Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial.
Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial.
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DOI：
10.1186/s12887-015-0533-2
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发表时间：
2015-12-18
期刊：
影响因子：
2.4
通讯作者：
Bjørke Monsen AL
中科院分区：
文献类型：
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作者：
Torsvik IK;Ueland PM;Markestad T;Midttun Ø;Bjørke Monsen AL
假定6个月的纯母乳喂养可确保足月婴儿获得充足的微量营养素。我们的目的是调查80名出生体重低于正常（2000-3000 g）的婴儿长期母乳喂养对B族维生素状态和神经发育的影响，并检查补充钴胺素是否有益于6个月时出现钴胺素功能受损生化体征（总同型半胱氨酸（tHcy）> 6.5 μmol/L）的婴儿的运动功能。在6周、4个月和6个月时测定钴胺素、叶酸、核黄素和5 ′-磷酸吡哆醛以及代谢标志物tHcy和甲基丙二酸（MMA）的水平（n = 80/68/66）。在6个月时用阿尔伯塔婴儿运动量表（AIMS）和父母年龄和阶段问卷（ASQ）评估神经发育。在6个月时，32/36例tHcy > 6.5 μmol/L的婴儿入选双盲随机对照试验，接受400 μg羟钴胺肌内注射（n = 16）或假注射（n = 16）。一个月后评估生化状态和神经发育。除叶酸外，纯母乳喂养>1个月的婴儿在所有评估中的B族维生素水平较低，而在4个月和6个月时的tHcy和MMA水平较高。在6个月时，这些婴儿的AIMS评分（p = 0.03）和ASQ粗大运动评分（p = 0.01）较低。与安慰剂组相比，钴胺素治疗导致血浆tHcy（p < 0.001）和MMA（p = 0.001）水平降低，AIMS（p = 0.02）和ASQ粗大运动评分（p = 0.03）增加更多。研究结果表明，长时间的纯母乳喂养可能无法为小婴儿提供足够的B族维生素，这可能对早期粗大运动发育产生负面影响。在6个月时患有轻度钴胺素缺乏症的婴儿中，钴胺素治疗显著改善了钴胺素状态和运动功能，这表明观察到的与长期纯母乳喂养相关的运动功能受损可能是由于钴胺素缺乏症。ClinicalTrials.gov，编号NCT 01201005
Exclusive breastfeeding for 6 months is assumed to ensure adequate micronutrients for term infants. Our objective was to investigate the effects of prolonged breastfeeding on B vitamin status and neurodevelopment in 80 infants with subnormal birth weights (2000-3000 g) and examine if cobalamin supplementation may benefit motor function in infants who developed biochemical signs of impaired cobalamin function (total homocysteine (tHcy) > 6.5 μmol/L) at 6 months. Levels of cobalamin, folate, riboflavin and pyridoxal 5´-phosphate, and the metabolic markers tHcy and methylmalonic acid (MMA), were determined at 6 weeks, 4 and 6 months (n = 80/68/66). Neurodevelopment was assessed with the Alberta Infants Motor Scale (AIMS) and the parental questionnaire Ages and Stages (ASQ) at 6 months. At 6 months, 32 of 36 infants with tHcy > 6.5 μmol/L were enrolled in a double blind randomized controlled trial to receive 400 μg hydroxycobalamin intramuscularly (n = 16) or sham injection (n = 16). Biochemical status and neurodevelopment were evaluated after one month. Except for folate, infants who were exclusively breastfed for >1 month had lower B vitamin levels at all assessments and higher tHcy and MMA levels at 4 and 6 months. At 6 months, these infants had lower AIMS scores (p = 0.03) and ASQ gross motor scores (p = 0.01). Compared to the placebo group, cobalamin treatment resulted in a decrease in plasma tHcy (p < 0.001) and MMA (p = 0.001) levels and a larger increase in AIMS (p = 0.02) and ASQ gross motor scores (p = 0.03). The findings suggest that prolonged exclusive breastfeeding may not provide sufficient B vitamins for small infants, and that this may have a negative effect on early gross motor development. In infants with mild cobalamin deficiency at 6 months, cobalamin treatment significantly improvement cobalamin status and motor function, suggesting that the observed impairment in motor function associated with long-term exclusive breastfeeding, may be due to cobalamin deficiency. ClinicalTrials.gov, number NCT01201005