摘要目的:探讨早产儿生后早期应用不同喂养配方对其喂养情况和生长代谢的影响。方法:选取2023年3月至2024年3月住院的胎龄≤34周早产儿，排除先天遗传代谢性疾病、严重先天性心脏病及消化道发育畸形等患儿，符合入组标准，根据早产儿生后2周内的喂养方式分为捐赠母乳（donor human milk，DHM）组、早产儿配方奶（preterm formula，PF）组、深度水解蛋白配方奶（extensively hydrolyzed protein formula，eHF）组，收集早产儿基本信息、母亲围产情况、喂养方式、第7天奶量、第14天奶量、奶量分别达到120 ml/（kg·d）和150 ml/（kg·d）的日龄，静脉营养应用时间、住院天数、喂养不耐受、胆汁淤积、宫外生长发育迟缓情况以及生后7 d、14 d、出院时生化代谢指标等。比较三组在喂养及生化代谢指标之间的差异。结果:符合入组标准共108例，DHM组39例，PF组37例，eHF组32例，三组出生胎龄、体重、头围及母亲合并症方面差异均无统计学意义（ P>0.05）。DHM组在生后第7天奶量［（50.7±29.1）ml/（kg·d）比（34.2±27.3）ml/（kg·d）， P=0.031］、第14天奶量［（103.1±36.7）ml/（kg·d）比（73.9±39.2）ml/（kg·d）， P=0.003］均明显高于PF组；DHM组比PF组更早达到120 ml/（kg·d）奶量［（18.5±10.4）d比（24.1±10.3）d］，差异有统计学意义（ P=0.020），DHM组静脉营养时间短于PF组［（17.9±10.9）d比（23.2±11.2）d］，差异有统计学意义（ P=0.042）；DHM组喂养不耐受发生率低于PF组（28.2%比48.6%），差异有统计学意义（ P=0.044）。DHM组住院时间比PF组短［（33.8±15.5）d比（37.8±17.6）d］，但差异无统计学意义（ P=0.489）。DHM组和eHF组在第7天、第14天奶量、奶量达120 ml/（kg·d）的日龄、静脉营养时间、住院时间及喂养不耐受比较差异均无统计学意义（ P均>0.05）。DHM组在生后1周、2周时碱性磷酸酶高于PF及eHF组（均为 P<0.05），但出院时三组生化营养代谢指标（血红蛋白、尿素氮、白蛋白、前白蛋白、碱性磷酸酶、总胆汁酸）差异均无统计学意义（均为 P>0.05）。 结论:早产儿生后早期使用DHM喂养比PF更容易耐受，更早达到完全胃肠内营养时间，缩短静脉营养应用时间，且不影响早产儿生长发育。

abstractsObjective:To investigate the effects of different feeding formulas on the feeding and growth and metabolism of premature infants in the early postnatal period.Methods:Eligible premature infants with the gestational age of ≤ 34 weeks hospitalized from March 2023 to March 2024 were selected as per inclusion criteria, excluding those with congenital metabolic diseases, severe congenital heart disease and developmental malformations of digestive tract. According to the feeding formulas within 2 weeks after birth, premature infants were divided into three groups, namely donor human milk (DHM) group, preterm formula (PF) group and extensively hydrolyzed formula (eHF) group. The characteristics of premature infants, perinatal condition, feeding formulas, milk intake on the 7th and 14th day, the time to the daily milk intake of 120ml/kg and 150ml/kg respectively, the time on parenteral nutrition, the length of hospitalization, feeding intolerance, cholestasis, extrauterine growth retardation and biochemical metabolic indexes at 7 days, 14 days and discharge were collected. The differences of feeding and biochemical metabolic parameters were compared across the three groups.Results:A total of 108 cases were enrolled ,of whom 39 were in DHM group, 37 in PF group and 32 in eHF group. There was no significant difference in gestational age, birth weight, head circumference and maternal complications across the three groups. The milk intake in the DHM group was (50.7±29.1) ml/(kg·d) on the 7th day, compared with (34.2±27.3) ml/(kg·d) in PF group ( P=0.031), and (103.1±36.7) ml/(kg·d) on the 14th day, compared with (73.9±39.2) ml/(kg·d) in the PF group. Compared with the PF group, the DHM group reached the daily milk intake of 120 ml/(kg·d) earlier [(18.5±10.4) days vs. (24.1±10.3) days, P=0.020], had shorter duration of parenteral nutrition [(17.9±10.9) days vs. (23.2±11.2) days, P=0.042], and lower incidence of feeding intolerance (28.2% vs. 48.6%). The length of hospitalization in DHM group was shorter than that in PF group [(33.8±15.5) days vs. (37.8±17.6) days], but there was no significant difference ( P>0.05). There was no significant difference between the DHM group and the eHF group in terms of the milk intake on the 7th and 14th day, the time to the daily milk intake of 120 ml/(kg·d), the time on parenteral nutrition, the length of hospitalization and feeding intolerance. At 1 and 2 weeks after birth, alkaline phosphatase in DHM group was higher than that in PF group and eHF group ( P<0.05), but there was no significant difference in biochemical nutritional metabolism parameters (hemoglobin, urea nitrogen, albumin, prealbumin, alkaline phosphatase and total bile acid) across the three groups at discharge( P>0.05). Conclusion:Early use of DHM in premature infants is better tolerated than PF and can help achieve complete enteral nutrition earlier and shorten the use of parenteral nutrition, while not affecting the growth and development of premature infants.