早产儿母乳喂养的临床与实验研究
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摘要
摘要目的：回顾性研究强化母乳喂养对早产儿住院期间生长代谢及合并症的影响。方法：收集我院2009年1月1日至2012年12月31日胎龄≦36w且出生体重≦1800g符合入选条件的早产儿148例,根据喂养方式不同分为强化母乳喂养组73例,早产儿配方奶喂养组75例,比较两组早产儿生长、代谢指标和合并症发生情况。结果：强化母乳喂养组和早产儿配方奶喂养组的胎龄、出生体重、出生身长、出生头围、恢复出生体重的日龄及出生时小于胎龄儿、新生儿呼吸窘迫综合征、≧Ⅲ级脑室内出血、窒息的比例均无统计学差异(P>0.05)；强化母乳喂养组住院期间的肠外营养时间短于早产儿配方奶喂养组[18d (14d,25d)比24d (18d,31d), z=-2.950, P=0.003]、奶量达120ml/kg. d日龄早于配方奶喂养组[16d(12d,23d)比22d(16d,30d), Z=-2.950, P=0.004],总热卡达120kcal/(kg.d)的日龄早于配方奶喂养组[11d (8d,15d)比14d(10d,17.5d),Z=-2.895, P=0.017]。强化母乳喂养组住院费用低于早产儿配方奶喂养组[47078元(30802元,67039元)比58400元(38166元,82737元),Z=-1.970,P=0.049],差异有统计学意义。两组早产儿开奶时间、喂养不耐受发生率、恢复出生体重后平均每日体重增长速率、每周身长和头围增长速度、出院时EUGR发生率、出生体重Z评分、出院体重Z评分、出院体重、出院身长及出院头围差异均无统计学意义(P>0.05)。强化母乳喂养组出院前血碱性磷酸酶高于早产儿配方奶喂养组[(347.65±149.42U/L)比(288.62±108.75U/L), t=2.570, P=0.011],其余生化指标均无显著性差异。强化母乳喂养组败血症的发生率11.0%(8/73)低于早产儿配方奶喂养组20.0%(15/75),但差异未达到统计学意义(χ2=2.30,P>0.05),两组早产儿视网膜病,支气管肺发育不良及坏死性小肠结肠炎发生率差异均无统计学意义(P>0.05)。结论：早产儿强化母乳喂养不仅可达到与早产儿配方奶喂养相似的生长速率,且加速肠内喂养进程,缩短肠外营养时间,减少败血症发生率,降低住院费用。
摘要目的：探讨早产母乳营养成分特点及动态变化,为个体化母乳强化喂养提供可靠的实验依据。方法：2012年11月-2014年1月间在我院产科住院产妇170人,早产产妇82人,足月产妇88人,收集母乳339份,早产母乳207份,足月母乳132份,用MIRIS母乳分析仪检测母乳蛋白质(g/100ml)、脂肪(g/100ml)、碳水化合物(g/100ml)、干物质(g/100ml)和能量(kcal/100m1),比较各组母乳营养成分差异。对其中23例早产母乳进行营养成分动态检测,每周检测两次,观察母乳中蛋白质、脂肪、碳水化合物和能量的动态变化。结果：(1)早产初乳蛋白质高于过渡乳(2.22±0.49g/100ml比1.83+0.39g/100ml,P<0.01),过渡乳高于成熟孚(1.40±0.28g/100ml,P<0.05),均有显著性差异；早产初乳脂肪和碳水化合物均低于过渡乳,分别(2.40±1.27g/100ml比3.07±1.05g/100ml, P<0.01)和(6.40±0.91g/100ml比6.63±0.40g/100ral,P<0.05);干物质初乳和过渡乳无显著性差异(P>0.05)；能量初乳低于过渡乳(55.3±8.5kcal/100ml比62.4±8.3kcal/100ml P<0.01);脂肪、碳水化合物、干物质和能量早产过渡乳和成熟乳无显著性差异(P>0.05)。(2)早产初乳蛋白质高于足月初乳(2.22±0.49g/100ml比2.07±0.34g/100ml, P<0.05),有显著性差异；脂肪、碳水化合物、干物质及能量在早产初乳与足月初乳之间无显著性差异(P>0.05),早产成熟乳蛋白质、脂肪、碳水化合物、干物质及能量与足月成熟乳比较均无显著性差异(P>0.05)。(3)孕龄≤30w产妇初乳蛋白质(2.48±0.68g/100ml)高于30+1-33+6w产妇初乳(2.11±0.25g/100ml)和≥34w产妇初乳(2.22±0.39g/100m1),有显著性差异(P<0.05)；脂肪含量≤30w初乳显著低于30+1-33+6w初乳(1.74±0.84g/100ml比2.52±0.76g/100m1,P<0.05)；能量≤30w显著低于30+1～33+6w(51.0±6.4kcal/100ml比58.4±7.6kcal/100ml, P<0.05)。不同孕周产妇过渡乳的蛋白质和脂肪无显著性差异(P>0.05),碳水化合物则≤30w(6.85±0.27g/100ml)显著高于其它两组(P<0.05)。30+1-33+-成熟乳蛋白质(1.53±0.37g/100ml)显著高于其它两组(P<0.05),不同孕周产妇成熟乳的脂肪、碳水化合物和能量无显著性差异(P>0.05)。(4)早产小于胎龄儿母乳营养成分与早产适于胎龄儿母乳营养成分比较无显著性差异(P均>0.05)。(5)高龄早产产妇母乳与适龄早产产妇母乳营养成分比较无显著性差异(P均>0.05)。(6)早产产妇母乳中蛋白质水平随日龄增加呈下降趋势,脂肪在初乳阶段呈上升趋势,含量相对不稳定,碳水化合物初乳阶段亦升高,含量则相对稳定,能量成熟乳高于初乳。结论：(1)早产初乳、过渡乳和成熟乳营养成分差异显著；(2)早产初乳蛋白质显著高于足月初乳,这种差异未能持续到成熟乳阶段；(3)不同孕龄产妇母乳营养成分存在差异,孕龄≤30w初乳蛋白质含量最高,产后下降速度也最快；(4)SGA早产儿组与AGA早产儿组、高龄产妇组与适龄产妇组的母乳中蛋白质、脂肪、碳水化合物及能量未发现显著差异；(5)早产儿母乳动态变化趋势：从初乳到过渡乳、成熟乳,蛋白质呈下降趋势,脂肪含量自初乳阶段开始升高,含量不稳定,碳水化合物含量则相对稳定。
摘要目的：调查早产产妇产后膳食情况及与母乳营养成分相关性。方法：采用24小时膳食调查表对34例早产产妇在产后2周和6周时进行膳食调查,以30例足月产妇作为对照,资料整理后参照食物成分表计算产妇膳食营养素和能量摄入,与产妇膳食营养素推荐摄入量比较,并与产妇母乳营养成分作相关分析。结果：共发放膳食调查表85份,收回77份。早产产妇46份,其中产后2周30份,产后6周16份,足月产妇产后6周膳食调查表31份。分析发现：(1)早产产妇产后膳食存在多种不合理情况：蛋白质摄入量显著低于推荐摄入量(P<0.05)；能量摄入不足或过多；矿物质如钙、铁、锌等不足等。(2)早产产妇产后2周与6周宏量营养摄入无显著性差异(P>0.05)；早产产妇产后6周宏量营养素摄入与足月产妇比较无显著性差异(P>0.05)；(3)BMI正常组产妇与超重肥胖组产妇母乳营养成分未见显著性差异(P>0.05)；(4)不同蛋白质和能量摄入水平产妇的乳汁营养成分无显著性差异(P>0.05)；(5)早产产妇产后蛋白质、脂肪、碳水化合物摄入与其母乳中蛋白质、脂肪和碳水化合物含量不能说明有相关性(P>0.05)。结论：(1)早产产妇产后膳食情况不容乐观,应注意营养指导。(2)尚无证据说明早产产妇产后蛋白质、脂肪、碳水化合物摄入与其母乳蛋白质、脂肪和碳水化合物含量存在明确相关性。
[Abstract] Objective:to explore the effect of fortified human milk feeding on growth, metabolism and complications of premature infants during hospital stay. Methods: Totally,148premature infants of gestational age<36weeks and birth weight≤1800g, admitted to NICU between January lst,2009and December31st,2012, were retrospectively enrolled and divided into two groups. Infants fed predominantly (>50%) with fortified human breast milk,combined with formula when breast milk was insufficient during hospital stay, were named HMF group(n=73),and those fed exclusively with premature formula were called premature formula feeding group(PF group, n=75). Data of infants on growth, metabolism and incidence of various complications were compared between the two groups. Results:Among the148cases included, there was no significant difference in gestational age, birth weight, head circumference, length at birth, time for regaining birth weight, SGA at birth, RDS, intraventricular hemorrhage over grade III, asphyxia rate between HMF and PF group(all P>0.05). Infants of the HMF group showed shorter duration of parenteral nutrition [18d (14d,25d) vs.24d (18d,31d), z=-2.950,P=0.003],smaller age to achieve120ml/kg.d through enteral feeding [16d (12d,23d) vs.22d(16d,30d),z=-2.895,P=0.004], smaller age to achieve total energy intake of120kcal/(kg.d)[11d (8d,15d) vs.14d (10d,17.5d), z=-2.392, P=0.017] than those of the PF group. Medical cost during hospital stay in the HMF group was significantly less than in the PF group [RMB:47078yuan (30802yuan,67039yuan) vs.58400yuan (38166yuan,82737yuan), z=-1.970, P=0.049]. The time for initial feeding, rat of feeding intolerance, daily weight gain after regaining birth weight, weekly increase of body length and head circumference, weight, body length and head circumference at discharge, proportion of small for gestational age infants at discharge, z scores of both birth weight and weight at discharge showed no significant difference(all P>0.05).The level of blood alkaline phosphates before discharge in HMF group was significantly higher than that of the PF group[347.65±149.42U/L vs.288.62±108.75U/L,t=2.570,P=0.011]. The incidence of sepsis in HMF group was slightly lower than that in the PF group[11.0%(8/73) vs.20.0%(15/75)] without significant difference(χ2=2.30,P>0.05), neither the morbidity of retinopathy of premature, bronchopulmonary dysplasia, necrotizing enterocolitis of newborns(all P>0.05). Conclusion:HMF for premature infants may ensure the same growth pattern as those fed by premature formula, and it also can accelerate the enteral feeding process, reduce the incidence of sepsis and decrease the medical cost during hospital stay.
