捐献人乳库对极/超低出生体重儿的临床效果

doi:10.19723/j.issn.1671-167X.2025.04.021

摘要/Abstract

摘要：

目的: 评价捐赠人乳库建立后对极/超低出生体重儿的母乳喂养率及临床并发症的影响，为极/超低出生体重儿喂养管理提供科学依据。方法: 采用回顾性队列研究设计，选择2022年2月至2023年11月北京市某三级甲等医院收治的极/超低出生体重儿作为研究对象，其中将捐赠人乳库建立前136例极/超低出生体重儿作为对照组，捐赠人乳库建立后143例极/超低出生体重儿作为观察组。收集极/超低出生体重儿及其母亲的临床资料，母亲信息包括分娩年龄、合并症、分娩方式；极/超低出生体重儿信息包括性别、体重、胎龄、接受母乳喂养时间、达到全肠道喂养时间、住院天数、并发症(早产儿喂养不耐受、坏死性小肠结肠炎、早产儿视网膜病变和晚发型败血症)发生情况。结果: 观察组和对照组的产妇年龄分别为(33.5±4.2)岁、(32.5±3.9)岁，接受剖宫产的例数分别为95(70.4%)例、81(66.9%)例；两组极/超低出生体重儿胎龄分别为(29.2±2.1)周和(29.1±2.2)周，出生体重分别为(1 140.5±247.1) g和(1 169.4±228.6) g，男婴分别为72例(50.3%)和63例(46.3%)。两组基线特征差异均无统计学意义(P均>0.05)。观察组和对照组的纯母乳喂养率分别为10.5%和3.1%，差异有统计学意义(χ²=5.778，P=0.016)。达到完全肠内喂养的时间从13 d缩短至10 d (Z=-4.567，P < 0.001)，首次母乳喂养时间从入院第3天提前至第1天(Z=-11.812，P < 0.001)，住院期间喂养不耐受发生率从34.0% 降至10.0%(χ²=17.015，P < 0.001)，但发现首次接受亲母母乳喂养时间从入院第3天延长至第4天(Z=-4.652，P < 0.001)。两组坏死性小肠结肠炎、晚发型败血症、早产儿视网膜病变的并发症发生率及总住院时长差异均无统计学意义(P>0.05)。结论: 捐赠人乳库的应用可提高极/超低出生体重儿的母乳喂养率、缩短首次母乳喂养时间、降低喂养不耐受发生率，为临床治疗该类患儿提供了参考依据。

关键词: 极低出生体重儿, 超低出生体重儿, 母乳喂养, 捐赠人乳库

Abstract:

Objective: To compare the differences in breastfeeding rates and the incidence of clinical complications in very/extremely low birth weight infants with and without the use of donor milk banks. Methods: Before and after the establishment of the donor milk bank, a total of 279 very/extremely low birth weight infants who were hospitalized in neonatal intensive care unit in a tertiary hospital in Beijing were selected. In the study, 136 infants who did not receive donated breast-feeding were included in control group and 143 infants who received donated breast-feeding were included in observation group. The clinical data of mothers and their infants were collected. The mother' s information included gestational age, maternal comorbidities, and mode of delivery. Infant information includes gender, weight, gestational age, duration of breastfeeding, total enteral feeding time, hospitalization time and incidence of complications (feeding intolerance, necrotizing enterocolitis, retinopathy of prematurity). Results: The maternal ages were (33.5 ± 4.2) years in the observation group and (32.5 ± 3.9) years in the control group. Cesareans were performed in 95 cases (70.4%) and 81 cases (66.9%), respectively. The gestational ages of preterm infants were (29.2 ± 2.1) weeks and (29.1 ± 2.2) weeks, with birth weights of (1 140.5 ± 247.1) g and (1 169.4 ± 228.6) g, respectively. Newborn boys accounted for 72 cases (50.3%) in the observation group and 63 cases (46.3%) in the control group. No statistically significant differences were found in baseline characteristics between the two groups (all P > 0.05). After the use of donor milk banks, the rate of exclusive breastfeeding in very/low birth weight infants increased from 3.1% to 10.5% (χ²=5.778, P=0.016) during hospitalization, the time to full enteral feeding was shortened from 13 d to 10 d (Z=-4.567, P < 0.001), the first breastfeeding time was shortened from the third day of admission to the first day of admission (Z= -11.812, P < 0.001), the first breastfeeding of mother' s own milk was extended from the third day of admission to the fourth day of admission (Z=-4.652, P < 0.001), and the incidence of feeding intolerance during hospitalization was reduced from 34.0% to 10.0% (χ²=17.015, P < 0.001). There were no significant differences in the incidence of necrotizing enterocolitis, late-onset sepsis, retinopathy of prematurity and total length of hospital stay (P>0.05). Conclusion: The use of donor milk bank can improve the breastfeeding rate, shorten the time to first breastfeeding, and reduce the incidence of feeding intolerance in very/extremely low birth weight infants, which provides a reference for the clinical treatment of very/extremely low birth weight infants.

Key words: Very low birth weight infant, Extremely low birth weight infant, Breastfeeding, Donor human milk bank

中图分类号:

R722.6

李蕊, 潘京, 杨青, 邢燕, 童笑梅. 捐献人乳库对极/超低出生体重儿的临床效果[J]. 北京大学学报（医学版）, 2025, 57(4): 759-763.

Rui LI, Jing PAN, Qing YANG, Yan XING, Xiaomei TONG. Impact of donor human milk bank on clinical outcomes in infants with very/extremely low birth weight[J]. Journal of Peking University (Health Sciences), 2025, 57(4): 759-763.

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Characteristics	Control group (n=136)	Observation group (n=143)	χ²/t	P
Newborn
Gestational age/weeks	29.1±2.2	29.2±2.1	-0.326^*	0.745
Weight/g	1 169.4±228.6	1 140.5±247.1	1.013^*	0.312
Gender
Newborn boy	63 (46.3)	72 (50.3)	0.452^#	0.501
Newborn girl	73 (53.7)	71(49.7)
Mother of the newborn
Mother’s age at birth/years	32.5±3.9	33.5±4.2	-1.920^*	0.056
Gestational hypertension	53 (43.8)	58 (43.0)	0.018^#	0.892
Gestational diabetes	39 (32.2)	37 (27.4)	0.711^#	0.399
Cesarean	81 (66.9)	95 (70.4)	0.349^#	0.555
Postpartum hemorrhage	8 (6.6)	9 (6.7)	0.000^#	0.986

Variable	Control group (n=136)	Observation group (n=143)	χ²/Z	P
Exclusive breastfeeding throughout hospitalization	4 (3.1)	15 (10.5)	5.778^*	0.016
First breastfeeding after birth/d	3.0 (2.0, 4.0)	1.0 (1.0, 1.0)	-11.812^#	< 0.001
First mother’s own milk breastfeeding/d	3.0 (2.0, 4.0)	4.0 (3.0, 5.0)	-4.652^#	< 0.001
Time to achieve full enteral feeding/d	13.0 (10.0, 18.0)	10.00 (6.3, 14.0)	-4.567^#	< 0.001
Total length of stay/d	50 (39.0, 67.3)	50 (38.5, 69.8)	-0.365^#	0.715

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