极早产儿初始母乳喂养时间与新生儿结局的关系:中国的一项多中心队列研究

IF 2.3 4区 医学 Q2 PEDIATRICS
Rong Lin, Zhihui Rong, Rong Zhang, Zhi Zheng, Ya Ding, Chao Ning, Yun Cao, Chen Chao, Jie Yang, Xinzhu Lin
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引用次数: 0

摘要

目的:评估极早产儿(vpi)初始母乳喂养时间与坏死性小肠结肠炎(NEC)和其他新生儿结局风险之间的关系,设计:多中心观察队列研究。背景:通过中国新生儿网络收集2019年至2023年间中国102个三级新生儿重症监护病房(NICUs)的数据。患者:共纳入12679例出生24小时内入住新生儿重症监护病房并在7天内开始母乳喂养的vpi。干预措施:根据初始母乳喂养时间将婴儿分为四组:24小时内(n=2242)、24-48小时(n=3657)、48-72小时(n=1870)和72小时后(n=4910,参照组)。主要结局指标:主要结局为NEC(≥2期)。次要结局包括死亡率、支气管肺发育不良、严重神经损伤、早产儿严重视网膜病变、晚发性败血症、新生儿重症监护病房住院时间和静脉营养持续时间。结果:早期母乳喂养(结论:早期母乳喂养(
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Association of timing of initial breastfeeding and neonatal outcome in very preterm infants: a multicentre cohort study in China.

Association of timing of initial breastfeeding and neonatal outcome in very preterm infants: a multicentre cohort study in China.

Association of timing of initial breastfeeding and neonatal outcome in very preterm infants: a multicentre cohort study in China.

Objective: To evaluate the association between the timing of initial breastfeeding and the risk of necrotising enterocolitis (NEC) and other neonatal outcomes in very preterm infants (VPIs, <32 weeks' gestation).

Design: Multicentre observational cohort study.

Setting: Data were collected from 102 tertiary neonatal intensive care units (NICUs) in China between 2019 and 2023 through the Chinese Neonatal Network.

Patients: A total of 12 679 VPIs admitted to NICUs within 24 hours of birth and initially breastfed within 7 days were included.

Interventions: Infants were categorised into four groups based on initial breastfeeding timing: within 24 hours (n=2242), 24-48 hours (n=3657), 48-72 hours (n=1870) and after 72 hours (n=4910, reference group).

Main outcome measures: The primary outcome was NEC (stage ≥2). Secondary outcomes included mortality, bronchopulmonary dysplasia, severe neurological injury, severe retinopathy of prematurity, late-onset sepsis, NICU length of stay and intravenous nutrition duration.

Results: Early breastfeeding initiation (<24 hours) was associated with a higher incidence of NEC (7.5% vs 4.3%, OR 1.92, 95% CI 1.21 to 3.06). No significant NEC risk increase was observed for feeding initiation after 24 hours. Early breastfeeding was linked to a shorter duration of intravenous nutrition (median 15 days (IQR 10-27) vs 22 days (IQR 14-33), mean difference -3.93 days, 95% CI -6.57 to -1.3). Subgroup analysis revealed increased NEC risk in neonates delivered via caesarean section, those receiving blood transfusions and those born <28 weeks' gestation.

Conclusions: While early breastfeeding initiation (<24 hours) reduces intravenous nutrition duration, it may elevate NEC risk in specific high-risk subgroups. Feeding strategies should be individualised based on gestational age, delivery mode and transfusion status. Further randomised trials are needed to optimise early feeding protocols for VPIs.

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来源期刊
BMJ Paediatrics Open
BMJ Paediatrics Open Medicine-Pediatrics, Perinatology and Child Health
CiteScore
4.10
自引率
3.80%
发文量
124
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