[Abstract] Objective:to study the macronutrients and energy levels in human milk from mothers of both premature and term infants. Methods:Human milk samples were collected from170mothers, among them82were mothers of premature infants, and88were mothers of term infants. In total339samples were collected at3-7days,7-14days and30-42days, and samples from23premature infants mothers were collected twice a week. Protein (g/dl), fat (g/dl), carbohydrates (g/dl), dry matter (g/dl) and energy (kcal/dl) were detected with the MIRIS human milk analyzer. Results:(1) in premature infants' mothers, protein in colostrums(2.22±0.49g/dl)was significantly higher than that in transitional milk (1.83±0.39g/dl,P<0.01), and protein in transitional milk was significantly higher than that in mature milk(1.40±0.28g/dl,P<0.05),fat in colostrums(2.40±1.27g/dl)was significantly lower than that in transitional milk(3.07±1.05g/dl,P<0.01), carbohydrates in colostrums(6.40±0.91g/dl) was significantly lower than that in transitional milk(6.63±0.40g/dl,P<0.05). No significant differences were found in dry matter between colostrums and transitional milk(P>0.05), energy in colostrums(55.3±8.5kcal/dl) was significantly lower than that in transitional milk(62.4±8.3kcal/dl, P<0.01). No significant differences were found in fat, carbohydrates, dry matter and energy between transitional milk and mature milk (P>0.05).(2)Protein levels in premature colostrums(2.22±0.49g/dl) were significantly higher than that in term infants colostrums (2.07±0.34g/dl,P<0.05), but fat, carbohydrates, dry matter and energy in both colostrums and mature milk from premature and full infants'mothers showed no significant difference (P>0.05).(3)In the milk samples from premature infants' mothers, proteins levels in colostrums from≤30weeks (2.48±0.68g/dl),30+1-33+6w (2.11±0.25g/dl) and≥34weeks (2.22±0.39g/dl) showed significant difference (P<0.05); fat levels from30+1-33+6weeks group(2.52±0.76g/dl) was significantly higher than that in≤30weeks group (1.74±0.84g/dl, P<0.05); energy levels in colostrums from30+1-33+6weeks group (58.4±7.6kcal/dl) was significantly higher than that in the ≤30weeks group (51±6.4kcal/dl, P<0.05); no significant differences were found in protein and fat levels among different gestational age groups in premature transitional milk (P>0.05); carbohydrates in≤30weeks (6.85±0.27g/dl)were higher than the other two groups (P<0.05); Protein levels in30+1-33+6weeks premature mature milk (1.53±0.37g/dl) were higher than two other groups (P<0.05); No significant differences were found in fat, carbohydrate and energy from different gestational age mature milk (P>0.05);(4) In premature mother's samples, no significant difference were found in milk protein, fat, carbohydrates, dry matter and energy levels between the SGA group and AGA group (P>0.05);(5)In the premature group, samples from elderly mothers showed no significant difference in macronutrients and energy levels compared to that from the appropriate age mothers(P>0.05).(6)Milk protein levels declined throughout lactation, fat levels increased first and got stable, while carbohydrates levels. Conclusion:(1) Macronutrients and energy in milk from mothers of premature infants varied during the lactation.(2)Protein levels in colostrums from mothers of premature infants were significantly higher than that from mothers of term infants.(3) Macronutrients and energy in milk did not differ between SGA and AGA mothers, among different gestational age groups, different maternal age groups.(4) Protein and energy levels in milk from mothers of premature infants declined during the lactation, while fat levels increased first then got stable, and carbohydrate levels remained stable.
[Abstract] Objective To evaluate dietary intakes and possible associations with macronutrients and energy in human milk from mothers of premature and term infants. Methods Dietary intakes were surveyed in mothers of premature and term infants at2and6weeks postpartum using a24-hour dietary questionnaire. Milk samples were collected at the same time. Macronutrients (including protein, fat, carbohydrate and dry matter) and energy were measured by Miris milk analyzer. Results:In total77questionnaires were collected, in which46were from mothers of premature infants (30at2weeks and16at6weeks) and31were from mothers of term infants at6weeks postpartum.(1) There were many problems in the general dietary intakes among mothers of premature infants:their general protein intakes were significantly lower than recommended dietary intakes(RDIs)(p<0.05), while energy intakes were either lower or much higher than RDIs, mineral intakes including calcium, iron and zinc were not enough.(2) In the group of mothers of premature infants, dietary intakes did not differ between2weeks and6weeks postpartum (p>0.05), and at6weeks postpartum, general dietary intakes didn't differ between mothers of premature infants and term infants (p>0.05).(3) There was no significantly difference in milk macronutrients and energy between normal BMI group and overweight group (p>0.05).(4) Milk intergredient did not differ between different protein and energy intake groups (p>0.05).(5) No association was found between the dietary intakes and the macronutrients and energy in milk from mothers of premature infants. Conclusions:(1) Mothers of premature infants need more instructions on their postpartum dietary intakes.(2) There was no proof on the association between the dietary intakes and the macronutrients and energy in milk from mothers of premature infants.
