美国儿科学会：给早产儿喂母乳好处多多

给早产儿喂母乳从短期或者长远来看都有许多益处。哺喂母乳有利于提高早产儿未发育成熟的机体防御能力，从而降低败血症和坏死性小肠结肠炎的发病率。母乳喂养不仅有益于在新生儿重症监护病房照护期间的早产儿，也对少数从监护病房出院后同年内再次入院的早产儿同样有益。另外，降低坏死性小肠结肠炎的患病率，意味着不仅减少了新生儿的死亡率，也减少了由该病引发的长期生长发育迟缓和神经发育残疾。通过喂母乳还能增强早产儿的临床喂养耐受能力，可帮助婴儿尽快接受完全肠道内喂养。 哺喂母乳可改善早产儿神经发育状况。通过对8岁儿童整个青春期的长期研究，我们发现在新生儿重症监护病房得到母乳喂养的孩子智商测试成绩更高，白质发育情况更佳，脑容量更大。在新生儿重症监护病房中得到最大比例母乳哺喂的极早产儿，在其18个月和30个月时在心理、运动、行为能力方面都能获得更高的评估分数。即使将一系列混杂因素如母亲生育年龄、教育背景、婚姻状况、种族和婴儿发病率的影响进行调整后，上述数据优势仍然十分明显。神经发育结果一般与主要喂食母乳有关，但不一定是纯母乳喂养。新生儿重症监护期间的母乳喂养也可降低严重的早产儿视网膜病的发病率。此外，对早产儿的长期研究结果显示，母乳喂养可以降低新生儿的代谢综合症，降低青春期血压和低密度脂蛋白浓度，增强体内瘦素和胰岛素代谢能力。 母乳的好处如此之多，因此所有早产儿都应接受母乳喂养（表3）。不管是新鲜或者冷冻，母亲自身的乳汁都应当是婴儿最主要的食物，对于出生体重少于1.5公斤的新生儿应对母乳进行适当强化。如果早产儿的母亲在大力的母乳支持下仍然无法分泌母乳，则应当使用经巴氏杀菌的捐助母乳。对巴氏杀菌的捐助母乳进行质量控制非常重要，必须监控。新的数据显示早产儿母亲自身的母乳可在新生儿重症监护期间以4°C冷藏储存长达96小时。67母乳解冻、加热和延长储存期限方面的相关数据还需进一步更新。实践中应当制定适当方案，以避免母乳的管理不善。 表3早产儿母乳喂养管理建议 1 所有早产儿都应接受人乳喂养。 出生时体重少于1500克的新生儿应喂食强化了蛋白质、矿物质和维生素的母乳，以确保其营养摄入得以优化。 如果母亲不能泌乳，或者母乳因禁忌症不能喂，应使用适当强化的经巴氏杀菌的捐助母乳 2 应当向母亲提供手动挤奶或机器挤奶的方法和训练方案。 3 新生儿重症监护病房应当具备采集、储存和标示母乳的可循证的条件 4 新生儿重症监护病房应避免母乳的管理不善 5 没有研究数据支持定期培养母乳中的细菌或者其它有机体 There are several significant short- and long-term beneficial effects of feeding preterm infants human milk. Lower rates of sepsis and NEC indicate that human milk contributes to the development of the preterm infant’s immature host defense. The benefits of feeding human milk to preterm infants are realized not only in the NICU but also in the fewer hospital readmissions for illness in the year after NICU discharge. Furthermore, the implications for a reduction in incidence of NEC include not only lower mortality rates but also lower long-term growth failure and neurodevelopmental disabilities. Clinical feeding tolerance is improved, and the attainment of full enteral feeding is hastened by a diet of human milk. Neurodevelopmental outcomes are improved by the feeding of human milk. Long-term studies at 8 years of age through adolescence suggest that intelligence test results and white matter and total brain volumes are greater in subjects who had received human milk as infants in the NICU. Extremely preterm infants receiving the greatest proportion of human milk in the NICU had significantly greater scores for mental, motor, and behavior ratings at ages 18 months and 30 months. These data remain significant after adjustment for confounding factors, such as maternal age, education, marital status, race, and infant morbidities. These neurodevelopmental outcomes are associated with predominant and not necessarily exclusive human milk feeding. Human milk feeding in the NICU also is associated with lower rates of severe retinopathy of prematurity. Long-term studies of preterm infants also suggest that human milk feeding is associated with lower rates of metabolic syndrome, and in adolescents, it is associated with lower blood pressures and low-density lipoprotein concentrations and improved leptin and insulin metabolism. The potent benefits of human milk are such that all preterm infants should receive human milk (Table 3). Mother’s own milk, fresh or frozen, should be the primary diet, and it should be fortified appropriately for the infant born weighing less than 1.5 kg. If mother’s own milk is unavailable despite significant lactation support, pasteurized donor milk should be used. Quality control of pasteurized donor milk is important and should be monitored. New data suggest that mother’s own milk can be stored at refrigerator temperature (4°C) in the NICU for as long as 96 hours.67 Data on thawing, warming, and prolonged storage need updating. Practices should involve protocols that prevent misadministration of milk. 来源：http://pediatrics.aappublications.org/content/129/3/e827.full 翻译：http://www.weibo.com/2514526082/zvv2Aev2H