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Neonatologie Scan 2023; 12(03): 229-244
DOI: 10.1055/a-1996-6397
DOI: 10.1055/a-1996-6397
CME-Fortbildung
Enterale Ernährung bei Frühgeborenen – ein Update
Die enterale Ernährung von Früh- und Neugeborenen bietet ernährungsphysiologische Vorteile, fördert die Darmentwicklung und wirkt sich positiv auf Morbidität und Mortalität aus. Dieser Beitrag liefert einen Überblick über die enterale Ernährung bei Frühgeborenen unter Berücksichtigung der neusten Empfehlungen der European Society for Gastroenterology, Hepatology and Nutrition (ESPGHAN).
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Jede NICU sollte über ein standardisiertes Ernährungsprotokoll verfügen.
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Muttermilch ist die bevorzugte Nahrung Früh- und Reifgeborener.
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Der enterale Nahrungsaufbau sollte sobald wie möglich postnatal begonnen werden.
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Die enterale Nahrungsmenge sollte täglich um 18–30ml/kg/Tag nach klinischer Verträglichkeit gesteigert werden.
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Bei klinisch stabilen Frühgeborenen sollten Magenreste nicht routinemäßig bestimmt werden.
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Eine Fortifizierung mit Mehr-Komponenten-Fortifiern sollte ab einer Nahrungsmenge von 40–100ml/kg/Tag begonnen werden.
Publication History
Article published online:
30 August 2023
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Literatur
- 1 Ehrenkranz RA, Dusick AM, Vohr BR. et al. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006; 117: 1253-1261 DOI: 10.1542/peds.2005-1368. (PMID: 16585322)
- 2 Stephens BE, Walden RV, Gargus RA. et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics 2009; 123: 1337-1343 DOI: 10.1542/peds.2008-0211.
- 3 Fang JL, Sorita A, Carey WA. et al. Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis. Pediatrics 2016; 137: e20153387 DOI: 10.1542/peds.2015-3387. (PMID: 26962240)
- 4 Stoltz Sjöström E, Lundgren P, Öhlund I. et al. Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2016; 101: F108-F113 DOI: 10.1136/archdischild-2014-306816.
- 5 Klevebro S, Westin V, Stoltz Sjöström E. et al. Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants. Clin Nutr 2019; 38: 1289-1295 DOI: 10.1016/j.clnu.2018.05.012.
- 6 Hulst J, Joosten K, Zimmermann L. et al. Malnutrition in critically ill children: from admission to 6 months after discharge. Clin Nutr 2004; 23: 223-232 DOI: 10.1016/S0261-5614(03)00130-4.
- 7 Mameli C, Mazzantini S, Zuccotti GV. Nutrition in the First 1000 Days: The Origin of Childhood Obesity. Int J Environ Res Public Health 2016; 13 DOI: 10.3390/ijerph13090838. (PMID: 27563917)
- 8 Embleton ND, Moltu SJ, Lapillonne A. et al. Enteral Nutrition in Preterm Infants (2022): A Position Paper from the ESPGHAN Committee on Nutrition and invited experts. J Pediatr Gastroenterol Nutr 2023; 76 (02) 248-268 DOI: 10.1097/MPG.0000000000003642. (PMID: 36705703)
- 9 Thoene M, Anderson-Berry A. Early Enteral Feeding in Preterm Infants: A Narrative Review of the Nutritional, Metabolic, and Developmental Benefits. Nutrients 2021; 13: 2289 DOI: 10.3390/nu13072289. (PMID: 34371799)
- 10 Agostoni C, Buonocore G, Carnielli VP. et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010; 50: 85-91 DOI: 10.1097/MPG.0b013e3181adaee0. (PMID: 19881390)
- 11 Patel AL, Johnson TJ, Engstrom JL. et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol 2013; 33: 514-519 DOI: 10.1038/jp.2013.2.
- 12 Johnson TJ, Patel AL, Bigger HR. et al. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology 2015; 107: 271-276 DOI: 10.1159/000370058.
- 13 Patel AL, Johnson TJ, Robin B. et al. Influence of own mother’s milk on bronchopulmonary dysplasia and costs. Arch Dis Child Fetal Neonatal Ed 2017; 102: F256-F261 DOI: 10.1136/archdischild-2016-310898. (PMID: 27806990)
- 14 Johnson TJ, Patel AL, Schoeny ME. et al. Cost Savings of Mother’s Own Milk for Very Low Birth Weight Infants in the Neonatal Intensive Care Unit. Pharmacoecon Open 2022; 6: 451-460 DOI: 10.1007/s41669-022-00324-8.
- 15 Mathur NB, Dwarkadas AM, Sharma VK. et al. Anti-infective factors in preterm human colostrum. Acta Paediatr Scand 1990; 79: 1039-1044 DOI: 10.1111/j.1651-2227.1990.tb11380.x. (PMID: 2267920)
- 16 Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 2002; 360: 187-195 DOI: 10.1016/S0140-6736(02)09454-0.