摘要目的：探讨早产母乳营养成分特点及动态变化,为个体化母乳强化喂养提供可靠的实验依据。方法：2012年11月-2014年1月间在我院产科住院产妇170人,早产产妇82人,足月产妇88人,收集母乳339份,早产母乳207份,足月母乳132份,用MIRIS母乳分析仪检测母乳蛋白质(g/100ml)、脂肪(g/100ml)、碳水化合物(g/100ml)、干物质(g/100ml)和能量(kcal/100m1),比较各组母乳营养成分差异。对其中23例早产母乳进行营养成分动态检测,每周检测两次,观察母乳中蛋白质、脂肪、碳水化合物和能量的动态变化。结果：(1)早产初乳蛋白质高于过渡乳(2.22±0.49g/100ml比1.83+0.39g/100ml,P<0.01),过渡乳高于成熟孚(1.40±0.28g/100ml,P<0.05),均有显著性差异；早产初乳脂肪和碳水化合物均低于过渡乳,分别(2.40±1.27g/100ml比3.07±1.05g/100ml, P<0.01)和(6.40±0.91g/100ml比6.63±0.40g/100ral,P<0.05);干物质初乳和过渡乳无显著性差异(P>0.05)；能量初乳低于过渡乳(55.3±8.5kcal/100ml比62.4±8.3kcal/100ml P<0.01);脂肪、碳水化合物、干物质和能量早产过渡乳和成熟乳无显著性差异(P>0.05)。(2)早产初乳蛋白质高于足月初乳(2.22±0.49g/100ml比2.07±0.34g/100ml, P<0.05),有显著性差异；脂肪、碳水化合物、干物质及能量在早产初乳与足月初乳之间无显著性差异(P>0.05),早产成熟乳蛋白质、脂肪、碳水化合物、干物质及能量与足月成熟乳比较均无显著性差异(P>0.05)。(3)孕龄≤30w产妇初乳蛋白质(2.48±0.68g/100ml)高于30+1-33+6w产妇初乳(2.11±0.25g/100ml)和≥34w产妇初乳(2.22±0.39g/100m1),有显著性差异(P<0.05)；脂肪含量≤30w初乳显著低于30+1-33+6w初乳(1.74±0.84g/100ml比2.52±0.76g/100m1,P<0.05)；能量≤30w显著低于30+1～33+6w(51.0±6.4kcal/100ml比58.4±7.6kcal/100ml, P<0.05)。不同孕周产妇过渡乳的蛋白质和脂肪无显著性差异(P>0.05),碳水化合物则≤30w(6.85±0.27g/100ml)显著高于其它两组(P<0.05)。30+1-33+-成熟乳蛋白质(1.53±0.37g/100ml)显著高于其它两组(P<0.05),不同孕周产妇成熟乳的脂肪、碳水化合物和能量无显著性差异(P>0.05)。(4)早产小于胎龄儿母乳营养成分与早产适于胎龄儿母乳营养成分比较无显著性差异(P均>0.05)。(5)高龄早产产妇母乳与适龄早产产妇母乳营养成分比较无显著性差异(P均>0.05)。(6)早产产妇母乳中蛋白质水平随日龄增加呈下降趋势,脂肪在初乳阶段呈上升趋势,含量相对不稳定,碳水化合物初乳阶段亦升高,含量则相对稳定,能量成熟乳高于初乳。结论：(1)早产初乳、过渡乳和成熟乳营养成分差异显著；(2)早产初乳蛋白质显著高于足月初乳,这种差异未能持续到成熟乳阶段；(3)不同孕龄产妇母乳营养成分存在差异,孕龄≤30w初乳蛋白质含量最高,产后下降速度也最快；(4)SGA早产儿组与AGA早产儿组、高龄产妇组与适龄产妇组的母乳中蛋白质、脂肪、碳水化合物及能量未发现显著差异；(5)早产儿母乳动态变化趋势：从初乳到过渡乳、成熟乳,蛋白质呈下降趋势,脂肪含量自初乳阶段开始升高,含量不稳定,碳水化合物含量则相对稳定。
摘要目的：调查早产产妇产后膳食情况及与母乳营养成分相关性。方法：采用24小时膳食调查表对34例早产产妇在产后2周和6周时进行膳食调查,以30例足月产妇作为对照,资料整理后参照食物成分表计算产妇膳食营养素和能量摄入,与产妇膳食营养素推荐摄入量比较,并与产妇母乳营养成分作相关分析。结果：共发放膳食调查表85份,收回77份。早产产妇46份,其中产后2周30份,产后6周16份,足月产妇产后6周膳食调查表31份。分析发现：(1)早产产妇产后膳食存在多种不合理情况：蛋白质摄入量显著低于推荐摄入量(P<0.05)；能量摄入不足或过多；矿物质如钙、铁、锌等不足等。(2)早产产妇产后2周与6周宏量营养摄入无显著性差异(P>0.05)；早产产妇产后6周宏量营养素摄入与足月产妇比较无显著性差异(P>0.05)；(3)BMI正常组产妇与超重肥胖组产妇母乳营养成分未见显著性差异(P>0.05)；(4)不同蛋白质和能量摄入水平产妇的乳汁营养成分无显著性差异(P>0.05)；(5)早产产妇产后蛋白质、脂肪、碳水化合物摄入与其母乳中蛋白质、脂肪和碳水化合物含量不能说明有相关性(P>0.05)。结论：(1)早产产妇产后膳食情况不容乐观,应注意营养指导。(2)尚无证据说明早产产妇产后蛋白质、脂肪、碳水化合物摄入与其母乳蛋白质、脂肪和碳水化合物含量存在明确相关性。
[Abstract] Objective:to explore the effect of fortified human milk feeding on growth, metabolism and complications of premature infants during hospital stay. Methods: Totally,148premature infants of gestational age<36weeks and birth weight≤1800g, admitted to NICU between January lst,2009and December31st,2012, were retrospectively enrolled and divided into two groups. Infants fed predominantly (>50%) with fortified human breast milk,combined with formula when breast milk was insufficient during hospital stay, were named HMF group(n=73),and those fed exclusively with premature formula were called premature formula feeding group(PF group, n=75). Data of infants on growth, metabolism and incidence of various complications were compared between the two groups. Results:Among the148cases included, there was no significant difference in gestational age, birth weight, head circumference, length at birth, time for regaining birth weight, SGA at birth, RDS, intraventricular hemorrhage over grade III, asphyxia rate between HMF and PF group(all P>0.05). Infants of the HMF group showed shorter duration of parenteral nutrition [18d (14d,25d) vs.24d (18d,31d), z=-2.950,P=0.003],smaller age to achieve120ml/kg.d through enteral feeding [16d (12d,23d) vs.22d(16d,30d),z=-2.895,P=0.004], smaller age to achieve total energy intake of120kcal/(kg.d)[11d (8d,15d) vs.14d (10d,17.5d), z=-2.392, P=0.017] than those of the PF group. Medical cost during hospital stay in the HMF group was significantly less than in the PF group [RMB:47078yuan (30802yuan,67039yuan) vs.58400yuan (38166yuan,82737yuan), z=-1.970, P=0.049]. The time for initial feeding, rat of feeding intolerance, daily weight gain after regaining birth weight, weekly increase of body length and head circumference, weight, body length and head circumference at discharge, proportion of small for gestational age infants at discharge, z scores of both birth weight and weight at discharge showed no significant difference(all P>0.05).The level of blood alkaline phosphates before discharge in HMF group was significantly higher than that of the PF group[347.65±149.42U/L vs.288.62±108.75U/L,t=2.570,P=0.011]. The incidence of sepsis in HMF group was slightly lower than that in the PF group[11.0%(8/73) vs.20.0%(15/75)] without significant difference(χ2=2.30,P>0.05), neither the morbidity of retinopathy of premature, bronchopulmonary dysplasia, necrotizing enterocolitis of newborns(all P>0.05). Conclusion:HMF for premature infants may ensure the same growth pattern as those fed by premature formula, and it also can accelerate the enteral feeding process, reduce the incidence of sepsis and decrease the medical cost during hospital stay.
