.9%,P=0.013)。快强化组41例,慢强化组26例,两组基本情况、NEC等合并症发生率差异无统计学意义(P>0.05)。快强化组住院时间更短[(34.0±15.6)天比(43.0±13.6)天,P=0.02],住院期间体重增长速率更快[(18.3±5.3)g/(kg·d)比(15.7±3.7)g/(kg·d),P=0.03]。快强化组出院时SGA比例与出生时比较差异无统计学意义(P>0.05),慢强化组出院时SGA比例较出生时更多(65.4%比30.8%,P=0.012)。结论早产儿母乳喂养晚强化或慢强化均加剧宫外生长迟缓,早强化或快强化对早产儿是安全的。建议在早产儿母乳喂养量达90 ml/(kg·d)之前开始添加母乳强化剂;足量强化应尽量在3天内完成。
Objective To evaluate the effect of breast enhancement in preterm infants on the growth of premature infants during their hospitalization by retrospective cohort study and to explore the optimal timing and progress of breastfeeding enhancement in preterm infants. METHODS: From November 2009 to March 2011, hospitalizations were performed in four NICU neonatal intensive care units. During the hospitalization, preterm infants whose breastfeeding was greater than 50% of the total feeding and breast augmentation were selected as the study subjects. According to the time of the start of adding the human milk fortifier into early strengthening group [milk <90ml / (kg · d) that began to strengthen] and late strengthening group [milk ≥ 90ml / (kg · d) began to strengthen], according to The time from the start of breast augmentation to the full fortification was divided into fast-strengthening group (adequate strengthening for 1 to 3 days) and slow strengthening group (full strengthening for more than 4 days). The comparisons, enteral nutrition and growth of preterm infants in different groups were compared. Results A total of 67 preterm infants met the inclusion criteria. There were 32 cases of early strengthening group and 35 cases of late strengthening group. There was no significant difference in the incidence of complications such as necrotizing enterocolitis (NEC) and the rate of weight gain during hospitalization between the two groups (P> 0.05). There was no significant difference in the proportion of SGA between discharge and early delivery (P> 0.05). The percentage of SGA at late delivery was higher than that at birth (72.7% versus 42.9%, P = 0.013) . Forty-one patients in the fast-strengthening group and 26 patients in the slow-strengthening group had no significant difference in the basic conditions and the incidence of complications such as NEC (P> 0.05). The fasting group had a shorter length of stay [(34.0 ± 15.6) days vs (43.0 ± 13.6 days, P = 0.02]] and a faster rate of weight gain during hospitalization (18.3 ± 5.3 g / (kg · d) vs 15.7 ± 3.7) g / (kg · d), P = 0.03]. There was no significant difference in the proportion of SGA at discharge between fasting group and at birth (P> 0.05). The proportion of SGA at discharge in the fasting group was significantly higher than that at birth (65.4% vs. 30.8%, P = 0.012). Conclusion Breastfeeding in late preterm infants with late enhancement or slow enhancement both exacerbate ectopic growth retardation. Early or fortified premature infants are safe for premature infants. It is recommended that breast-milk fortifier be added before breast-feeding in preterm infants reaches 90 ml / (kg · d); adequate fortification should be completed within 3 days.