- 17 Chowdhury R, Sinha B, Sankar MJ. et al. Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatr 2015; 104: 96-113 DOI: 10.1111/apa.13102. (PMID: 26172878)
- 18 Aune D, Norat T, Romundstad P. et al. Breastfeeding and the maternal risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis 2014; 24: 107-115 DOI: 10.1016/j.numecd.2013.10.028. (PMID: 24439841)
- 19 Bobrow KL, Quigley MA, Green J. et al. Persistent effects of women’s parity and breastfeeding patterns on their body mass index: results from the Million Women Study. Int J Obes (Lond) 2013; 37: 712-717 DOI: 10.1038/ijo.2012.76.
- 20 Horta BL, Victora CG. World Health Organization. Short-term effects of breastfeeding: a systematic review on the benefits of breastfeeding on diarrhoea and pneumonia mortality. 2013
- 21 Bowatte G, Tham R, Allen KJ. et al. Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatr 2015; 104: 85-95 DOI: 10.1111/apa.13151. (PMID: 26265016)
- 22 Chen A, Rogan WJ. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics 2004; 113: e435-439 DOI: 10.1542/peds.113.5.e435. (PMID: 15121986)
- 23 Kramer MS, Aboud F, Mironova E. et al. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry 2008; 65: 578-584 DOI: 10.1001/archpsyc.65.5.578.
- 24 Horta BL, Loret de Mola C, Victora CG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatr 2015; 104: 30-37 DOI: 10.1111/apa.13133. (PMID: 26192560)
- 25 Lodge CJ, Tan DJ, Lau MXZ. et al. Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatr 2015; 104: 38-53 DOI: 10.1111/apa.13132. (PMID: 26192405)
- 26 Amitay EL, Keinan-Boker L. Breastfeeding and Childhood Leukemia Incidence: A Meta-analysis and Systematic Review. JAMA Pediatr 2015; 169: e151025 DOI: 10.1001/jamapediatrics.2015.1025. (PMID: 26030516)
- 27 Altobelli E, Angeletti PM, Verrotti A. et al. The Impact of Human Milk on Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis. Nutrients 2020; 12: 1322 DOI: 10.3390/nu12051322. (PMID: 32384652)
- 28 Manzoni P, Stolfi I, Pedicino R. et al. Human milk feeding prevents retinopathy of prematurity (ROP) in preterm VLBW neonates. Early Hum Dev 2013; 89: S64-68 DOI: 10.1016/S0378-3782(13)70019-7. (PMID: 23809355)
- 29 Villamor-Martínez E, Pierro M, Cavallaro G. et al. Donor Human Milk Protects against Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis. Nutrients 2018; 10: 238 DOI: 10.3390/nu10020238. (PMID: 29461479)
- 30 Furman L, Taylor G, Minich N. et al. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med 2003; 157: 66-71 DOI: 10.1001/archpedi.157.1.66.
- 31 Kreissl A, Sauerzapf E, Repa A. et al. Starting enteral nutrition with preterm single donor milk instead of formula affects time to full enteral feeding in very low birthweight infants. Acta Paediatr 2017; 106: 1460-1467 DOI: 10.1111/apa.13914.
- 32 Vohr BR, Poindexter BB, Dusick AM. et al. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics 2007; 120: e953-959 DOI: 10.1542/peds.2006-3227. (PMID: 17908750)
- 33 Patra K, Hamilton M, Johnson TJ. et al. NICU Human Milk Dose and 20-Month Neurodevelopmental Outcome in Very Low Birth Weight Infants. Neonatology 2017; 112: 330-336 DOI: 10.1159/000475834.
- 34 Singhal A, Cole TJ, Lucas A. Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials. Lancet 2001; 357: 413-419 DOI: 10.1016/S0140-6736(00)04004-6. (PMID: 11273059)
- 35 Chetta KE, Schulz EV, Wagner CL. Outcomes improved with human milk intake in preterm and full-term infants. Sem Perinatol 2021; 45: 151384 DOI: 10.1016/j.semperi.2020.151384.
- 36 Brown JVE, Embleton ND, Harding JE. et al. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev 2016; DOI: 10.1002/14651858.CD000343.pub3.
- 37 Fabrizio V, Trzaski JM, Brownell EA. et al. Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk. Cochrane Database Syst Rev 2020; 11: CD013465 DOI: 10.1002/14651858.CD013465.pub2. (PMID: 33226632)
- 38 Sullivan S, Schanler RJ, Kim JH. et al. An Exclusively Human Milk-Based Diet Is Associated with a Lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products. J Pediatr 2010; 156: 562-567.e1 DOI: 10.1016/j.jpeds.2009.10.040.
- 39 Cristofalo EA, Schanler RJ, Blanco CL. et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J Pediatr 2013; 163: 1592-1595.e1 DOI: 10.1016/j.jpeds.2013.07.011.