[Abstract] Objective:to study the macronutrients and energy levels in human milk from mothers of both premature and term infants. Methods:Human milk samples were collected from170mothers, among them82were mothers of premature infants, and88were mothers of term infants. In total339samples were collected at3-7days,7-14days and30-42days, and samples from23premature infants mothers were collected twice a week. Protein (g/dl), fat (g/dl), carbohydrates (g/dl), dry matter (g/dl) and energy (kcal/dl) were detected with the MIRIS human milk analyzer. Results:(1) in premature infants' mothers, protein in colostrums(2.22±0.49g/dl)was significantly higher than that in transitional milk (1.83±0.39g/dl,P<0.01), and protein in transitional milk was significantly higher than that in mature milk(1.40±0.28g/dl,P<0.05),fat in colostrums(2.40±1.27g/dl)was significantly lower than that in transitional milk(3.07±1.05g/dl,P<0.01), carbohydrates in colostrums(6.40±0.91g/dl) was significantly lower than that in transitional milk(6.63±0.40g/dl,P<0.05). No significant differences were found in dry matter between colostrums and transitional milk(P>0.05), energy in colostrums(55.3±8.5kcal/dl) was significantly lower than that in transitional milk(62.4±8.3kcal/dl, P<0.01). No significant differences were found in fat, carbohydrates, dry matter and energy between transitional milk and mature milk (P>0.05).(2)Protein levels in premature colostrums(2.22±0.49g/dl) were significantly higher than that in term infants colostrums (2.07±0.34g/dl,P<0.05), but fat, carbohydrates, dry matter and energy in both colostrums and mature milk from premature and full infants'mothers showed no significant difference (P>0.05).(3)In the milk samples from premature infants' mothers, proteins levels in colostrums from≤30weeks (2.48±0.68g/dl),30+1-33+6w (2.11±0.25g/dl) and≥34weeks (2.22±0.39g/dl) showed significant difference (P<0.05); fat levels from30+1-33+6weeks group(2.52±0.76g/dl) was significantly higher than that in≤30weeks group (1.74±0.84g/dl, P<0.05); energy levels in colostrums from30+1-33+6weeks group (58.4±7.6kcal/dl) was significantly higher than that in the ≤30weeks group (51±6.4kcal/dl, P<0.05); no significant differences were found in protein and fat levels among different gestational age groups in premature transitional milk (P>0.05); carbohydrates in≤30weeks (6.85±0.27g/dl)were higher than the other two groups (P<0.05); Protein levels in30+1-33+6weeks premature mature milk (1.53±0.37g/dl) were higher than two other groups (P<0.05); No significant differences were found in fat, carbohydrate and energy from different gestational age mature milk (P>0.05);(4) In premature mother's samples, no significant difference were found in milk protein, fat, carbohydrates, dry matter and energy levels between the SGA group and AGA group (P>0.05);(5)In the premature group, samples from elderly mothers showed no significant difference in macronutrients and energy levels compared to that from the appropriate age mothers(P>0.05).(6)Milk protein levels declined throughout lactation, fat levels increased first and got stable, while carbohydrates levels. Conclusion:(1) Macronutrients and energy in milk from mothers of premature infants varied during the lactation.(2)Protein levels in colostrums from mothers of premature infants were significantly higher than that from mothers of term infants.(3) Macronutrients and energy in milk did not differ between SGA and AGA mothers, among different gestational age groups, different maternal age groups.(4) Protein and energy levels in milk from mothers of premature infants declined during the lactation, while fat levels increased first then got stable, and carbohydrate levels remained stable.
[Abstract] Objective To evaluate dietary intakes and possible associations with macronutrients and energy in human milk from mothers of premature and term infants. Methods Dietary intakes were surveyed in mothers of premature and term infants at2and6weeks postpartum using a24-hour dietary questionnaire. Milk samples were collected at the same time. Macronutrients (including protein, fat, carbohydrate and dry matter) and energy were measured by Miris milk analyzer. Results:In total77questionnaires were collected, in which46were from mothers of premature infants (30at2weeks and16at6weeks) and31were from mothers of term infants at6weeks postpartum.(1) There were many problems in the general dietary intakes among mothers of premature infants:their general protein intakes were significantly lower than recommended dietary intakes(RDIs)(p<0.05), while energy intakes were either lower or much higher than RDIs, mineral intakes including calcium, iron and zinc were not enough.(2) In the group of mothers of premature infants, dietary intakes did not differ between2weeks and6weeks postpartum (p>0.05), and at6weeks postpartum, general dietary intakes didn't differ between mothers of premature infants and term infants (p>0.05).(3) There was no significantly difference in milk macronutrients and energy between normal BMI group and overweight group (p>0.05).(4) Milk intergredient did not differ between different protein and energy intake groups (p>0.05).(5) No association was found between the dietary intakes and the macronutrients and energy in milk from mothers of premature infants. Conclusions:(1) Mothers of premature infants need more instructions on their postpartum dietary intakes.(2) There was no proof on the association between the dietary intakes and the macronutrients and energy in milk from mothers of premature infants.
引文
[1]王丹华.呵护早产儿从母乳喂养开始[J].临床儿科杂志,2012,30：201-203.
[2]母乳强化剂研究协作组.母乳强化剂在早产儿母乳喂养中应用的多中心研究[J].中华儿科杂志,2012,5：336-337.
[3]Patel AL, Engstrom JL, Meier PP, et al. Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants [J]. J Perinatol, 2009,29:618-622.
[4]韩露艳、王晨、李正红、王丹华.早期营养支持策略对早产儿生长和代谢的影响[J].中国新生儿科杂志,2012,27：296-301.
[5]Michael J Dibley, Norman Staehling, Philip Nieburg. Interpretation of Z-score anthropometric indicators derived from the international growth reference[J]. Am J Clin Nutr 1987,46:749-62.
[6]孙秀静,余欣庭,王丹华.以年龄别体重z评分方法评价早产儿住院期间生长情况的临床研究[J].中国新生儿科杂志,2010,25：263-265.
[7]邵肖梅、叶鸿瑁、丘小汕.实用新生儿学[M].北京：人民卫生出版社,2011：340,416,887.
[8]早产儿营养调查协作组.新生儿重症监护病房中早产儿营养相关状况多中心调查974例报告[J],中华儿科杂志,2009,47：12-17.
[9]王洪敏、李海英、张萍、单若冰.不同喂养方式对早产儿近期生长发育的影响[J].齐鲁医学杂志,2011.26：454-456.
[10]O'Connor DL., Jacobs J, Hall R, Adamkin D, et al. Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula[J]. J Pediatr Gastroenterol Nutr,2003,37:437-446.
[11]Reali A, Greco F, Fanaro S, et al. Fortification of maternal milk for very low birth weight (VLBW) pre-term neonates[J]. Early Hum Dev,2010,86 Suppl 1:33-36.
