Muttermilch und Frauenmilchspende in der Frühgeborenenernährung

Zusammenfassung

Frühgeborene stellen eine heterogene Gruppe dar mit unterschiedlichen Bedürfnissen in Bezug auf Ernährung und immunologischen Schutz. Das Risiko für Wachstumsretardierung, nekrotisierende Enterokolitis, nosokomiale Infektion und beeinträchtigter neuro-kognitiver Entwicklung steigt mit sinkendem Gestationsalter und Geburtsgewicht. Die Ernährung mit der Milch der eigenen Mutter trägt vor allem in der vulnerablen Gruppe der sehr unreifen Frühgeborenen zum Schutz vor nekrotisierender Enterokolitis und damit zur Senkung der Morbidität und Mortalität bei. Um ein adäquates postnatales Wachstum zu gewährleisten, muss die Muttermilch mit zusätzlichen Nährstoffen, insbesondere Eiweiß, angereichert werden. Gespendete Frauenmilch ist die erste Alternative zur Muttermilch, auch in der Ernährung von kleinen Frühgeborenen. Nachteilig ist, dass Frauenmilch nicht in allen neonatologischen Einheiten verfügbar ist. Die aktuell verbreiteten Pasteurisiermethoden führen zu einem nachweisbaren Verlust der immunologischen und nutritiven Eigenschaften der Frauenmilch, die jedoch insgesamt noch deutlich der Ernährung mit Formulanahrung überlegen ist. Auch in der poststationären Phase ist der Wachstumsverlauf regelmäßig zu kontrollieren und die Ernährung individuell anzupassen, um das Risiko einer frühen Wachstumsretardierung zu minimieren.

Summary

Preterm infants are heterogeneous regarding nutrition and immunological system. The risk of growth retardation, incidence of necrotizing enterocolitis, nosocomial infection and impaired neurocognitive development increases with decreasing gestational age and birth weight. Nutrition with mother’s own milk has a beneficial effect mainly in very low birth weight infants and decreases the incidence of necrotizing enterocolitis, morbitity and mortality. Fortified milk, especially protein fortification is necessary to guarantee an adequate postnatal growth. Donor milk should be the first alternative to mother’s own milk, however donor milk banks are unequally distributed. The current methods of pasteurization lead to a diminished immunologic and nutritive quality of donor milk. But even pasteurized donor milk exhibits more beneficial characteristics than formula. Monitoring of the postdischarge growth and adjustment of the nutrional need is essential to reduce the risk of an early growth retardation.

