早产母乳营养成分的分析

Macronutrients and energy in milk from mothers of premature infants

摘要:

目的 探讨早产儿母亲乳汁营养成分的特点及动态变化。方法 收集2012 年11 月至2014 年1月在北京协和医院产科分娩产妇170 人的母乳339 份，用MIRIS 母乳分析仪检测母乳中宏量营养素及能量，比较各组母乳营养成分的差异。结果 （1）早产母乳中蛋白质含量：初乳> 过渡乳> 成熟乳（2.22±0.49 g/dL vs1.83±0.39 g/dL vs 1.40±0.28 g/dL；P<0.01）； 初乳的脂肪、碳水化合物和能量低于过渡乳（分别为2.4±1.3 g/dLvs 3.1±1.1 g/dL，P<0.01；6.4±0.9 g/dL vs 6.6±0.4 g/dL，P<0.05；55±9 kcal/dL vs 62±8 kcal/dL，P<0.01）。（2）早产初乳蛋白质高于足月初乳（2.22±0.49 g/dL vs 2.07±0.34 g/dL，P<0.05）。（3）≤ 30 周早产初乳蛋白质含量最高（2.48±0.68 g/dL），与30⁺¹~33⁺⁶ 周组（2.11±0.25 g/dL）和≥ 34 周组（2.22±0.39 g/dL）比较差异有统计学意义（P<0.05）；≤ 30 周早产初乳能量显著低于30⁺¹~33⁺⁶ 周（51±6 kcal/dL vs 58±8 kcal/dL，P<0.05）。≤ 30 周早产过渡乳中碳水化合物显著高于30⁺¹~33⁺⁶ 周组和≥ 34 周组（P<0.05）。30⁺¹~33⁺⁶ 周成熟乳蛋白质显著高于≤ 30 周和≥ 34 周组（P<0.05）。结论 （1）早产初乳、过渡乳和成熟乳营养成分差异显著；（2）早产初乳蛋白质显著高于足月初乳，这种差异未能持续到成熟乳阶段；（3）不同孕周早产产妇母乳营养成分亦存在差异，以适应不同胎龄早产儿的营养需要。

Abstract:

Objective To study the dynamic changes in macronutrients and energy in human milk from mothers of premature infants. Methods A total of 339 human milk samples were collected from 170 women who delivered preterm or full-term infants in the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital between November 2012 and January 2014. Macronutrients (proteins, fats and carbohydrates and energy were measured using a MIRIS human milk analyzer and compared between groups. Results In milk samples from premature infants' mothers, the protein levels were the highest in colostrum (2.22±0.49 g/dL), less in transitional milk (1.83±0.39 g/dL), and the least in mature milk (1.40±0.28 g/dL) (P<0.01), and the levels of fats (2.4±1.3 g/dL vs 3.1±1.1 g/dL; P<0.01), carbohydrates (6.4±0.9 g/dL vs 6.6±0.4 g/dL; P<0.05) and energy (55±9 kcal/dL vs 62±8 kcal/dL; P<0.01) were significantly lower in colostrum than in transitional milk. The protein levels in colostrum from premature infants' mothers were significantly higher than those in colostrum from term infants' mothers (2.22±0.49 g/dL vs 2.07±0.34 g/dL; P<0.05). The colostrum from mothers of premature infants with a gestational age of ≤30 weeks had significantly higher protein levels than those from mothers of premature infants with gestational ages of 30⁺¹-33⁺⁶ weeks and ≥34 weeks (2.48±0.68 g/dL vs 2.11±0.25 g/dL and 2.22±0.39 g/dL respectively, P<0.05); the energy levels in colostrum from mothers of premature infants with a gestational age of ≤30 weeks group (51±6 kcal/dL) were significantly lower than those in colostrum from mothers of premature infants with a gestational age of 30⁺¹-33⁺⁶ weeks (58±8 kcal/d; P<0.05). The carbohydrate levels in transitional milk from mothers of premature infants with a gestational age of ≤30 weeks were significantly higher than those in transitional milk from mothers of premature infants with gestational ages of 30⁺¹-33⁺⁶ weeks and ≥34 weeks (P<0.05). The protein levels in mature milk from mothers of premature infants with a gestational age of 30⁺¹-33⁺⁶ weeks were significantly higher than those in mature milk from mothers of premature infants with gestational ages of ≤30 weeks and ≥34 weeks (P<0.05). Conclusions The levels of macronutrients and energy in milk from mothers of premature infants vary significantly between colostrum, transitional milk, and mature milk. Protein levels are significantly higher in colostrum from premature infants' mothers than in colostrum from term infants' mothers, but the significant difference is not seen for mature milk. Macronutrient and energy levels show significant differences between milk samples from mothers of premature infants with different gestational ages, so as to meet different needs of premature infants.