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中晚期早產兒的餵奶策略與生長比較

Comparison of the Feeding Milk Strategy and Growth for Mid-to-Late Preterm Infants

摘要


滿足早產兒出生後的營養需求,以達成追趕式成長目標是一項極大的臨床挑戰。本研究目的為探討不同餵奶策略對早產兒的生長結果。本研究採回溯性電子病歷研究,分析對象為新生兒加護病房(neonatal intensive care unit, NICU)之中期(32~34妊娠週數)及晚期(34~37妊娠週數)早產兒,早產兒住院過程選擇母奶或配方奶種類由父母決定,並由主治醫師依餵養過程腸胃耐受性變化及成長階段循序調整使用,以整個住院期間使用母奶(human milk, HM)組(熱量介於67~68 kcal/100 mL,蛋白質介於1.3~2.0 g/100 mL)或早產兒配方(preterm formula, PF)組(熱量介於73~81 kcal/100 mL,蛋白質介於1.9~2.9 g/100mL),依各組奶品餵養持續時間達75%以上作為分組依據,觀察比較早產兒在第7天、第15天、轉出NICU日及出院日,餵養早產兒的營養攝取狀況和生長過程。結果發現HM組與PF組早產兒各分別為32位與71位,兩組基本資料在妊娠週數、男女比、子宮內生長遲滯(intrauterine growth restriction)人數比、阿普伽新生兒5分鐘評分(5-minute Apgar score)皆相當,無達到統計上顯著差異。PF組因為出生體重顯著低於HM組(1882 g vs. 2195 g, p < 0.001),故之後生長指標及腸道營養數值以增加幅度百分比,做為兩組之比較。在熱量攝取量比較,於出院時PF組可達137.4 kcal/kg birth weight (BW)/day,HM組為123.7 kcal/kg BW/day,達統計上顯著差異(p = 0.004)。在蛋白質攝取量及增加幅度比較,PF組皆高於HM組,且皆達統計上顯著差異,於出院時蛋白質攝取量可達3.5 g/kg BW/day,HM組為2.4 g/kg BW/day(p < 0.001)。雖然在研究開始之出生體重,PF組顯著低於HM組,隨著腸道營養餵養進展,因為PF組營養密度較高,其腸道餵養進展策略較為積極,因此表現在體重增加幅度比較上,PF組於第15天(PF: 12.4%vs. HM: 6.3%, p < 0.001)、轉出NICU時(PF: 27.8% vs. HM: 14.1%, p = 0.017)及出院時(PF: 46% vs. HM: 25.1%, p < 0.001),PF組體重增加幅度皆高於HM組且達統計上顯著差異。本研究為臺灣國內少數研究中晚期早產兒,以HM組及PF組之營養攝取量與成長效益之比較,因為PF營養密度較高,結果顯示其體重增加幅度高於HM組並達統計上顯著差異。未來可進一步延長觀察研究時間,至更長時間六個月或一年後,才能更加確定PF之成長優勢。

並列摘要


Meeting the nutritional requirements of preterm infants after birth to achieve catch-up growth is a major clinical challenge. This study was to investigate the effects of different feeding strategies on the growth outcome of preterm infants. Retrospective electronic medical records were used to collect data in mid-term (32-34 gestational weeks) and late-term (34-37 gestational weeks) preterm infants of neonatal intensive care unit (NICU). Choices to select human milk (HM) or formula milk during the hospitalization of preterm babies were first determined by the parents, and the adjustment of different types of commercial formulas was then adjusted by the attending physicians according to the changes in gastrointestinal tolerance during feeding and the growth stage. The group allocation criteria for HM (67-68 kcal/100 mL, 1.3-2.0 g protein/100 mL) or preterm formula (PF) (73-81 kcal/100 mL, 1.9-2.9 g protein/100 mL) during the entire hospitalization period was based on the duration of feeding in each group reaching above 75%. Nutritional intake and growth process of preterm infants on the 7th, 15th day, transferred from NICU, and discharge day were recorded and compared. There were 32 and 71 preterm infants in the HM and PF groups included in this analysis. There were no differences between the two groups for the clinical characters including gestation weeks, male to female ratio, intrauterine growth restriction ratio, 5-minute Apgar scores at baseline. Because the birth weight (BW) of the PF group was significantly lower than the HM group (1882 g vs. 2195 g, p < 0.001), the growth index and enteral nutrition value were thus expressed as percentage increase for comparison. With regard to caloric intake at discharge, the PF group was fed at levels of 137.4 kcal/kg BW/day and the HM group at 123.7 kcal/kg BW/day, reaching a statistically difference (p = 0.004). In terms of protein intake at discharge, the PF group showed significantly higher levels than the HM group. The protein intake was up to 3.5 g/kg BW/day in the PF group, and 2.4 g/kg BW/day in the HM group (p < 0.001). Although the PF group had a significantly lower BW than the HM group at the baseline, significant higher weight gain was observed for the PF group as compared with the HM on the 15th day (PF 12.4% vs. HM 6.3%, p < 0.001), time for being transferred to NICU (PF 27.8% vs. HM 14.1%, p = 0.017) and discharge day (PF 46% vs. HM 25.1%, p < 0.001). This observation may be partially due to a more aggressive enteral feeding strategy with higher nutrient density content during the hospital stay period. This study is one of the few domestic studies among mid-to-late term preterm infants in Taiwan, comparing the nutritional intake and growth benefits in infants fed HM or PF. Our study results showed a higher weight gain in the formula-fed group than the HM group. Future studies need to be extended to a longer period of six months or up to one year to further confirm the impact on growth by different feeding strategies.

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