[12]Richard J. Schanler, RJ, Lau C. Feeding Strategies for Premature Infants: Beneficial Outcomes of Feeding [J]. Fortified Human Milk Versus Preterm Formula. Pediatrics 1999.103:1150-1153.
[13]Meier PP, Engstrom JL, Patel AL, et al. Improving the Use of Human Milk During and After the NICU Stay[J]. Clin Perinatol,2010,37:217-245.
[14]王晨、王丹华.母乳强化剂在母乳喂养早产儿中的应用[J].临床儿科杂志.2009.3：259-263.
[15]Henriksen C, Westerberg AC, R(?)nnestad A, etal. Growth and nutrient intake among very-low-birth-weight infants fed fortified human milk during hospitalization[J]. Br J Nutr.2009,102:1179-1186.
[16]Halleux V, Rigo J. Variability in human milk composition:benefit of individualized fortification in very-low-birth-weight infants [J]. Am J Clin Nutr 2013;98(suppl):529S-35S.
[17]Kociszewska-Najman B, Borek-Dzieciol B, Szpotanska-Sikorska M, etal. The creamatocrit, fat and energy concentration in human milk produced by mothers of preterm and term infants [J]. J Matern Fetal Neonatal Med.2012, 25:1599-1602.
[1]Gobalakichenane P, Mitanchez D. Nutrition and growth follow-up in the preterm infant[J]. Rev Prat,2012,62:379-381.
[2]Meier PP, Engstrom JL, Patel AL, et al. Improving the use of human milk during and after the NICU stay[J]. Clin Perinatol,2010,37:217-245.
[3]Reali A, Greco F, Fanaros, etal. Fortification of maternal milk for very low birth weight(VLBW)preterm neonates[J]. Early Hum Dev.2010,86:33-36.
[4]王丹华.呵护早产儿从母乳喂养开始[J].临床儿科杂志,2012,30：201-203.
[5]Arslanoglu S, Moro GE, Ziegler EE. Preterm infants fed fortified human milk receive less protein than they need[J]. J Perinatol.2009,29:489-492.
[6]Jacqueling B, Joachim G. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants[J]. clin Nutr,2011,30:215-220.
[7]米延,张馨丹.哈尔滨地区早产儿母乳营养素含量的调查研究[J].中国新生儿科杂.2007,6：337-338.
[8]Pang WW, Hartmann PE. Initiation of human lactation:secretory differentiation and secretory activation [J]. J Mammary Gland Biol Neoplasia 2007:12:211-21.
[9]Hill PD, Aldag JC, Demirtas H, etal. Association of serum prolactin and oxytocin with milk production in mothers of preterm and term infants [J]. Biol Res Nurs 2009;10:340-9.
[10]Larios-Del YE, Vasquez-Garibay EM, Gonzalez-Ojeda, etal. A longitudinal evaluation of growth outcomes at hospital discharge of very-low-wight preterm infants[J]. Eur J Clin Nutr.2012,66:474-480.
[11]Faerk J, Skafte L, Petersen S. Macronutrients in milk from mothers delivering preterm[J]. Adv Exp Med Biol.2001,51:409-13.
[12]Alan AV, Fernanda VM, Hellen PP, etal. Analysis of the influence of pasteurization, freezing/thawing, and offer processes on human milk's macronutrient concentrations[J]. Early Hum Dev.2011:87:577-580.
[13]Jang SH, Lee BS, Park JH, etal. serial changes of fatty acids in preterm breast milk of Korean woman[J].J Hum Lact.2011:(3)279-285.
[14]何必子,孙秀静,王丹华.早产小于胎龄儿与适于胎龄生长代谢的临床研究[J],中国新生儿科杂志,2014：(29)73-77.
[15]Tudehope D, Vento M, Bhutta Z, et al. Nutritional requirements and feeding recommendations for small for gestational age infants[J]. J Pediatr.2013,162:S81-89.
[16]Mukhopadhyay K, Narnag A, Mahajan R. Effect of human milk fortification in appropriate for gestation and small for gestation preterm babies:a randomized controlled trial[J]. Indian Pediatr.2007,44:286-290.
[17]Olsen IE, Harris CL, Lawson L. Higher protein intake improve length, not weight, z-scores in preterm infants[J].J Pediatr Gastroenterol Nutr.2013,13,1097.
[18]Lepage G, Collet S. The composition of preterm milk in relation to the degree of prematurity[J]. The Amer J Clin Nutri.1984,40:1042-1049.
[19]Gitte Z, Jesper FG, Mette VH. The content of macronutrients in milk from mothers of very preterm infants is highly variable[J].Dan Med J.2013,6:A4613.
[20]全美盈,王丹华.早产儿母乳喂养新概念：个体化母乳强化[J].中国新生儿科杂志.2013,28：129-132.
[21]Christoph M, Cornelia W, Wolfgang B, etal. Early feeding of fortified breast milk and in-hospital-growth in very premature infants:a retrospective cohort analysis[J]. BMC Pediatr.2013,13:178.
[22]Arslanoglu S, Moro GE, Ziegler EE. et al. Optimization of human milk fortification for preterm infants:new concepts and recommendations[J]. J Perinat Med.2010,38:233-238.
[1]唐仪、郝玲.妇女儿童营养学[M].北京：化学工业出版社.2012：202.
[2]张雪琰,于红霞.哺乳期妇女营养状况及干预研究[D].山东：山东大学,2007.
[3]杨月欣,王光亚,潘兴昌.中国食物成分表[M],北京：北京大学医学出版社.2012.
[4]中国营养学会编著.中国居民膳食营养素参考摄入量(简要本)[M].北京：中国轻工业出版社,2001：18.
[5]吴国豪.实用临床营养学[M].上海：复旦大学出版社,2006.
[6]Anna W, Jean-Pierre H, Kathleen MR. Linking maternal and infant benefits of a nutritional supplement during pregnancy and lactation[J]. Am J Clin Nutr 1998:68:656-61.
[7]Chapman DJ, Nommsen-Rivers L. Impact of Maternal Nutritional Status on Human Milk Quality and Infant Outcomes:An Update on Key Nutrients [J]. Adv. Nutr.2012,3:351-352.
[8]Antonakou A, Skenderi KP, Chiou A, etal. Breast milk fat concentration and fatty acid pattern during the first six months in exclusively breastfeeding Greek women[J]. Eur J Nutr.2013,52:963-973.
[9]Karl-Goran S, Cristina LP, Elsa B, etal. Fatty acid patterns early premature birth, simultaneously analysed in mother's food, breast milk and serum phospholipids of mothers and infants[J]. Lipids in Health and Disease.2009,8:20.
[10]Mahmoud A, Agneta L, Morey W. Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation[J]. Am J Clin Nutr 2009;89:1821-7.
[11]Ramin I, Roya K, Sharareh B, etal. Comparison of long chain polyunsaturated fatty acid content in human milk in preterm and term deliveries and its correlation with mothers'diet[J].J Res Med Sci.2013,18(1):1-5.
[12]Ballard 0, Morrow A L. Human milk composition:nutrients and bioactive factors[J]. Pediatr Clin North Am.2013,60(1):49-74.
[13]李芳,莫洁玲.膳食指导对哺乳期妇女饮食营养状况和乳汁中锌铜镁含量的影响分析[J].中国临床新医学,2013,6：583.
[1]Grovslien AH, Gronn M. Donor milk banking and breastfeeding in Norway. J Hum Lact[J],2009.25:206-210.
