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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2015; 09(04): 186-190
DOI: 10.1055/s-0037-1618936
Übersichtsarbeit
Schattauer GmbH

Muttermilch und Frauenmilchspende in der Frühgeborenenernährung

Mother’s own milk and donor milk in the nutrition of preterm infants
C. Gebauer
1   Universitätsklinik für Kinder und Jugendliche, Abteilung Neonatologie, Leipzig
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Publication History

Publication Date:
22 December 2017 (online)

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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
 

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