- 40 O’Connor DL, Kiss A, Tomlinson C. et al. Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial. Am J Clin Nutr 2018; 108: 108-116 DOI: 10.1093/ajcn/nqy067.
- 41 Parker LA, Sullivan S, Krueger C. et al. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med 2015; 10: 84-91 DOI: 10.1089/bfm.2014.0089.
- 42 Parker LA, Sullivan S, Kruger C. et al. Timing of milk expression following delivery in mothers delivering preterm very low birth weight infants: a randomized trial. J Perinatol 2020; 40: 1236-1245 DOI: 10.1038/s41372-020-0688-z.
- 43 Fewtrell MS, Kennedy K, Ahluwalia JS. et al. Predictors of expressed breast milk volume in mothers expressing milk for their preterm infant. Arch Dis Child Fetal Neonatal Ed 2016; 101: F502-F506 DOI: 10.1136/archdischild-2015-308321.
- 44 PROVIDE – LactaHub. Accessed February 13, 2023 at: https://lactahub.org/nicu-training/
- 45 Hoban R, Bigger H, Schoeny M. et al. Milk Volume at 2 Weeks Predicts Mother’s Own Milk Feeding at Neonatal Intensive Care Unit Discharge for Very Low Birthweight Infants. Breastfeed Med 2018; 13: 135-141 DOI: 10.1089/bfm.2017.0159.
- 46 Martín-Álvarez E, Diaz-Castro J, Peña-Caballero M. et al. Oropharyngeal Colostrum Positively Modulates the Inflammatory Response in Preterm Neonates. Nutrients 2020; 12: 413 DOI: 10.3390/nu12020413. (PMID: 32033312)
- 47 Nasuf AWA, Ojha S, Dorling J. Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2018; DOI: 10.1002/14651858.CD011921.pub2. (PMID: 30191961)
- 48 Tao J, Mao J, Yang J. et al. Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs. Eur J Clin Nutr 2020; 74: 1122-1131 DOI: 10.1038/s41430-019-0552-4. (PMID: 31901083)
- 49 Young L, Oddie SJ, McGuire W. Delayed introduction of progressive enteral feeds to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev 2022; DOI: 10.1002/14651858.CD001970.pub6. (PMID: 35049036)
- 50 Dorling J, Abbott J, Berrington J. et al. Controlled Trial of Two Incremental Milk-Feeding Rates in Preterm Infants. N Engl J Med 2019; 381: 1434-1443 DOI: 10.1056/NEJMoa1816654. (PMID: 31597020)
- 51 Oddie SJ, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev 2021; 2021: CD001241 DOI: 10.1002/14651858.CD001241.pub8. (PMID: 34427330)
- 52 Parker LA, Weaver M, Murgas Torrazza RJ. et al. Effect of Gastric Residual Evaluation on Enteral Intake in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Pediatrics 2019; 173: 534-543 DOI: 10.1001/jamapediatrics.2019.0800.
- 53 Abiramalatha T, Thanigainathan S, Ninan B. Routine monitoring of gastric residual for prevention of necrotising enterocolitis in preterm infants. Cochrane Database Syst Rev 2019; DOI: 10.1002/14651858.CD012937.pub2. (PMID: 31425604)
- 54 Aynsley-Green A, Adrian TE, Bloom SR. Feeding and the development of enteroinsular hormone secretion in the preterm infant: effects of continuous gastric infusions of human milk compared with intermittent boluses. Acta Paediatr Scand 1982; 71: 379-383 DOI: 10.1111/j.1651-2227.1982.tb09438.x. (PMID: 6814175)
- 55 de Ville K, Knapp E, Al-Tawil Y. et al. Slow infusion feedings enhance duodenal motor responses and gastric emptying in preterm infants. Am J Clin Nutr 1998; 68: 103-108 DOI: 10.1093/ajcn/68.1.103. (PMID: 9665103)
- 56 Sadrudin Premji S, Chessell L, Stewart F. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for preterm infants less than 1500 grams. Cochrane Database Syst Rev 2021; 2021: CD001819 DOI: 10.1002/14651858.CD001819.pub3. (PMID: 34165778)
- 57 Parker P, Stroop S, Greene H. A controlled comparison of continuous versus intermittent feeding in the treatment of infants with intestinal disease. J Pediatr 1981; 99: 360-364 DOI: 10.1016/s0022-3476(81)80318-6.
- 58 DeMauro SB, Abbasi S, Lorch S. The impact of feeding interval on feeding outcomes in very low birth-weight infants. J Perinatol 2011; 31: 481-486 DOI: 10.1038/jp.2010.153. (PMID: 21252961)
- 59 Foster JP, Psaila K, Patterson T. Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev 2016; 10: CD001071 DOI: 10.1002/14651858.CD001071.pub3. (PMID: 27699765)