The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT.
The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT.
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DOI：
10.1136/bmjopen-2012-000834
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发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Ancel PY
中科院分区：
文献类型：
--
作者：
Rozé JC;Darmaun D;Boquien CY;Flamant C;Picaud JC;Savagner C;Claris O;Lapillonne A;Mitanchez D;Branger B;Simeoni U;Kaminski M;Ancel PY
一旦婴儿吃奶，就很难补充母乳，通常在住院结束和出院后停止。因此，母乳喂养的早产儿暴露于营养缺乏的风险增加，并可能对神经发育结果产生影响。评估出院时母乳喂养、住院期间体重增加与神经发育结局之间的关系。观察性队列研究。两个大型的、独立的、基于人群的极早产儿队列：卢瓦尔婴儿随访组（LIFT）和EPIPAGE队列。2925名极早产儿在出院时存活。次优的神经发育结果，定义为在较低阶段的得分，在LIFT中使用年龄和阶段问卷，在5年的EPIPAGE中使用考夫曼儿童评估测试。出院时母乳喂养的两个倾向评分，每个队列一个，用于减少偏倚。LIFT组中只有278/1733例（16%）婴儿和EPIPAGE组中只有409/2163例（19%）婴儿在出院时进行母乳喂养。母乳喂养与住院期间体重下降1个z评分的风险增加显著相关(LIFT: n=1463，调整奇数比(aOR)=2.51 (95% CI 1.87至3.36)；EPIPAGE: n=1417, aOR=1.55 (95% CI 1.14 ~ 2.12))，神经发育评估次优的风险降低(LIFT: n=1463, aOR=0.63 (95% CI 0.45 ~ 0.87)；EPIPAGE: n=1441, aOR=0.65 (95% CI 0.47至0.89)，2年时LIFT队列（n=1276, aOR=1.43 (95% CI 1.02至2.02)）和5年时EPIPAGE队列（n=1412, aOR=1.47 (95% CI 1.10至1.95)）头围z评分高于0.5的机会增加。在早产儿中，尽管最初的体重增加不理想，但观察到的更好的神经发育可以称为“明显的母乳喂养悖论”。无论涉及的机制如何，目前的数据都鼓励在早产儿中使用母乳喂养。在早产儿中，尽管最初的体重增加不理想，但观察到的更好的神经发育可以称为“明显的母乳喂养悖论”。无论涉及的机制如何，目前的数据都鼓励在早产儿中使用母乳喂养。在两个不同的大队列中观察到同样的效果。观察性研究：尽管使用了倾向评分，但仍然存在一些潜在的混杂因素。
Supplementation of breast milk is difficult once infants suckle the breast and is often discontinued at end of hospitalisation and after discharge. Thus, breastfed preterm infants are exposed to an increased risk of nutritional deficit with a possible consequence on neurodevelopmental outcome. To assess the relationship between breast feeding at time of discharge, weight gain during hospitalisation and neurodevelopmental outcome. Observational cohort study. Two large, independent population-based cohorts of very preterm infants: the Loire Infant Follow-up Team (LIFT) and the EPIPAGE cohorts. 2925 very preterm infants alive at discharge. Suboptimal neurodevelopmental outcome, defined as a score in the lower tercile, using Age and Stages Questionnaire at 2 years in LIFT and Kaufman Assessment Battery for Children Test at 5 years in EPIPAGE. Two propensity scores for breast feeding at discharge, one for each cohort, were used to reduce bias. Breast feeding at time of discharge concerned only 278/1733 (16%) infants in LIFT and 409/2163 (19%) infants in EPIPAGE cohort. Breast feeding is significantly associated with an increased risk of losing one weight Z-score during hospitalisation (LIFT: n=1463, adjusted odd ratio (aOR)=2.51 (95% CI 1.87 to 3.36); EPIPAGE: n=1417, aOR=1.55 (95% CI 1.14 to 2.12)) and with a decreased risk for a suboptimal neurodevelopmental assessment (LIFT: n=1463, aOR=0.63 (95% CI 0.45 to 0.87); EPIPAGE: n=1441, aOR=0.65 (95% CI 0.47 to 0.89) and an increased chance of having a head circumference Z-score higher than 0.5 at 2 years in LIFT cohort (n=1276, aOR=1.43 (95% CI 1.02 to 2.02)) and at 5 years in EPIPAGE cohort (n=1412, aOR=1.47 (95% CI 1.10 to 1.95)). The observed better neurodevelopment in spite of suboptimal initial weight gain could be termed the ‘apparent breastfeeding paradox’ in very preterm infants. Regardless of the mechanisms involved, the current data provide encouragement for the use of breast feeding in preterm infants. The observed better neurodevelopment in spite of suboptimal initial weight gain could be termed the ‘apparent breastfeeding paradox’ in very preterm infants. Regardless of the mechanisms involved, the current data provide encouragement for the use of breast feeding in preterm infants. The same effect was observed in two large distinct cohorts. Observational study: despite the use of propensity score, a few potential confounder can remain.
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影响因子：
7.1
作者：
Fewtrell, Mary S.;Morgan, Jane B.;Kleinman, Ronald E.
通讯作者：
Kleinman, Ronald E.
影响因子：
168.9
作者：
LANTING, CI;FIDLER, V;BOERSMA, ER
通讯作者：
BOERSMA, ER
影响因子：
8
作者：
Ehrenkranz, RA;Dusick, AM;Poole, WK
通讯作者：
Poole, WK
DOI：
10.7326/0003-4819-127-8_part_2-199710151-00064
发表时间：
1997-10-15
影响因子：
39.2
作者：
Rubin, DB
通讯作者：
Rubin, DB
影响因子：
8
作者：
Mok, Elise;Multon, Clarisse;Hankard, Regis
通讯作者：
Hankard, Regis