钟萍　李宗年　肖厚兰　杨敏霞　黎芹冰　谢燕凤

【摘要】 目的：探讨出院后不同喂养方式对低出生体质量早产儿骨发育的影响。方法：选择本院新生儿科2017年1-12月出院的早产儿90例，根据出院后喂养方式不同分为早产儿出院后配方奶喂养组（PDF组，n=30）、母乳喂养组（BM组，n=30）和足月儿配方奶喂养组（TF组，n=30）。观察比较各组早产儿生后3、6、12月超声骨密度及骨源性碱性磷酸酶的变化情况，评估骨发育状况。结果：在3月龄时，不同喂养方式对早产儿骨密度和骨源性碱性磷酸酶水平的影响差异无统计学意义（P>0.05）。在6、12月龄时，PDF组的骨密度水平优于BM组和TF组，骨源性碱性磷酸酶水平均低于BM组和TF组，差异均有统计学意义（P<0.05）。结论：不同喂养方式对低出生体质量早产儿早期影响不明显，但会影响后期的骨发育，通过出院后配方奶喂养方式可提高早产儿骨密度的增长水平，降低骨源性碱性磷酸酶水平，促进骨发育，合理的营养支持有助于促进和协调低出生体质量早产儿骨生长发育、避免代谢性骨病和降低远期骨骼发育异常。

【关键词】 代谢性骨病； 营养科学； 喂养方式； 早产

Effect of Different Feeding Methods on Bone Development in Low Birth Weight Premature Infants after Discharge/ZHONG Ping，LI Zongnian，XIAO Houlan，et al.//Medical Innovation of China，2018，15（27）：-127

【Abstract】 Objective：To investigate the effect of different feeding methods on bone development in low birth weight premature infants after discharge.Method：A total of 90 premature infants who discharged from January to December 2017 in our department of pediatrics were selected.According to the different ways of feeding after discharge，they were divided into formula milk feeding group（PDF group，n=30），breastfeeding group（BM group， n=30） and formula milk feeding group（TF group， n=30）.The changes of bone mineral density（BMD） and bone alkaline phosphatase（AKP） in preterm infants at 3，6 and 12 months after birth were observed and compared.Result：At 3 month old，there were no significant differences in BMD and ALP level between preterm infants and different feeding methods（P>0.05）.At 6 and 12 month old，the level of BMD in PDF group was better than that in BM group and TF group，and the level of AKP was lower than those of BM group and group TF，and the differences were statistically significant（P<0.05）.Conclusion：The effect of different feeding methods on early birth quality of low birth weight premature infant is not obvious，but it can affect the bone development in the later period.The formula of formula feeding can improve the growth level of bone density，reduce the level of bone alkaline phosphatase and promote bone development.The nutritional support can help to promote and coordinate low birth weight.Preterm infants have bone growth and development，avoid metabolic bone disease and reduce long-term skeletal development abnormalities.

【Key words】 Metabolic bone disease； Nutrition science； Feeding mode； Premature delivery

First-authors address：Foshan Gaoming District Peoples Hospital，Foshan 528500，China

doi：10.3969/j.issn.1674-4985.2018.27.033

代謝性骨病是低出生体质量（low birth weight，LBW）早产儿常见并发症，临床特征为骨生长线性减少，骨骺畸形或骨折，骨密度检查骨强度低，骨矿化少及骨源性碱性磷酸酶升高等，影响婴儿生长乃至成年后骨骼健康[1]。随着围生医学的进步和新生儿重症监护救治水平的提高，更多的LBW早产儿得以存活，使得婴儿代谢性骨病的发病率也日益增加。LBW早产儿体内钙磷储备不足，肾功能发育不成熟，尿中钙磷排泄较多，加上生后追赶性生长对钙磷的需求增多，因此，早期喂养及钙、磷的摄入对LBW早产儿骨发育将起到重要作用[2]。目前，我国LBW早产儿的喂养状况并不理想，营养支持偏重于解决早产儿住院期间的问题，而忽视对LBW早产儿出院后的营养供给，无法满足LBW早产儿“追赶性生长”需求[3]。“……