| Objects:To study the effects of human milk fortification on growth and safety in premature infants in China during hospital stay.Methods:A prospective control study was conducted in4tertiary hospitals in Beijing and Shanghai, premature infants born from Nov2009to Mar2011were included according to certain enrollment criterions. Premature infants were divided into two groups:human milk fortification group (HMF group those fed by human milk over50percent during hospital stays, preterm formula was used for those who didn't have enough human milk.), and preterm formula group as control(those fed fully by preterm formula). The enteral and parenteral nutritional intakes, complications and growth were compared between the two groups.Results:Among the125cases included,62were in the HMF group, and63were in the control group. Birth weight of the infants in HMF group was lower than those in the control group (1429.1±209.0vs.1514.0±210.5g, p=0.025), there was no difference in gestational age, length, head circumference at birth, and correction gestational age at discharge, weight, length and head circumference at discharge, time for regaining birth weight, the mean daily energy, protein, fluid intakes, length of hospilization between the two groups(P>0.05). The enteral energy intakes at7th day in HMF group were lower than that in the control group (25vs.50kcal/kg.d, p=0.015),while the enteral and parenteral energy intakes after two weeks were similar in both groups. There was also no difference in the days for achieving total energy intake of120kcal/kg.d and150ml/kg.d through enteral feeding between the two groups. The velocity of weight,head circumference, length gain after regaining birth weight showed no difference in the two groups(16.9vs.16.2g/kg.d;0.7vs.0.6cm/w;1.1vs.0.9cm/w). The biochemical parameters were similar at birth,but the serum Urea Nitrogen, prealbumin levels in HMF group were lower than those in the control group[2.20±1.17vs.2.66±1.21mmol/L (p=0.036);91.33±21.21vs.107.0±33.58mg/L(p=0.003)], while the calcium levels were higher than the control group (2.48±0.21vs.2.39±0.15mmol/L P=0.016). Serum phosphorus and alkaline phosphatase showed no significant difference (2.01±0.36vs.2.02±0.42mmol/L;311.68±142vs.284.67±111U/L). Nosocomial infection in the HMF group was significantly lower than in the control group[10cases(16.1%)vs.20cases(31.7%),p=0.021],2cases of blood culture positive sepsis in HMF group, and6cases in the control group. There was no significant difference in incidence of feeding intolerance, necrotizing enterocolitis(NEC) between the two groups. The frequency and lasting time of feeding intolerance was obviously less in the HMF group than that in the control group.Conclusions:Premature infants fed with fortified human milk showed similar growth pattern to those fed with preterm formula during hospital stay. Fortified human milk feeding may decrease the incidence of nosocomial infection and feeding intolerance and don't increase incidence of NEC. Objects:To evaluate the variation of adiponectin,leiptin,true insulin and ghrelin in neonatal cord blood and human milk of preterm and term mothers,to study the association among these hormones and to determine the possible effect of these hormones on the development of infants.Methods:Preterm infants were enrolled from August2011to December2011from PUMCH and Beijing Maternity hospital as preterm group, term babies born by mothers without complications were enrolled from PUMCH as control group.Cord blood was collected at birth, colostrums and mature milk were collected at day3and day42postpartum respectively, date of mothers age, BMI at pre-pregnancy/prenatal/42days postpartum delivery mode, complications and infants sex, weight\head circumference and length at birth were collected, Infants and mothers were followed up on42days postpartum,and milk samples were collected, leptin, true insulin and ghrelin in cord blood, colostrums, human milk on day42were tested by ELISA.T test and non-parameters test were used to compare the difference between the preterm group and control group, spearman and partial correlated were used to analysis the linkage of hormones and the association with the development of infants.Results:One hundred forty-nine mother infant pairs were enrolled,149cord blood samples were collected,100from the preterm group, and49from the control group,129colostrums were collected,80were from the preterm group,and49from the control group;99milk samples were collected on day42,50were from the preterm group and49were from the control group.(1) Adiponectin in cord blood in the preterm group was significantly lower than that in control group(16662ng/ml vs.28245ng/ml,p<0.001);Adiponectin in human milk showed no significant difference between the two groups, but adiponectin levels in colostrums was significantly higher than that in mature milk in both two groups. In preterm group, adiponectin levels in cord blood and human milk showed no significant difference between birth weight≤2000g and>2000g group,gestational age≤34weeks and>34weeks group;adiponectin in cord blood in SGA group was significantly lower than that in AGA group, but not in human milk.(2) Leptin levels in cord blood in preterm group was significantly lower than that in control group(1.56ng/ml vs5.39ng/ml,p<0.001),leptin in human milk showed no significant difference between the two groups, but leptin leves in colostrums was significantly higher than mature milk in both groups; leptin in cord blood in≤2000g group were significantly lower than>in2000group(0.77ng/ml vs1.88ng/ml, p=0.000). leptin in cord blood in gestational age≤34weeks group were significantly lower than>34weeks group (0.66ng/ml vs2.13ng/ml, p=0.000).there was no significant difference between SGA and AGA group.(3) True insulin in cord blood and human milk showed no significant difference between preterm group and control group, colostrums and mature milk also showed no difference. True insulin in cord blood in different gestational ages groups,birth weight groups,SGA/AGA groups showed no difference. But true insulin in mature milk in gestational age≤34weeks group was significantly higher than in>34group,true insulin in mature milk in birth weight≤2000g group was significantly also higher than in>2000g group;true insulin in colostrums was significantly lower than in mature milk in both≤34group and≤2000g group.(4) Ghrelin in cord blood and human milk in preterm group was significantly lower than in control group, ghrelin in colostrums was significantly lower than in mature milk in both two groups.Ghrelin in cord blood in birth weight≤2000g group was significantly higher than in>2000g group(347.1pg/ml vs296.1pg/ml, p<0.001).ghrelin in cord blood in SGA group was significantly higher than that in AGA group, and no significant difference between≤34week group and>34week group.Pregnancy-induced hypertension (PIH) can affect adiponectin levels in colostrums;the affecting factors of leptin in cord blood include maternal BM I,gestational age,antenatal Dexamethasone, preterm rupture of membranes(PROM),delivery mode; the affecting factors of true insulin in cord blood and human milk include maternal BMI,delivery mode,PIH; the affecting factors of ghrelin in cord blood include delivery mode,PIH,PROM, antenatal Dexamethasone.In preterm group, adiponectin in cord blood present positive tendency with infant birth weight and head circumference(r=0.184and0.186,respectively);adiponectin in colostrums was negatively correlated with infant weight gain on42days(p=0.025).leptin in cord blood were positive ly correlated with infant birth weight, head circumference and length(p<0.001);True insulin in mature milk were negatively correlated with birth weight(p=0.029).Ghrelin in cord blood presents negative correlation with birth weight, length and head circumference, and also present negatively correlation with infant weight, length, head circumference and weight gain on42days.(p<0.001);ghrelin in colostrums were positive correlation with weight, length head circumference at birth and head circumference on42days(p<0.05);ghrelin in colostrums was associated with higher weight and length (r=0.312and0.31,respectively).Conclusions:Preterm can affect hormones levels in cord blood and human milk, the difference among these hormone concentrations between preterm infants and term infants may relate to prevalence of metabolism disease syndrome in later life. At the same time, hormones in human milk may be associated with appropriate growth in preterm infant, supporting breastfeeding in preterm infants.
|
PDF Full Text Request