| ObjectiveRetinopathy of prematurity(ROP)is a common serious ophthalmic disease among premature infants,human milk and early aggressive parenteral nutrition may provide a protective effect for retinal development.The purpose of our study is to explore the effect of early human milk feeding combines parenteral nutrition on the development of retinal blood vessels of premature infants and ROP,in addition,prospecting effective clinical strategies on preventing ROP.Methods(1)Object and groupingA total of 99 cases of premature infants with gestation from 27 weeks to 36 weeks and birth weight lower than 2500 g who was hopitalized in the neonatology department of The Second Affiliated Hospital of Guangzhou Medical University between January 2016 and December 2016 were included in the study.They were randomly devided into breastfeeding group(experimental group,n=54)and formula-fed group(control group,n=45)according to the parity of the last number of their admission number.This project was approved by the ethics committee of hospital and got guardian's signature on informed consent form.(2)Nutrition protocolsTwo groups of premature infants were given small volumes of milk called minimal enteral feeding which target milk-volume was 20ml/(kg.d)within 24 hours after birth,feeding with human milk and formula milk respectively,when reached the target milk volume of MEF their daily increment of milk were accelerated ranging 10 to 30ml/(kg.d)until reached full enteral feeding[150ml/(kg.d)].As for supplying parenteral nutrition,all was given 6.7% pediatric amino acid [the initial dose was 1.5-2.0g/(kg.d),increased by 0.5-1.0g/(kg.d)until maximum dose of 3.5g/(kg.d)] within 12 hours after birth and 20% lipid emulsion [the initial dose was 1.0g/(kg.d),increased by 0.5-1.0g/(kg.d)until maximum dose of 3.0g/(kg.d)] within 24 hours.(3)Observation indexRecording the following items of two groups respectively.It contains the data of perinatal period including gender,gestational age,birth weight,way of birth,character of amniotic fluid,etc,the duration of mechanical ventilation and oxygen therapy,duration of parenteral nutrition,average energy and protein intake during the first week of life,duration of MEF,days to full enteral feeding,physical growth index(including weight,head circumference and body length),situation of retinal vascular development,neonatal behavioral neurological assessment scores at the 40 weeks corrected gestational age,morbidity of ROP,encephalopathy of prematurity and other related complications and so on.(4)Statistical analysisData were analyzed using the SPSS 16.0.The data were expressed as mean±standard deviation(`x±s)or median(minimum to maximum value).Independent t-test was used for normal distribution data and nonparametric test for abnormal distribution data.Enumeration data was analyzed by chi-square test.P<0.05 was considered to be statistically significant.Results(1)There were no statiscally significant differences in the gender ratio,gestational age,birth weight,birth body length,head circumference,proportion of natural birth,duration of mechanical ventilation and oxygen therapy,duration of hospitalization,growthrate of body length and head circumference during hospitalization between two groups(P>0.05).(2)Compared breastfeeding group to formula-fed group,the duration of parent eral nutrition [(14.85±8.26)versus(19.22±12.37)d,P=0.039],duration of MEF[5.50(1.0-21.0)versus7.0(1.0-27.0)d,P=0.021],the time to regain birth weight[(5.68±2.57)versus(6.73±2.99)d,P=0.042],time to reach full enteral feeding [(17.40±9.03)versus(22.82±13.13)d,P=0.032]were significantly shorter.In addition,the proportion of weight loss[(3.46±2.00)versus(4.20±1.64)%,P=0.048]was lower,the average daily weight gain[(22.64±6.88)versus(19.77±3.98)d,P=0.015]was faster and the average energy[(77.13±5.15)versus(68.54±5.41)kcal/(kg.d),P=0.000]and protein [(3.24±0.15)versus(2.63±0.34)g/(kg.d),P=0.000]intake during the first week of life was higher,they had significant defferences(P<0.05).(3)The morbidity of feeding intolerance(9.3% versus 26.7%,P=0.022)was significantly lower in breastfeeding group versus to formula-fed group(P<0.05).Morbidity of respiratory distress syndrome,necrotizing enterocolitis,bronchopulmonary dysplasia,patent ductus arteriosus,cholestasis,extrauterine growth restrition did not show statistical differences in these two study groups(P>0.05).(4)There were no statiscally significant differences in the morbidity of encephalopathy of prematurity(7.4% versus 6.7%,P=0.886)and neonatal behavioral neurological assessment scores at the 40 weeks corrected gestational age[(36.25±2.23)versus(35.75±2.58),P=0.300],but the proportion of NBNA scores lower than 35(12.9% versus 28.8%,P=0.049)was significantly lower in breastfeeding group versus to formula-fed group(P<0.05).(5)The proportion of immature retina at the 34 weeks corrected gestational age(27.8% versus 48.9%,P=0.031)and the morbidity of ROP(5.6% versus 22.2%,P=0.032)was significantly lower in breastfeeding group versus to formula-fed group(P<0.05).ConclusionEarly human milk feeding conbines aggressive parenteral nutrition can reduce the morbidity of ROP,which also effectively promotes the development of retinal vessels andweight gain.Moreover,early human milk feeding reduces the morbidity of feeding intolerance,but did not increase the morbidity of other common complication of premature infants. |
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