JAMA子刊:早产儿更需要母乳喂养
创作:Epi汪 审核:Epi汪 2022年08月05日
  • 纳入澳大利亚586名孕周小于33周出生的婴儿,随访到7岁时评估其神经发育情况;
  • 在住院期间,这群婴儿母乳摄入量平均为99ml/kg,平均母乳持续时间为5.1个月;
  • 在7岁时,IQ平均得分为98.5分;
  • 新生儿住院期间较高的母乳摄入量与较高的IQ、阅读、数学方面的得分呈现相关,与较少的多动症症状得分存在关联;
  • 母乳摄入持续时间越长,阅读、拼写、数学等方面得分越高;
  • 但是母乳喂养行为与全面智商、言语智商、执行功能或行为的改善无关。
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Epi汪
母乳喂养的益处一直被广泛关注。发表在《JAMA Network Open》中的一项长期队列研究提示,针对早产儿人群,持续更长时间的母乳喂养可以提高其在7岁时的神经系统发育水平。并且这个规律在早于30周早产的儿童中更加明显。
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JAMA Network Open [IF:13.353]

Associations of Maternal Milk Feeding With Neurodevelopmental Outcomes at 7 Years of Age in Former Preterm Infants

母乳喂养与早产儿 7 岁时神经发育结果的关联

10.1001/jamanetworkopen.2022.21608

2022-07-01, Article

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Importance : Maternal milk feeding may have unique long-term neurodevelopmental benefits in very preterm infants.
Objective : To examine the extent to which maternal milk feeding after very preterm birth is associated with cognitive, academic, and behavioral outcomes at school age.
Design, Setting, and Participants: This prospective cohort study assessed 586 infants born at less than 33 weeks’ gestation at 5 Australian perinatal centers and enrolled in the Docosahexaenoic Acid for Improvement of Neurodevelopmental Outcomes study (January 1, 2001, to December 31, 2005) who were evaluated at a corrected age of 7 years. The statistical analysis was completed on January 19, 2022.
Exposures : Maternal milk intake, including mean volume (milliliters per kilogram per day) during neonatal hospitalization and total duration (in months).
Main Outcomes and Measures: Neurodevelopmental outcomes at 7 years of age were (1) IQ (Wechsler Abbreviated Scale of Intelligence), (2) academic achievement (Wide Range Achievement Test, Fourth Edition), (3) symptoms of attention-deficit/hyperactivity disorder (ADHD) (Conners Third Edition ADHD Index, parent reported), (4) executive function (Behavior Rating Inventory of Executive Functioning, parent reported), and (5) behavior (Strengths and Difficulties Questionnaire, parent reported).
Results : A total of 586 infants (mean [SD] gestational age at birth, 29.6 [2.3] weeks; 314 male [53.6%]) born to 486 mothers (mean [SD] age, 30.6 [5.5] years; 447 [92.0%] White) were included. Mean (SD) maternal milk intake in the neonatal intensive care unit was 99 (48) mL/kg daily, and mean (SD) maternal milk duration was 5.1 (5.4) months. Mean (SD) full-scale IQ was 98.5 (13.3) points. After covariate adjustment, higher maternal milk intake during the neonatal hospitalization was associated with higher performance IQ (0.67 points per additional 25 mL/kg daily; 95% CI, 0.10-1.23 points), reading scores (1.14 points per 25 mL/kg daily; 95% CI, 0.39-1.89 points), and math scores (0.76 points per 25 mL/kg daily; 95% CI, 0.14-1.37 points) and fewer ADHD symptoms (−1.08 points per 25 mL/kg daily; 95% CI, −1.96 to −0.20 points). Longer duration of maternal milk intake was associated with higher reading (0.33 points per additional month; 95% CI, 0.03-0.63 points), spelling (0.31 points per month; 95% CI, 0.01-0.62 points), and math (0.30 points per month; 95% CI, 0.03-0.58 points) scores. Maternal milk was not associated with improved full-scale IQ, verbal IQ, executive function, or behavior. Most associations were stronger among infants born at lower gestational ages, particularly less than 30 weeks (interaction P values <.01).
Conclusions and Relevance: In this cohort study of preterm infants, maternal milk feeding during the neonatal hospitalization and after discharge were associated with better school-age performance IQ and academic achievement and with a reduction in ADHD symptoms, particularly among infants born at less than 30 weeks’ gestation.

First Authors:
Mandy B Belfort

Correspondence Authors:
Mandy B Belfort

All Authors:
Mandy B Belfort,Emma Knight,Shikha Chandarana,Emmanuella Ikem,Jacqueline F Gould,Carmel T Collins,Maria Makrides,Robert A Gibson,Peter J Anderson,Karen Simmer,Henning Tiemeier,Alice Rumbold

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