Anne sütünün bireysel güçlendirilmesi: Gerçekten fark yaratıyormu
Başlık çevirisi mevcut değil.
- Tez No: 171289
- Danışmanlar: PROF.DR. NİLGÜN KÜLTÜRSAY
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2005
- Dil: Türkçe
- Üniversite: Ege Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: Belirtilmemiş.
Özet
SUMMARY Background: Recently inadequate nutrition with subsequent growth failure has become one of the most important issues for very low birth weight (VLBW) infants in NICUs. Insufficient protein intakes have been shown to be primarily responsible for this growth failure. Fortified breast milk is undoubtly the first choice as the nutrient supply. However, even fortified breast milk falls short of satisfying consistently the variable and high protein intakes of this special group of infants. This is particularly due to the highly inter- and intra-individual variations in breast milk composition, and the inadequate protein content of milk fortifiers. Objective: To test the hypothesis that a“New Individualized Fortification Approach”- designed to ensure that protein needs of premature infants are met all the time - could lead to higher protein intakes compared to standard fortification. Methods: Preterm infants with birth weights of 600-1750 grams and gestational ages between 26-34 weeks were enrolled for this prospective, randomized, controlled trial. All of the infants were fed breast milk and were randomly assigned before 21 days of life to either the new individualized fortification regimen or the standad regimen. The study period began when feeding volume reached 150 ml/kg/day and ended when infants reached a weight of 2000 g. In the standard fortification regimen (STD), a recommended amount of human milk fortifier (HMF) was added to breast milk. The individualized regimen (IND) consisted of standard fortification, but with addition of extra HMF and supplemental protein guided by twice-weekly BUN determinations. Primary outcome was protein intake, serum biochemical indicators, fat and energy intakes were secondary outcomes. Results: Thirty-two infants completed the study as planned (16 STD, 16 IND). Infants receiving the IND regimen achieved the mean fortification levels of +0.9, +1.7 ve +2.3 during the l8^1“1 and 3rd weeks of the study leading to mean protein intakes of 2.9, 3.2 and 3.4 g/kg/day. In the STD regimen group, protein intakes remained stable during the whole study period (2.9, 2.9, 2.8 g/kg/day, respectively). Significant statistical differences between the protein intakes of the two fortification groups were found in the second and third weeks of the study (p<0.01). There were no significant differences in serum albumin and creatinine concentrations between groups and over time. As expected, in the IND group BUN concentrations increased significantly (p<0.001) over time. BUN and creatinine levels remained in the normal range throughout the study. None of the babies had nutritional intolerance leading to the withholding of the feeds. Conclusions: Tiny premature infants managed with this new individualized fortification regimen had significantly higher protein intakes than infants fed to standard fortification. With the new regimen, protein intake approached intrauterine accretion rates without evidence of metabolic stress and gastrointestinal intolerance. The ”New Individualized Fortification Method" seems to be a promising approach to solving the problem of undernutrition among premature infants fed breast milk.
Özet (Çeviri)
SUMMARY Background: Recently inadequate nutrition with subsequent growth failure has become one of the most important issues for very low birth weight (VLBW) infants in NICUs. Insufficient protein intakes have been shown to be primarily responsible for this growth failure. Fortified breast milk is undoubtly the first choice as the nutrient supply. However, even fortified breast milk falls short of satisfying consistently the variable and high protein intakes of this special group of infants. This is particularly due to the highly inter- and intra-individual variations in breast milk composition, and the inadequate protein content of milk fortifiers. Objective: To test the hypothesis that a“New Individualized Fortification Approach”- designed to ensure that protein needs of premature infants are met all the time - could lead to higher protein intakes compared to standard fortification. Methods: Preterm infants with birth weights of 600-1750 grams and gestational ages between 26-34 weeks were enrolled for this prospective, randomized, controlled trial. All of the infants were fed breast milk and were randomly assigned before 21 days of life to either the new individualized fortification regimen or the standad regimen. The study period began when feeding volume reached 150 ml/kg/day and ended when infants reached a weight of 2000 g. In the standard fortification regimen (STD), a recommended amount of human milk fortifier (HMF) was added to breast milk. The individualized regimen (IND) consisted of standard fortification, but with addition of extra HMF and supplemental protein guided by twice-weekly BUN determinations. Primary outcome was protein intake, serum biochemical indicators, fat and energy intakes were secondary outcomes. Results: Thirty-two infants completed the study as planned (16 STD, 16 IND). Infants receiving the IND regimen achieved the mean fortification levels of +0.9, +1.7 ve +2.3 during the l8^1“1 and 3rd weeks of the study leading to mean protein intakes of 2.9, 3.2 and 3.4 g/kg/day. In the STD regimen group, protein intakes remained stable during the whole study period (2.9, 2.9, 2.8 g/kg/day, respectively). Significant statistical differences between the protein intakes of the two fortification groups were found in the second and third weeks of the study (p<0.01). There were no significant differences in serum albumin and creatinine concentrations between groups and over time. As expected, in the IND group BUN concentrations increased significantly (p<0.001) over time. BUN and creatinine levels remained in the normal range throughout the study. None of the babies had nutritional intolerance leading to the withholding of the feeds. Conclusions: Tiny premature infants managed with this new individualized fortification regimen had significantly higher protein intakes than infants fed to standard fortification. With the new regimen, protein intake approached intrauterine accretion rates without evidence of metabolic stress and gastrointestinal intolerance. The ”New Individualized Fortification Method" seems to be a promising approach to solving the problem of undernutrition among premature infants fed breast milk.
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