[2]早产儿营养调查协作组.新生儿重症监护病房中早产儿营养相关状况多中心调查974例报告[J],中华儿科杂志,2009,47：12-17.
[3]Arslanoglu S, Moro GE, Ziegler EE. Preterm infants fed fortified human milk receive less protein than they need[J]. J Perinatol.2009,29:489-492.
[4]Henriksen C, Westerberg AC, Ronnestad A, etal. Growth and nutrient intake among very-low-birth-weight infants fed fortified human milk during hospitalization[J].Br J Nur 2009,102:1179-86.
[5]Anderson DM, Williams FH, Merkatz RB, etal. Length of gestation and nutritional composition of human milk[J]. The Am J Clin Nutr 1983,37:810-814.
[6]米延,张馨丹.哈尔滨地区早产儿母乳营养素含量的调查研究[J].中国新生儿科杂.2007,6：337-338.
[7]Anderson GH, Atkinson SA, Bryan MH. Energy and macronutrient content of human milk during early lactation from mothers giving birth prematurely and at term[J]. The Am J Clin Nutri.1981,34:258-265.
[8]Zachariassen G, Fenger-Gron J,Hviid MV. The content of macronutrients in milk from mothers of very preterm infants is highly variable [J]. Dan Med J.2013,6:A4613.
[9]Charpak N, Ruiz JG. Breast milk composition in a cohort of preterm infants' mothers followed in an ambulatory programme in Colombia. Acta Padiatr[J],2007,96:1755-1759.
[10]Zhang Z, Adelman AS, Rai D, etal. Amino acid profiles in term and preterm human milk through lactation:a systematic review[J]. Nutrients,2013,5:4800-4821.
[11]翁梅倩、田小琳、吴圣楣.足月儿和早产儿母乳中游离和构成蛋白质的氨基酸含量动态比较[J].上海医学.1999,22：217-222.
[12]Wan J, cui XW, Zhang J, etal. Peptidome analysis of human skim milk in term and preterm milk[J]. Biochem Biophys Res commun.2013,7:236-241.
[13]Cristellote C, Casillas R, Ramirez-Santana C, etal. Premature delivery influences the immunological composition of colostrum and transitional and mature human milk[J].J Nutr.2011,4:1181-1187.
[14]Atiya M, Strandvik B, Sabel KG, etal. Polyamine levels in breast milk are associated with mothers'dietary intake and are higher in preterm than full-term human milk and formulas[J]. J Hum nutr Diet.2013,10:1-8.
[15]戚秋芬,吴圣楣,张伟利.早产儿和足月儿母乳中脂肪酸组成比较研究.中华儿科杂志[J].1997,35：580-582.
[16]Spencer SA, HULL D. Fat content of expressed breast milk:a case for quality control[J].Br Med J.1981,282:99-101.
[17]Lepage G, Collet S, Bougle D, etal. The composition of preterm milk in relation to the degree of prematurity [J]. Am J Clin Nutr.1984,40:1042-1049.
[18]Czank C, Simmer K, Hartmann PE. A method for standardizing the fat content of human milk for use in the neonatal intensive care unit[J]. int breastfeed J.2009,4:1-7.
[19]Morton J, Wong RJ, Hall JY, etal. Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants[J]. J Perinatol,2012,32:791-796.
[20]Jacqueling B, Joachim G. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants[J]. clin Nutr,2011,30:215-220.
[21]Bobin R, Mikulska M, Mojska, etal. Comparison of the fatty acid composition of transitional and mature milk of mothers who delivered healthy full-term babies, preterm babies and full-term small for gestational age infants[J]. Euro J Clin Nutr,2013,67:966-971.
[22]Arsic A, Vucic V, Prekajski, etal. Different fatty acid composition of serum phospholipids of small and appropriate for gestational age preterm infants and of milk from their mothers[J]. Hippokatia,2012,3:230-235.
[23]Bozena, Beata, Monika, etal. The creamatocrit, fat and energy concentration in human milk produced by mothers of preterm and term infants[J].J Matern Fetal Neonatal Med,2012,9:1599-1602.
[24]Carolina, Ana IC, Xavier CE. Differences in fat content and fatty acid proportions among colostrum, transitional, and mature milk from women delivering very preterm, preterm, and term infants[J]. Clin Nutr.2011, 30:116-123.
[25]Szlivia B, Berthold K, Tamas D. Systematic review of fatty acid composition of human milk from mothers of preterm compared to full-term infants[J]. Ann Nutr Metab.2007,51:550-556.
[26]Remko S, Martine, Janneke, etal. Fatty acid compositions of preterm and term colostrum, transitional and mature milks in a sub-Saharan population with high fish intakes[J]. Prostaglandins, Leukot Essent Fatty Acids.2012,86:201-207.
[27]Karl-Goran S, Cristina LP, Elsa B, etal. Fatty acid patterns early after premature birth, simultaneously analysed in mothers'food, breast milk and serum phospholipids of mothers and infants [J]. Lipids Health Dis.2009,8:20.
[28]Jang SH, Lee BS, Park JH, etal. serial changes of fatty acids in preterm breast milk of Korean woman[J].J Hum Lact,2011:(3)279-285.
[29]Carolin M, Renee B, Alison K, etal. Human milk oligosaccharide composition differs between donor milk and mother's own milk in the NICU[J]. Hum Lact.2013,26:01-03.
[30]钱继红,吴圣楣,陶美华等.早产儿母乳中淀粉酶活性观察.中国新生儿科杂志[J],2006,6：324-327.
[31]Yamawaki N, Yamada M, Kanno T. Macronutrient, mineral and trace element composition of breast milk from Japanese women [J]. J Trace Elem Med Biol.2005, 19:171-81.
[32]Seung-Yeon K, Jung HP, Ellen AR, etal. Longitudinal study on trace mineral compositions(selenium, zinc, copper, manganese) in Korean human preterm milk[J]. J Korean Med Sci.2012,27:532-536.
[33]戴定威,唐泽媛.早产儿母乳主要成分和矿物质动态变化.华西医大学报 [J],1991,22(3)： 32-336.
[34]Alan AV, Fernanda VM, Hellen PP, etal. Analysis of the influence of pasteurization, freezing/thawing, and offer processes on human milk's macronutrient concentrations[J]. Ear Hum Dev.2011:87:577-580.
[35]Nadia R, Diana EV, Oscar GA, etal. Effect of freezing time on macronutrients and energy content of breastmilk[J]. Mary Ann Liebert, Inc.2012,7:295-301.
[36]Yu-Chuan CH, Chao HC, Ming CL. The macronutrients in human milk change after storage in various containers [J]. Pediatr Neonatol.2012,53:205-209.
[37]Lev HM, Ovental A, Mandel D. Major losses of fat, carbohydrates and energy content of preterm human milk frozen at-80℃[J]. J Perinatol.2014,6:1038.
[2]母乳强化剂研究协作组.母乳强化剂在早产儿母乳喂养中应用的多中心研究[J].中华儿科杂志,2012,5：336-337.
[3]Patel AL, Engstrom JL, Meier PP, et al. Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants [J]. J Perinatol, 2009,29:618-622.
[4]韩露艳、王晨、李正红、王丹华.早期营养支持策略对早产儿生长和代谢的影响[J].中国新生儿科杂志,2012,27：296-301.
[5]Michael J Dibley, Norman Staehling, Philip Nieburg. Interpretation of Z-score anthropometric indicators derived from the international growth reference[J]. Am J Clin Nutr 1987,46:749-62.
[6]孙秀静,余欣庭,王丹华.以年龄别体重z评分方法评价早产儿住院期间生长情况的临床研究[J].中国新生儿科杂志,2010,25：263-265.
