CAJ | 학술논문

目的探讨母乳喂养对极低出生体重儿(very low birth weight infant,VLBWI)并发症及生后早期生长发育的影响. 方法 2010年1月1日至201 3年12月31日,在天津市中心妇产科医院新生儿重症监护病房住院的VLBWI中,排除小于胎龄儿和大于胎龄儿、出生时重度窒息、中途放弃治疗或死亡、混合喂养的患儿,纳入适于胎龄儿351例.2010年1月1日至201 1年12月31日入院的168例患儿为配方奶组,201 2年1月1日至2013年12月31日入院的183例患儿为母乳组,母乳组经口入量达100 ml/kg时添加母乳强化剂.随访至矫正胎龄40周.比较2组并发症发生率,以及从出生至生后30d时的生长发育情况.采用独立样本t检验和x2检验进行统计学分析.结果配方奶组与母乳组喂养不耐受的发生率分别为27.4％(46/168)与15.3％(28/183),坏死性小肠结肠炎发生率分别为14.9％(25/168)与5.5％(10/183),母乳组均低于配方奶组(x2值分别为7.683和8.651,P值均＜0.05).配方奶组与母乳组院内感染的发生率分别为34.5％(58/168)与33.3％(61/183),视网膜病变发生率分别为15.5％(26/168)与10.4％(1 9/183),支气管肺发育不良的发生率分别为11.3％(1 9/168)与9.3％(17/183),2组比较差异均无统计学意义(x2值分别为0.055、 2.033和0.388,P值均＞0.05).配方奶组与母乳组患儿从出生至生后30d的体重增长分别为(304±137)与(308±123)g、身长增长分别为(2.6±1.1)与(2.7±1.2)cm,头围增长分别为(2.5±1.0)与(2.4±0.9) cm,2组比较差异均无统计学意义(t值分别为0.106、 0.614和0.485,P值均＞0.05). 结论 VLBWI母乳喂养有利于降低喂养不耐受和NEC的发生率,且不影响生后早期的生长发育.
목적 탐토모유위양대겁저출생체중인(very low birth weight infant,VLBWI)병발증급생후조기생장발육적영향. 방법 2010년1월1일지201 3년12월31일,재천진시중심부산과의원신생인중증감호병방주원적VLBWI중,배제소우태령인화대우태령인、출생시중도질식、중도방기치료혹사망、혼합위양적환인,납입괄우태령인351례.2010년1월1일지201 1년12월31일입원적168례환인위배방내조,201 2년1월1일지2013년12월31일입원적183례환인위모유조,모유조경구입량체100 ml/kg시첨가모유강화제.수방지교정태령40주.비교2조병발증발생솔,이급종출생지생후30d시적생장발육정황.채용독립양본t검험화x2검험진행통계학분석.결과 배방내조여모유조위양불내수적발생솔분별위27.4％(46/168)여15.3％(28/183),배사성소장결장염발생솔분별위14.9％(25/168)여5.5％(10/183),모유조균저우배방내조(x2치분별위7.683화8.651,P치균＜0.05).배방내조여모유조원내감염적발생솔분별위34.5％(58/168)여33.3％(61/183),시망막병변발생솔분별위15.5％(26/168)여10.4％(1 9/183),지기관폐발육불량적발생솔분별위11.3％(1 9/168)여9.3％(17/183),2조비교차이균무통계학의의(x2치분별위0.055、 2.033화0.388,P치균＞0.05).배방내조여모유조환인종출생지생후30d적체중증장분별위(304±137)여(308±123)g、신장증장분별위(2.6±1.1)여(2.7±1.2)cm,두위증장분별위(2.5±1.0)여(2.4±0.9) cm,2조비교차이균무통계학의의(t치분별위0.106、 0.614화0.485,P치균＞0.05). 결론 VLBWI모유위양유리우강저위양불내수화NEC적발생솔,차불영향생후조기적생장발육.
Objective To study the incidence of complications and the influence on early postnatal growth and development in very low birth weight infant(VLBWI) fed by breast milk.Methods From January 1, 2010 to December 31, 2013, 351 VLBWIs, who were appropriate for gestational age and hospitalized in Neonatal Intensive Care Unit of Tianjin Central Hospital of Obstetrics and Gynecology, were included in this study after exclusion of those with small for gestational age, large for gestational age, severe perinatal asphyxia at birth, withdrawing treatment or death, and mixed feeding infants.The group of formula-fed infants (FFI) were 168 VLBWI admitted between January 1, 2010 to December 31, 2011 and the group of breast milk-fed infants (BFI) were 183 VLBWI admitted between January 1, 2012 to December 31, 2013.For BFIs, we added human milk fortifier when oral intake reached 100 ml/kg.All subjects were followed up to 40 weeks of corrected gestational age.We compared the incidence of complications and infantile growth and development from birth to 30 days old between the two groups.Independent sample t-test and Chi-square test were applied for statistical analysis.Results The incidence of feeding intolerance in FFIs was higher than that of the BFIs [27.4％ (46/168) vs 15.3％ (28/183)], so was the incidence of necrotizing enterocolitis [14.9％ (25/168) vs 5.5％ (10/183)] (x2=7.683 and 8.651, both P ＜ 0.05).The incidence of nosocomial infection, retinopathy of prematurity and bronchopulmonary dysplasia in FFI and BFI were 34.5％ (58/168) vs 33.3％ (61/183), 15.5％ (26/168) vs 10.4％ (19/183), and 11.3％ (19/168) vs 9.3％ (17/183), but none of them showed significant difference between the two groups (x2=0.055, 2.033 and 0.388, all P ＞ 0.05).Significant difference was neither found in weight gain from birth to 30 days old [(304± 137) vs (308± 123) g], height growth [(2.6± 1.1) vs (2.7± 1.2) cm] and head circumference growth [(2.5± 1.0) vs (2.4±0.9) cm] between the FFIs and BFIs (t=0.106, 0.614 and 0.485, all P ＞ 0.05).Conclusion Breast feeding is beneficial to VLBWI in decreasing the incidence of feeding intolerance and necrotizing enterocolitis without adverse effect on their early postnatal growth and development.