摘要
目的探讨国内使用捐献母乳喂养早产儿的可行性。方法对2013年8月1日至2014年7月31日南京医科大学附属南京市妇幼保健院母乳库建立后入NICU的199例极低、超低体质量儿的情况进行分析。选择母乳库建立前1年（2012年8月1日至2013年7月31日）148例母乳及配方奶混合喂养或配方奶喂养的极低、超低出生体质量儿作为对照。比较捐赠母乳喂养使用前、后1年中极低、超低出生体质量儿坏死性小肠结肠炎、脓毒症的发生率，平均住院时间，建立完全肠道喂养的时间及病死率。结果母乳库建立前1年共收治148例极低或超低出生体质量儿，采用混合喂养，其中16例发生新生儿坏死性小肠结肠炎，发生率为10.81%。母乳库建立1年内（2013年8月1日至2014年7月31日）共接受187例产妇捐献母乳，收集捐献母乳260 555 mL，1年中收治199例极低或超低出生体质量儿，其中198例曾予捐赠母乳喂养，9例患儿发生新生儿坏死性小肠结肠炎，发生率为4.52%。使用捐献母乳显著降低了新生儿坏死性小肠结肠炎的发生，差异有统计学意义（χ2＝5.02，P〈0.05）。同时，使用捐赠母乳喂养显著缩短了新生儿平均住院时间[（35.1±9.5） d比（37.3±10.4） d，t＝2.05，P〈0.05]，能尽早建立全胃肠道喂养[（16.4±5.3） d比（18.2±6.2） d，t＝2.84，P〈0.05]。而2组病死率和脓毒症的发生率差异均无统计学意义（P均〉0.05）。结论极低或超低出生体质量儿接受母乳或捐赠母乳喂养可以明显降低坏死性小肠结肠炎的发生率，尽快建立肠道喂养，缩短住院时间；国内正确使用捐献母乳安全、可行。
Objective To evaluate the safety and effects of feeding very low birth weight infants and extremely low birth weight infants with human donors＇ milk in China. Methods One hundred and ninety - nine very low birth weight infants and extremely low birth weight infants （VLBWI/ELBWI） admitted to NICU in Nanjing Maternity and Child Health Care Hospital were analyzed retrospectively （from August 1,2013 to July 31,2014） one year before and one year after the establishment of human donors＇ milk bank. Only 1 infant＇s parents（ 1/199 cases） refused to use do- nor milk,and 198 infants were fed with donors＇ milk since their own mothers＇ milk was unavailable. One hundred and forty -eight infants admitted to NICU from August 1,2012 to July 31,2013 were chosen as the control group, who were fed with formula milk since their own mothers＇ milk was unavailable. The mortality, incidence of necrotizing enterocolitis （NEC） and sepsis,time to full enteral feeding and hospital stay between 2 groups were analyzed. Results One year before the establishment of breast milk bank, there were 148 cases of very low or extremely low birth weight infants re- ceiving mixed feeding, and 16 cases of them had neonatal necrotizing enterocolitis, the incidence rate was 10.81%. Since the establishment of human milk bank, 187 women donated breast milk in the first year and 260 555 mL of human milk were collected and delivered. Only 1 infant （1/199 cases） refused to use donor milk, and 198 infants were fed with donors＇ milk since their own mothers＇ milk was unavailable. Nine babies with VLBWI/ELBWI were diagnosed as NEC in donor milk feeding group ,and 16 cases were diagnosed as NEC in formula -feeding group. The incidence rate of NEC was lower in the donor - milk - feeding group （4.52% vs 10.81% ,X2 = 5.02, P 〈 0.05 ）. Donor - milk - feeding group reached full enteral feeding[ （ 16.4 ± 5.3 ） d vs （ 18.2 ± 6.2 ） d, t = 2.84, P 〈 0. 05 ] and had shorter period of hospital stay[ （35.1 ± 9.5 ） d vs （37.3 ± 10.4） d, t = 2.05, P 〈 0.05 ] compared with formula feeding group. The mortality and incidence of sepsis had no difference between 2 groups （ all P 〉 0.05 ）. Conclusions Donors＇ breast milk is associated with a lower risk of NEC, sooner full enteral feeding and shorter hospital stay. Further research is needed to confirm these findings and measure the growth and long term neurodevelopment effects of donors＇ breast milk.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2016年第19期1464-1467,共4页
Chinese Journal of Applied Clinical Pediatrics