[7]邵肖梅、叶鸿瑁、丘小汕.实用新生儿学[M].北京：人民卫生出版社,2011：340,416,887.
[8]早产儿营养调查协作组.新生儿重症监护病房中早产儿营养相关状况多中心调查974例报告[J],中华儿科杂志,2009,47：12-17.
[9]王洪敏、李海英、张萍、单若冰.不同喂养方式对早产儿近期生长发育的影响[J].齐鲁医学杂志,2011.26：454-456.
[10]O'Connor DL., Jacobs J, Hall R, Adamkin D, et al. Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula[J]. J Pediatr Gastroenterol Nutr,2003,37:437-446.
[11]Reali A, Greco F, Fanaro S, et al. Fortification of maternal milk for very low birth weight (VLBW) pre-term neonates[J]. Early Hum Dev,2010,86 Suppl 1:33-36.
[12]Richard J. Schanler, RJ, Lau C. Feeding Strategies for Premature Infants: Beneficial Outcomes of Feeding [J]. Fortified Human Milk Versus Preterm Formula. Pediatrics 1999.103:1150-1153.
[13]Meier PP, Engstrom JL, Patel AL, et al. Improving the Use of Human Milk During and After the NICU Stay[J]. Clin Perinatol,2010,37:217-245.
[14]王晨、王丹华.母乳强化剂在母乳喂养早产儿中的应用[J].临床儿科杂志.2009.3：259-263.
[15]Henriksen C, Westerberg AC, R(?)nnestad A, etal. Growth and nutrient intake among very-low-birth-weight infants fed fortified human milk during hospitalization[J]. Br J Nutr.2009,102:1179-1186.
[16]Halleux V, Rigo J. Variability in human milk composition:benefit of individualized fortification in very-low-birth-weight infants [J]. Am J Clin Nutr 2013;98(suppl):529S-35S.
[17]Kociszewska-Najman B, Borek-Dzieciol B, Szpotanska-Sikorska M, etal. The creamatocrit, fat and energy concentration in human milk produced by mothers of preterm and term infants [J]. J Matern Fetal Neonatal Med.2012, 25:1599-1602.
[1]Gobalakichenane P, Mitanchez D. Nutrition and growth follow-up in the preterm infant[J]. Rev Prat,2012,62:379-381.
[2]Meier PP, Engstrom JL, Patel AL, et al. Improving the use of human milk during and after the NICU stay[J]. Clin Perinatol,2010,37:217-245.
[3]Reali A, Greco F, Fanaros, etal. Fortification of maternal milk for very low birth weight(VLBW)preterm neonates[J]. Early Hum Dev.2010,86:33-36.
[4]王丹华.呵护早产儿从母乳喂养开始[J].临床儿科杂志,2012,30：201-203.
[5]Arslanoglu S, Moro GE, Ziegler EE. Preterm infants fed fortified human milk receive less protein than they need[J]. J Perinatol.2009,29:489-492.
[6]Jacqueling B, Joachim G. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants[J]. clin Nutr,2011,30:215-220.
[7]米延,张馨丹.哈尔滨地区早产儿母乳营养素含量的调查研究[J].中国新生儿科杂.2007,6：337-338.
[8]Pang WW, Hartmann PE. Initiation of human lactation:secretory differentiation and secretory activation [J]. J Mammary Gland Biol Neoplasia 2007:12:211-21.
[9]Hill PD, Aldag JC, Demirtas H, etal. Association of serum prolactin and oxytocin with milk production in mothers of preterm and term infants [J]. Biol Res Nurs 2009;10:340-9.
[10]Larios-Del YE, Vasquez-Garibay EM, Gonzalez-Ojeda, etal. A longitudinal evaluation of growth outcomes at hospital discharge of very-low-wight preterm infants[J]. Eur J Clin Nutr.2012,66:474-480.
[11]Faerk J, Skafte L, Petersen S. Macronutrients in milk from mothers delivering preterm[J]. Adv Exp Med Biol.2001,51:409-13.
[12]Alan AV, Fernanda VM, Hellen PP, etal. Analysis of the influence of pasteurization, freezing/thawing, and offer processes on human milk's macronutrient concentrations[J]. Early Hum Dev.2011:87:577-580.
[13]Jang SH, Lee BS, Park JH, etal. serial changes of fatty acids in preterm breast milk of Korean woman[J].J Hum Lact.2011:(3)279-285.
[14]何必子,孙秀静,王丹华.早产小于胎龄儿与适于胎龄生长代谢的临床研究[J],中国新生儿科杂志,2014：(29)73-77.
[15]Tudehope D, Vento M, Bhutta Z, et al. Nutritional requirements and feeding recommendations for small for gestational age infants[J]. J Pediatr.2013,162:S81-89.
[16]Mukhopadhyay K, Narnag A, Mahajan R. Effect of human milk fortification in appropriate for gestation and small for gestation preterm babies:a randomized controlled trial[J]. Indian Pediatr.2007,44:286-290.
[17]Olsen IE, Harris CL, Lawson L. Higher protein intake improve length, not weight, z-scores in preterm infants[J].J Pediatr Gastroenterol Nutr.2013,13,1097.
[18]Lepage G, Collet S. The composition of preterm milk in relation to the degree of prematurity[J]. The Amer J Clin Nutri.1984,40:1042-1049.
[19]Gitte Z, Jesper FG, Mette VH. The content of macronutrients in milk from mothers of very preterm infants is highly variable[J].Dan Med J.2013,6:A4613.
[20]全美盈,王丹华.早产儿母乳喂养新概念：个体化母乳强化[J].中国新生儿科杂志.2013,28：129-132.
[21]Christoph M, Cornelia W, Wolfgang B, etal. Early feeding of fortified breast milk and in-hospital-growth in very premature infants:a retrospective cohort analysis[J]. BMC Pediatr.2013,13:178.
[22]Arslanoglu S, Moro GE, Ziegler EE. et al. Optimization of human milk fortification for preterm infants:new concepts and recommendations[J]. J Perinat Med.2010,38:233-238.
[1]唐仪、郝玲.妇女儿童营养学[M].北京：化学工业出版社.2012：202.
[2]张雪琰,于红霞.哺乳期妇女营养状况及干预研究[D].山东：山东大学,2007.
[3]杨月欣,王光亚,潘兴昌.中国食物成分表[M],北京：北京大学医学出版社.2012.
[4]中国营养学会编著.中国居民膳食营养素参考摄入量(简要本)[M].北京：中国轻工业出版社,2001：18.
[5]吴国豪.实用临床营养学[M].上海：复旦大学出版社,2006.
[6]Anna W, Jean-Pierre H, Kathleen MR. Linking maternal and infant benefits of a nutritional supplement during pregnancy and lactation[J]. Am J Clin Nutr 1998:68:656-61.
[7]Chapman DJ, Nommsen-Rivers L. Impact of Maternal Nutritional Status on Human Milk Quality and Infant Outcomes:An Update on Key Nutrients [J]. Adv. Nutr.2012,3:351-352.
[8]Antonakou A, Skenderi KP, Chiou A, etal. Breast milk fat concentration and fatty acid pattern during the first six months in exclusively breastfeeding Greek women[J]. Eur J Nutr.2013,52:963-973.
[9]Karl-Goran S, Cristina LP, Elsa B, etal. Fatty acid patterns early premature birth, simultaneously analysed in mother's food, breast milk and serum phospholipids of mothers and infants[J]. Lipids in Health and Disease.2009,8:20.
[10]Mahmoud A, Agneta L, Morey W. Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation[J]. Am J Clin Nutr 2009;89:1821-7.