Schlüsselwörter

Muttermilch - Milchspende - Ernährung - Frühgeborene

Keywords

Human milk - donor milk - nutrition - preterm infants

• Literatur

• 1 Underwood MA, Gilbert WM, Sherman MP. Amniotic fluid: not just fetal urine anymore, Journal of perinatology. 2005; 25: 341-348.
• 2 Bode L. Human milk oligosaccharides: every baby needs a sugar mama. Glycobiology 2012; 22: 1147-1162.
• 3 Gabrielli O, Zampini L, Galeazzi T. et al. Preterm milk oligosaccharides during the first month of lactation. Pediatrics 2011; 128: e1520-31.
• 4 Rudloff S, Kunz C. Milk oligosaccharides and metabolism in infants. Advances in nutrition 2012; 03: 398S-405S.
• 5 Jost T, Lacroix C, Braegger C, Chassard C. Impact of human milk bacteria and oligosaccharides on neonatal gut microbiota establishment and gut health. Nutrition reviews 2015; 73: 426-437.
• 6 Arslanoglu S, Corpeleijn W, Moro G. et al. Donor human milk for preterm infants: current evidence and research directions. Journal of pediatric gastroenterology and nutrition 2013; 57: 535-542.
• 7 Breastfeeding and the use of human milk. Pediatrics. 2012; 129: e827-41.
• 8 Grøvslien AH, Grønn M. Donor milk banking and breastfeeding in Norway. Journal of human lactation 2009; 25: 206-210.
• 9 Arnold LDW. Global health policies that support the use of banked donor human milk: a human rights issue. International breastfeeding journal 2006; 01: 26.
• 10 Tyson JE, Lasky RE, Mize CE. et al. Growth, metabolic response, and development in very-lowbirth-weight infants fed banked human milk or enriched formula. I. Neonatal findings. The Journal of Pediatrics 1983; 103: 95-104.
• 11 Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. The Cochrane database of systematic reviews 2014; 04: CD002971.
• 12 Cristofalo EA, Schanler RJ, Blanco CL. et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. The Journal of pediatrics 2013; 163: 1592-1595 e1..
• 13 Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 1999; 103: 1150-1157.
• 14 Tudehope DI. Human milk and the nutritional needs of preterm infants. The Journal of Pediatrics 2013; 162: S17-25.
• 15 Schanler RJ, Lau C, Hurst NM, Smith EO. Randomized trial of donor human milk versus preterm formula as substitutes for mothers’ own milk in the feeding of extremely premature infants. Pediatrics 2005; 116: 400-406.
• 16 Singhal A, Cole TJ, Lucas A. Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials. Lancet (London, England) 2001; 357: 413-419.
• 17 Singhal A, Cole TJ, Fewtrell M, Lucas A. Breastmilk feeding and lipoprotein profile in adolescents born preterm: follow-up of a prospective randomised study. Lancet (London, England) 2004; 363: 1571-1578.
• 18 Martin CR, Brown YF, Ehrenkranz RA, O’Shea TM, Allred EN, Belfort MB, McCormick MC, Leviton A. Nutritional practices and growth velocity in the first month of life in extremely premature infants. Pediatrics 2009; 124: 649-657.
• 19 Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics 2003; 111: 986-990.
• 20 Ofek NShlomai, Reichman B, Lerner-Geva L, Boyko V, Bar-Oz B. Population-based study shows improved postnatal growth in preterm very-lowbirthweight infants between 1995 and 2010. Acta paediatrica (Oslo, Norway: 1992) 2014; 103: 498-503.
• 21 Theile AR, Radmacher PG, Anschutz TW, Davis DW, Adamkin DH. Nutritional strategies and growth in extremely low birth weight infants with bronchopulmonary dysplasia over the past 10 years. Journal of perinatology 2012; 32: 117-122.
• 22 Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006; 117: 1253-1261.
• 23 Fanaro S. Which is the ideal target for preterm growth?. Minerva pediatrica 2010; 62: 77-82.
• 24 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. Journal of pediatric gastroenterology and nutrition 2010; 50: 85-91.
• 25 Brumberg HL, Kowalski L, Troxell-Dorgan A. et al. Randomized trial of enteral protein and energy supplementation in infants less than or equal to 1250 g at birth. Journal of perinatology 2010; 30: 517-521.
• 26 Morrison JL, Duffield JA, Muhlhausler BS, Gentili S, McMillen IC. Fetal growth restriction, catch-up growth and the early origins of insulin resistance and visceral obesity. Pediatric nephrology (Berlin, Germany) 2010; 25: 669-677.
• 27 Cooke RJ, Griffin IJ, McCormick K. Adiposity is not altered in preterm infants fed with a nutrientenriched formula after hospital discharge. Pediatric research 2010; 67: 660-664.
• 28 Rønnestad A, Abrahamsen TG, Medbø S. et al. Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding. Pediatrics 2005; 115: e269-276.
• 29 Eidelman AI. Breastfeeding and the use of human milk: an analysis of the American Academy of Pediatrics 2012 Breastfeeding Policy Statement. Breastfeeding medicine 2012; 07: 323-324.
• 30 Weber A, Loui A, Jochum F, Bührer C, Obladen M. Breast milk from mothers of very low birthweight infants: variability in fat and protein content. Acta paediatrica 2001; 90: 772-775.
• 31 Bauer J, Gerss J. Longitudinal analysis of macronutrients and minerals in human milk produced by mothers of preterm infants. Clinical nutrition 2011; 30: 215-220.
• 32 Arslanoglu S, Moro GE, Ziegler EE. Preterm infants fed fortified human milk receive less protein than they need. Journal of perinatology 2009; 29: 489-492.
• 33 Arslanoglu S, Moro GE, Ziegler EE. Adjustable fortification of human milk fed to preterm infants: does it make a difference?. Journal of perinatology 2006; 26: 614-621.
• 34 Polberger S, Räihä NC, Juvonen P, Moro GE, Minoli I, Warm A. Individualized protein fortification of human milk for preterm infants: comparison of ultrafiltrated human milk protein and a bovine whey fortifier. Journal of pediatric gastroenterology and nutrition 1999; 29: 332-338.
• 35 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. The Journal of pediatrics 2010; 156: 562-7 e1..
• 36 Moro G, Fulconis F, Minoli I, Pohlandt F, Räihä N. Growth and plasma amino acid concentrations in very low birthweight infants fed either human milk protein fortified human milk or a whey-predominant formula. Acta paediatrica Scandinavica 1989; 78: 18-22.
• 37 Empfehlung zur Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1500 g, Bundesgesundheitsblatt - Gesundheitsforschung – Gesundheitsschutz. 2007; 50: 1265-1303.
• 38 Goelz R, Hamprecht K, Vochem M. et al. Muttermilchernährung der sehr unreifen Frühgeborenen von HCMV-seropositiven Müttern – Stellungnahme. Zeitschrift für Geburtshilfe und Neonatologie 2004; 208: 118-121.
• 39 Stock K, Griesmaier E, Brunner B. et al. Pasteurization of breastmilk decreases the rate of postnatally acquired cytomegalovirus infections, but shows a nonsignificant trend to an increased rate of necrotizing enterocolitis in very preterm infants--a preliminary study. Breastfeeding medicine 2015; 10: 113-117.
• 40 Simmer K. The knowns and unknowns of human milk banking. Nestlé Nutrition workshop series. Paediatric programme 2011; 68: 49-61 discussion 61–64..
• 41 Czank C, Prime DK, Hartmann B, Simmer K, Hartmann PE. Retention of the immunological proteins of pasteurized human milk in relation to pasteurizer design and practice, Pediatric research. 2009; 66: 374-379.
• 42 Bertino E, Coppa GV, Giuliani F. et al. Effects of Holder pasteurization on human milk oligosaccharides. International journal of immunopathology and pharmacology 2008; 21: 381-385.
• 43 Moro GE, Arslanoglu S. Heat treatment of human milk. Journal of pediatric gastroenterology and nutrition 2012; 54: 165-166.
• 44 Czank C, Simmer K, Hartmann PE. Simultaneous pasteurization and homogenization of human milk by combining heat and ultrasound: effect on milk quality. The Journal of dairy research 2010; 77: 183-189.
• 45 Sousa SG, Delgadillo I, Saraiva JA. Human Milk Composition and Preservation: Evaluation of High-Pressure Processing as a Non-Thermal Pasteurisation Technology. Critical reviews in food science and nutrition. 2014 0..
• 46 Aggett PJ, Agostoni C, Axelsson I. et al. Feeding preterm infants after hospital discharge: a commentary by the ESPGHAN Committee on Nutrition. Journal of pediatric gastroenterology and nutrition 2006; 42: 596-603.