Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing < 1250 g: a randomized clinical trial
Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing < 1250 g: a randomized clinical trial
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DOI：
10.1093/ajcn/nqy067
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发表时间：
2018-07-01
影响因子：
7.1
通讯作者：
Unger, Sharon
中科院分区：
文献类型：
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作者：
O'Connor, Deborah L.;Kiss, Alex;Unger, Sharon
在新生儿护理中，尽管成本高昂且有效性数据有限，但仍采用了这种方法来丰富极低出生体重（VLBW）婴儿的母乳营养。没有随机临床试验评估了使用HMBF与牛乳为基础的强化剂（BMBF）相比，在配方喂养的情况下，目的：我们确定是否HMBF与BMBF相比，用于常规人乳营养强化，提高喂养耐受性，降低发病率，减少粪便钙卫蛋白（衡量肠道炎症），并支持< 1250 g的婴儿的生长。设计：在这项盲法随机临床试验中，出生时体重< 1250 g的婴儿于2014年8月至2015年11月期间从加拿大安大略的新生儿单位招募。婴儿按要求喂母乳和捐赠的牛奶。以100 mL/kg/天的HMBF（0.81 kcal/mL）或BMBF（0.72 kcal/mL）开始强化，并以140 mL/kg/天的剂量分别增加至0.88和0.78 kcal/mL。主要结果是喂养中断≥ 12小时或喂养量减少> 50%的婴儿百分比。次要结局包括二分死亡率和发病率指数（即，结果：在232名合格婴儿中，127名（54.7%）被随机分组（n = 64 HMBF，n = 63 BMBF）。婴儿的平均+/- SD出生体重和胎龄分别为888 +/- 201 g和27.7 +/- 2.5 wk。在喂养中断方面没有发现统计学显著差异[17/64 HMBF，20/61 BMBF;未校正的风险差异：-6.2%（95% CI：-22.2%，9.8%）]。在死亡率和发病率指数（48.4%HMBF，49.2%BMBF，调整后P = 0.76），粪便钙卫蛋白的变化，或生长z scores.Conclusions：在出生体重< 1250 g的婴儿和纯母乳喂养，使用HMBF没有改善喂养耐受性或降低死亡率和发病率相比，BMBF。
adopted in neonatal care to enrich the nutrients in human milk for very low birth weight (VLBW) infants despite being costly and there being limited efficacy data. No randomized clinical trial has evaluated the use of HMBF compared with bovine milk-based fortifiers (BMBFs) in the absence of formula feeding.Objective: We determined if HMBF compared with BMBF for routine nutrient enrichment of human milk improves feeding tolerance, reduces morbidity, reduces fecal calprotectin (a measure of gut inflammation), and supports the growth of infants < 1250 g.Design: In this blinded randomized clinical trial, infants born weighing < 1250 g were recruited from neonatal units in Ontario, Canada between August 2014 and November 2015. The infants were fed mother's milk and donor milk as required. Fortification commenced at 100 mL/kg per day of HMBF (0.81 kcal/mL) or BMBF (0.72 kcal/mL) and advanced at 140 mL/kg per day to 0.88 and 0.78 kcal/mL, respectively. The primary outcome was percentage of infants with a feeding interruption for >= 12 h or a > 50% reduction in feeding volume. Secondary outcomes included a dichotomous mortality and morbidity index (i.e., affirmative for any one of death, late-onset sepsis, necrotizing enterocolitis, chronic lung disease, or severe retinopathy of prematurity), fecal calprotectin, and growth.Results: Of 232 eligible infants, 127 (54.7%) were randomized (n = 64 HMBF, n = 63 BMBF). Mean +/- SD birth weight and gestational age of infants were 888 +/- 201 g and 27.7 +/- 2.5 wk, respectively. No statistically significant differences were identified in feeding interruptions [17/64 HMBF, 20/61 BMBF; unadjusted risk difference: -6.2% (95% CI: -22.2%, 9.8%)]. There was no statistically significant difference in the mortality and morbidity index (48.4% HMBF, 49.2% BMBF, adjusted P = 0.76), changes in fecal calprotectin, or growth z scores.Conclusions: Among infants born weighing < 1250 g and exclusively fed humanmilk, the use of HMBF did not improve feeding tolerance or reduce mortality and morbidity compared with BMBF.