Managing the human-milk-fed, preterm, VLBW infant at NICU discharge: the sprinkles dilemma.
Managing the human-milk-fed, preterm, VLBW infant at NICU discharge: the sprinkles dilemma.
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DOI：
10.1177/1941406414541293
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发表时间：
2014-01-01
期刊：
影响因子：
--
通讯作者：
Thompson, M.
中科院分区：
文献类型：
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作者：
Groh-Wargo, S.;Thompson, M.
早产、极低出生体重（VLBW）婴儿由于出生时营养储存不良、消化和神经发育不成熟以及医疗和手术并发症风险增加而面临很高的营养风险。母乳 (HM) 是几乎所有新生儿的首选喂养方式。它易于消化、吸收良好，并降低感染风险。然而，为了满足小婴儿的营养需求，HM 需要强化。 HM 强化是新生儿重症监护病房 (NICU) 住院期间公认的规范。本文回顾了如何在 NICU 出院时管理母乳喂养的早产 VLBW 婴儿。最近的证据表明，出院后单独使用 HM 可能无法补充住院期间积累的营养缺乏或在近期随访期间维持生长。从业者面临的挑战是设计实用且可持续的营养充足的饮食，同时保留母乳供应并保护母乳喂养体验。我们将回顾现有的科学知识；揭示常见做法中的陷阱，包括“洒水困境”；并提出了几种满足营养目标的方案。
Preterm, very-low-birth-weight (VLBW) infants are at high nutritional risk because of poor nutrient stores at birth, digestive and neurodevelopmental immaturity, and increased risk of medical and surgical complications. Human milk (HM) is the preferred feeding for nearly all newborns. It is easily digested, well absorbed, and decreases the risk of infection. To meet the nutritional needs of small babies, however, HM requires fortification. HM fortification is the accepted norm during neonatal intensive care unit (NICU) hospitalization. This article reviews how to manage the human-milk-fed preterm VLBW infant at NICU discharge. Recent evidence suggests that HM alone after discharge may not replenish nutrient deficits accumulated during the hospital stay or sustain growth in the immediate follow-up period. Practitioners are challenged with devising nutritionally adequate diets that are practical and sustainable while preserving the HM supply and protecting the breastfeeding experience. We will review the available science; reveal pitfalls in common practices, including "the sprinkles dilemma"; and present several options for regimens that meet nutritional goals.