Diet, weight gain, and head growth in hospitalized US very preterm infants: a 10-year observational study
Diet, weight gain, and head growth in hospitalized US very preterm infants: a 10-year observational study
复制标题
DOI：
10.1093/ajcn/nqz008
复制
发表时间：
2019-05-01
影响因子：
7.1
通讯作者：
Horbar, Jeffrey D.
中科院分区：
文献类型：
--
作者：
Belfort, Mandy B.;Edwards, Erika M.;Horbar, Jeffrey D.
背景资料：母乳对住院早产儿的益处已被充分证明，但目前母乳饮食足以支持生长的程度尚不确定。目的：1）量化母乳喂养的极早产儿与婴儿配方奶粉喂养的极早产儿在体重增加和头部生长方面的差异; 2）描述这些差异随时间变化的趋势。我们研究了佛蒙特州牛津网络数据库中777个美国NICU的婴儿。我们纳入了所有妊娠23-29周或出生体重401-1500 g（最大胎龄32周）的存活婴儿，排除了妊娠>42周或先天性畸形的婴儿。在饮食生长分析中，我们纳入了2012-2016年出生的婴儿（n = 138，703），以反映当前的实践。在趋势分析中，我们纳入了一个10岁队列（n = 263，367）。我们将NICU出院/转移时的饮食分类为：1）仅人乳（无配方奶粉或强化剂）; 2）人乳与配方奶粉或强化剂（混合）;或3）仅婴儿配方奶粉。结果：出院/转运时的饮食仅为母乳的18，274例（6.6%），混合的121，621例（44%），仅配方的137，067例（49%）。与仅喂养配方奶粉的婴儿相比，喂养两种人乳饮食的婴儿的体重偏离胎儿参考值的程度更大（仅喂养人乳的婴儿的体重z评分变化为-0.88;混合喂养的婴儿为-0.82;仅喂养配方奶粉的婴儿为-0.80;总体饮食的P < 0.0001）。不同饮食的头部z评分变化也存在差异（仅母乳，-0.52;混合，-0.49;仅配方，-0.45;对于总体饮食，P < 0.0001）。Themagitude的这些差异已经大大减少了10年以上的结论：非常早产儿接受母乳相比，婴儿配方奶粉饮食有一个缓慢的体重增加和头部生长在出院。
Background: The benefits of human milk for hospitalized preterm infants are well documented, but the extent to which current human milk diets adequately support growth is uncertain.Objectives: 1) To quantify differences in weight gain and head growth between very preterm infants fed human milk compared with infant formula; and 2) to describe trends in the magnitude of these differences over timeMethods: We studied infants from 777 US NICUs in the Vermont Oxford Network database. We included all surviving infants 23-29 weeks of gestation or 401-1500 g birth weight (maximum gestational age 32 wk) and excluded infants discharged >42 weeks of gestation or with congenital anomalies. In diet-growth analyses, we included infants born 2012-2016 (n = 138,703) to reflect current practice. In trend analyses, we included a 10-y cohort (n = 263,367). We categorized diet at NICU discharge/transfer as: 1) human milk only (no formula or fortifier); 2) human milk with formula or fortifier (mixed); or 3) infant formula only. Outcomes were weight and head circumference z-score change from birth to discharge relative to a fetal reference.Results: Diet at discharge/transfer was human milk only for 18,274 (6.6%), mixed for 121,621 (44%), and formula only for 137,067 (49%). Weight deviated more from the fetal reference for infants fed both human milk diets compared with formula only (weight zscore change for infants fed human milk only, -0.88; mixed, -0.82; formula only -0.80; P < 0.0001 for diet overall). There were also differences by diet in head z-score change (human milk only, -0.52; mixed, -0.49; formula only, -0.45; P < 0.0001 for diet overall). Themagnitude of these differences has diminished substantially over 10 y.Conclusions: Very preterm infants receiving human milk compared with infant formula diets have a slower weight gain and head growth at hospital discharge.