Neonatal intensive care 3 Advances in nutrition of the newborn infant
Neonatal intensive care 3 Advances in nutrition of the newborn infant
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DOI：
10.1016/s0140-6736(17)30552-4
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发表时间：
2017-04-22
期刊：
影响因子：
168.9
通讯作者：
Bloomfield, Frank H.
中科院分区：
文献类型：
--
作者：
Harding, Jane E.;Cormack, Barbara E.;Bloomfield, Frank H.
近年来，新生儿，特别是早产儿的营养状况有了很大改善。极早产儿对营养的需求很高，很难满足，因此生长迟缓是很常见的。生长不足与神经发育不良有关，尽管早期生长改善与更好的认知结果有关，但就更差的代谢结果而言，可能存在权衡，尽管早期营养对这些关联的贡献尚未确定。新的发展包括建议增加蛋白质供应，改进肠外脂质配方，并在鼓励母乳喂养的同时提供矿物质补充剂。然而，缺乏关于这些发展的风险和益处的高质量证据。还需要进行临床试验，以评估体验牛奶的气味和味道对早产儿的影响，以确定男孩和女孩是否应该以不同的方式喂养，并测试胰岛素和IGF-1补充剂对生长和发育结果的影响。中度至晚期早产儿的新生儿营养问题与早期妊娠期出生的婴儿相似，但可供临床决策依据的高质量证据甚至更少。足月出生婴儿营养研究的重点主要是针对新的配方产品，将改善认知和代谢结果。为早产儿提供最有效的营养应优先作为新生儿护理研究的重要重点，以改善长期代谢和发育结果。
Nutrition of newborn infants, particularly of those born preterm, has advanced substantially in recent years. Extremely preterm infants have high nutrient demands that are challenging to meet, such that growth faltering is common. Inadequate growth is associated with poor neurodevelopmental outcomes, and although improved early growth is associated with better cognitive outcomes, there might be a trade-off in terms of worse metabolic outcomes, although the contribution of early nutrition to these associations is not established. New developments include recommendations to increase protein supply, improve formulations of parenteral lipids, and provide mineral supplements while encouraging human milk feeding. However, high quality evidence of the risks and benefits of these developments is lacking. Clinical trials are also needed to assess the effect on preterm infants of experiencing the smell and taste of milk, to determine whether boys and girls should be fed differently, and to test effects of insulin and IGF-1 supplements on growth and developmental outcomes. Moderate-to-late preterm infants have neonatal nutritional challenges that are similar to those infants born at earlier gestations, but even less high quality evidence exists upon which to base clinical decisions. The focus of research in nutrition of infants born at term is largely directed at new formula products that will improve cognitive and metabolic outcomes. Providing the most effective nutrition to preterm infants should be prioritised as an important focus of neonatal care research to improve long-term metabolic and developmental outcomes.