本文由小咖机器人翻译整理

期刊来源：N Engl J Med

原文链接：https://doi.org/10.1056/NEJMoa2313942

摘要内容如下：

背景

大多数中晚期早产儿需要营养支持，直到他们完全依靠母亲的母乳喂养。缺乏指导这些婴儿营养策略的证据。

方法

我们进行了一项多中心、析因、随机试验，研究对象为妊娠32周0天至35周6天出生的婴儿，这些婴儿接受了静脉注射，其母亲打算进行母乳喂养。每个婴儿都被分配到三个干预措施或其对照：静脉注射氨基酸溶液（肠外营养）或葡萄糖溶液，直到完全用牛奶喂养；母乳不足时给予的牛奶补充剂，或仅有母亲的母乳而没有补充；以及胃管喂养前的味觉和嗅觉暴露或没有味觉和嗅觉暴露。肠外营养和牛奶补充剂干预的主要结果是纠正胎龄4个月时的体脂百分比，味觉和嗅觉干预的主要结果是完全肠道喂养（每天每公斤体重150毫升或全母乳喂养）的时间。

结果

共有532名婴儿（291名男孩[55%]）被纳入试验。接受肠外营养的婴儿和接受葡萄糖溶液的婴儿在4个月时的平均（±SD）体脂百分比相似（26.0±5.4%vs.26.2±5.2%；调整平均差，-0.20；95%置信区间[CI]，-1.32至0.92；P=0.72），补充母乳的婴儿和纯母乳喂养的婴儿（26.3±5.3%vs.25.8±5.4%；调整平均差，0.65；95%可信区间为-0.45~1.74；P=0.25）。在接触味觉和嗅觉的婴儿和未接触味觉和嗅觉的婴儿中，达到完全肠道喂养的时间相似（5.8±1.5对5.7±1.9天；P=0.59）。各干预措施的次要结果相似。1例婴儿发生严重不良事件。

结论

这项常规营养干预试验旨在支持中至晚期早产儿，直到母亲的母乳可以提供充分的营养，该试验未显示对完全肠道喂养的时间或纠正胎龄4个月时的身体成分有任何影响。（由新西兰健康研究委员会和其他机构资助；Diamond Australian New Zealand Clinical Trials Registry Number，ACTRN12616001199404）。

英文原文如下：

Abstracts

BACKGROUND  Most moderate-to-late-preterm infants need nutritional support until they are feeding exclusively on their mother's breast milk. Evidence to guide nutrition strategies for these infants is lacking.

METHODS  We conducted a multicenter, factorial, randomized trial involving infants born at 32 weeks 0 days' to 35 weeks 6 days' gestation who had intravenous access and whose mothers intended to breast-feed. Each infant was assigned to three interventions or their comparators: intravenous amino acid solution (parenteral nutrition) or dextrose solution until full feeding with milk was established; milk supplement given when maternal milk was insufficient or mother's breast milk exclusively with no supplementation; and taste and smell exposure before gastric-tube feeding or no taste and smell exposure. The primary outcome for the parenteral nutrition and the milk supplement interventions was the body-fat percentage at 4 months of corrected gestational age, and the primary outcome for the taste and smell intervention was the time to full enteral feeding (150 ml per kilogram of body weight per day or exclusive breast-feeding).

RESULTS  A total of 532 infants (291 boys [55%]) were included in the trial. The mean (±SD) body-fat percentage at 4 months was similar among the infants who received parenteral nutrition and those who received dextrose solution (26.0±5.4% vs. 26.2±5.2%; adjusted mean difference, -0.20; 95% confidence interval [CI], -1.32 to 0.92; P = 0.72) and among the infants who received milk supplement and those who received mother's breast milk exclusively (26.3±5.3% vs. 25.8±5.4%; adjusted mean difference, 0.65; 95% CI, -0.45 to 1.74; P = 0.25). The time to full enteral feeding was similar among the infants who were exposed to taste and smell and those who were not (5.8±1.5 vs. 5.7±1.9 days; P = 0.59). Secondary outcomes were similar across interventions. Serious adverse events occurred in one infant.

CONCLUSIONS  This trial of routine nutrition interventions to support moderate-to-late-preterm infants until full nutrition with mother's breast milk was possible did not show any effects on the time to full enteral feeding or on body composition at 4 months of corrected gestational age. (Funded by the Health Research Council of New Zealand and others; DIAMOND Australian New Zealand Clinical Trials Registry number, ACTRN12616001199404.).

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