[11]Ramin I, Roya K, Sharareh B, etal. Comparison of long chain polyunsaturated fatty acid content in human milk in preterm and term deliveries and its correlation with mothers'diet[J].J Res Med Sci.2013,18(1):1-5.
[12]Ballard 0, Morrow A L. Human milk composition:nutrients and bioactive factors[J]. Pediatr Clin North Am.2013,60(1):49-74.
[13]李芳,莫洁玲.膳食指导对哺乳期妇女饮食营养状况和乳汁中锌铜镁含量的影响分析[J].中国临床新医学,2013,6：583.
[1]Grovslien AH, Gronn M. Donor milk banking and breastfeeding in Norway. J Hum Lact[J],2009.25:206-210.
[2]早产儿营养调查协作组.新生儿重症监护病房中早产儿营养相关状况多中心调查974例报告[J],中华儿科杂志,2009,47：12-17.
[3]Arslanoglu S, Moro GE, Ziegler EE. Preterm infants fed fortified human milk receive less protein than they need[J]. J Perinatol.2009,29:489-492.
[4]Henriksen C, Westerberg AC, Ronnestad A, etal. Growth and nutrient intake among very-low-birth-weight infants fed fortified human milk during hospitalization[J].Br J Nur 2009,102:1179-86.
[5]Anderson DM, Williams FH, Merkatz RB, etal. Length of gestation and nutritional composition of human milk[J]. The Am J Clin Nutr 1983,37:810-814.
[6]米延,张馨丹.哈尔滨地区早产儿母乳营养素含量的调查研究[J].中国新生儿科杂.2007,6：337-338.
[7]Anderson GH, Atkinson SA, Bryan MH. Energy and macronutrient content of human milk during early lactation from mothers giving birth prematurely and at term[J]. The Am J Clin Nutri.1981,34:258-265.
[8]Zachariassen G, Fenger-Gron J,Hviid MV. The content of macronutrients in milk from mothers of very preterm infants is highly variable [J]. Dan Med J.2013,6:A4613.
[9]Charpak N, Ruiz JG. Breast milk composition in a cohort of preterm infants' mothers followed in an ambulatory programme in Colombia. Acta Padiatr[J],2007,96:1755-1759.
[10]Zhang Z, Adelman AS, Rai D, etal. Amino acid profiles in term and preterm human milk through lactation:a systematic review[J]. Nutrients,2013,5:4800-4821.
[11]翁梅倩、田小琳、吴圣楣.足月儿和早产儿母乳中游离和构成蛋白质的氨基酸含量动态比较[J].上海医学.1999,22：217-222.
[12]Wan J, cui XW, Zhang J, etal. Peptidome analysis of human skim milk in term and preterm milk[J]. Biochem Biophys Res commun.2013,7:236-241.
[13]Cristellote C, Casillas R, Ramirez-Santana C, etal. Premature delivery influences the immunological composition of colostrum and transitional and mature human milk[J].J Nutr.2011,4:1181-1187.
[14]Atiya M, Strandvik B, Sabel KG, etal. Polyamine levels in breast milk are associated with mothers'dietary intake and are higher in preterm than full-term human milk and formulas[J]. J Hum nutr Diet.2013,10:1-8.
[15]戚秋芬,吴圣楣,张伟利.早产儿和足月儿母乳中脂肪酸组成比较研究.中华儿科杂志[J].1997,35：580-582.
[16]Spencer SA, HULL D. Fat content of expressed breast milk:a case for quality control[J].Br Med J.1981,282:99-101.
[17]Lepage G, Collet S, Bougle D, etal. The composition of preterm milk in relation to the degree of prematurity [J]. Am J Clin Nutr.1984,40:1042-1049.
[18]Czank C, Simmer K, Hartmann PE. A method for standardizing the fat content of human milk for use in the neonatal intensive care unit[J]. int breastfeed J.2009,4:1-7.
[19]Morton J, Wong RJ, Hall JY, etal. Combining hand techniques with electric pumping increases the caloric content of milk in mothers of preterm infants[J]. J Perinatol,2012,32:791-796.
[20]Jacqueling B, Joachim G. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants[J]. clin Nutr,2011,30:215-220.
[21]Bobin R, Mikulska M, Mojska, etal. Comparison of the fatty acid composition of transitional and mature milk of mothers who delivered healthy full-term babies, preterm babies and full-term small for gestational age infants[J]. Euro J Clin Nutr,2013,67:966-971.
[22]Arsic A, Vucic V, Prekajski, etal. Different fatty acid composition of serum phospholipids of small and appropriate for gestational age preterm infants and of milk from their mothers[J]. Hippokatia,2012,3:230-235.
[23]Bozena, Beata, Monika, etal. The creamatocrit, fat and energy concentration in human milk produced by mothers of preterm and term infants[J].J Matern Fetal Neonatal Med,2012,9:1599-1602.
[24]Carolina, Ana IC, Xavier CE. Differences in fat content and fatty acid proportions among colostrum, transitional, and mature milk from women delivering very preterm, preterm, and term infants[J]. Clin Nutr.2011, 30:116-123.
[25]Szlivia B, Berthold K, Tamas D. Systematic review of fatty acid composition of human milk from mothers of preterm compared to full-term infants[J]. Ann Nutr Metab.2007,51:550-556.
[26]Remko S, Martine, Janneke, etal. Fatty acid compositions of preterm and term colostrum, transitional and mature milks in a sub-Saharan population with high fish intakes[J]. Prostaglandins, Leukot Essent Fatty Acids.2012,86:201-207.
[27]Karl-Goran S, Cristina LP, Elsa B, etal. Fatty acid patterns early after premature birth, simultaneously analysed in mothers'food, breast milk and serum phospholipids of mothers and infants [J]. Lipids Health Dis.2009,8:20.
[28]Jang SH, Lee BS, Park JH, etal. serial changes of fatty acids in preterm breast milk of Korean woman[J].J Hum Lact,2011:(3)279-285.
[29]Carolin M, Renee B, Alison K, etal. Human milk oligosaccharide composition differs between donor milk and mother's own milk in the NICU[J]. Hum Lact.2013,26:01-03.
[30]钱继红,吴圣楣,陶美华等.早产儿母乳中淀粉酶活性观察.中国新生儿科杂志[J],2006,6：324-327.
[31]Yamawaki N, Yamada M, Kanno T. Macronutrient, mineral and trace element composition of breast milk from Japanese women [J]. J Trace Elem Med Biol.2005, 19:171-81.
[32]Seung-Yeon K, Jung HP, Ellen AR, etal. Longitudinal study on trace mineral compositions(selenium, zinc, copper, manganese) in Korean human preterm milk[J]. J Korean Med Sci.2012,27:532-536.
[33]戴定威,唐泽媛.早产儿母乳主要成分和矿物质动态变化.华西医大学报 [J],1991,22(3)： 32-336.
[34]Alan AV, Fernanda VM, Hellen PP, etal. Analysis of the influence of pasteurization, freezing/thawing, and offer processes on human milk's macronutrient concentrations[J]. Ear Hum Dev.2011:87:577-580.
[35]Nadia R, Diana EV, Oscar GA, etal. Effect of freezing time on macronutrients and energy content of breastmilk[J]. Mary Ann Liebert, Inc.2012,7:295-301.
[36]Yu-Chuan CH, Chao HC, Ming CL. The macronutrients in human milk change after storage in various containers [J]. Pediatr Neonatol.2012,53:205-209.
[37]Lev HM, Ovental A, Mandel D. Major losses of fat, carbohydrates and energy content of preterm human milk frozen at-80℃[J]. J Perinatol.2014,6:1038.
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