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Z Geburtshilfe Neonatol 2007; 211(1): 8-12
DOI: 10.1055/s-2006-942116
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Stillen beim Frühgeborenen

Breastfeeding in Premature InfantsS. Herber-Jonat1
  • 1Klinikum der Universität München, Perinatalzentrum Großhadern der Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Klinik und Poliklinik für Frauenheilkunde und Geburthilfe - Großhadern, München
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Publication History

2006

2006

Publication Date:
27 February 2007 (online)

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Zusammenfassung

Frühgeborene Kinder haben im Vergleich zu Reifgeborenen deutlich geringere Nährstoffreserven. Zusätzliche Stressfaktoren, wie z. B. Infektionen oder ein Atemnotsyndrom beeinflussen ihren Nährstoffbedarf und ihren Stoffwechsel nachhaltig. Damit ist die Zufuhr einer ausreichenden Menge an Nährstoffen und Kalorien einer der Eckpfeiler der Versorgung und Pflege eines Frühgeborenen. Ab einem Gestationsalter von mehr als 34 Schwangerschaftswochen ist ein Frühgeborenes in der Lage effektiv an der Brust der Mutter zu saugen und den Trink- und Atemvorgang zu koordinieren. Aber auch bei der Ernährung von Frühgeborenen mit weniger als 34 Schwangerschaftswochen wird von den nationalen und internationalen Stillkommissionen der enterale Nahrungsaufbau mit Muttermilch empfohlen. Im vorliegenden Beitrag soll der Frage nachgegangen werden, ob es im Hinblick auf die Aspekte Wachstum bzw. Nährstoffbedarf, Infektionen und neurologische Entwicklung Nachteile bzw. Unsicherheiten bei der Verwendung von Muttermilch für die Versorgung sehr kleiner Frühgeborener gibt und welche Vorteile wissenschaftlich nachgewiesen werden konnten. Darüber hinaus werden praktische Vorgehensweisen zur Initiierung und Aufrechterhaltung der Milchbildung und dem Übergang von Sonden- auf Brusternährung erörtert.

Abstract

Preterm infants have fewer nutrient reserves at birth than term infants. Additional physiological and metabolic stress factors, such as infection or respiratory distress, can affect their nutritional needs and metabolism. Hence, the provision of appropriate nutrition for growth and development is a cornerstone of care of preterm infants. Well infants of a gestational age > 34 weeks are usually able to suck effectively and coordinate swallowing and breathing. Therefore establishment of breast feeding seems reasonable for newborns of this gestational age. For less mature infants, national and international advisory boards also recommend enteral human milk feeding early postnatally. Challenges remain, particularly in establishing evidence-based standards of breastfeeding and the use of human milk for preterm infants in the intensive-care nursery. This article highlights the aspects of growth and nutritional needs, infection prophylaxis and neurological development with regard to the use of human milk versus formula for the preterm infant. Approaches to the initiation and maintenance of milk supply and the decision about when to replace gavage by breast feeding are illustrated.

Schlüsselwörter

Stillen - Frühgeborene - Muttermilch

Key words

breast feeding - infant, premature - milk, human

Literatur

  • 1 Bundeszentrale für gesundheitliche Aufklärung .Stillen und Muttermilchernährung: Grundlagen, Erfahrungen und Empfehlungen. In: Przyrembel H (Hrsg). Gesundheitsförderung konkret. Bundeszentrale für gesundheitliche Aufklärung, BZgA, Köln 2001
    Google Scholar
  • 2 Gartner L M, Morton J, Lawrence R A, Naylor A J, O'Hare D, Schanler R J, Eidelman A I. Breastfeeding and the use of human milk.  Pediatrics. 2005;  115 496-506
    CrossrefPubMedGoogle Scholar
  • 3 Klaus M. Mother and infant: Early emotional ties.  Pediatrics. 1998;  102 S 1244-S 1246
    PubMedGoogle Scholar
  • 4 Premji S S, Fenton T R, Sauve R S. Higher versus lower protein intake in formula-fed low birth weight infants. Cochrane Database Syst Rev 2006:CD003959
    Google Scholar
  • 5 Pohlandt F, Mihatsch W A. Wichtige Aspekte der enteralen Ernährung von sehr kleinen Frühgeborenen.  Monatsschrift Kinderheilkunde. 2001;  149 S 38-S 45
    PubMedGoogle Scholar
  • 6 McGuire W, Anthony M Y. Donor human milk versus formula for preventing necrotising enterocolitis in preterm infants: systematic review.  Arch Dis Child Fetal Neonatal Ed. 2003;  88 F 11-F 14
    PubMedGoogle Scholar
  • 7 Voigt M, Schneider K T, Jahrig K. Analysis of a 1992 birth sample in Germany. New percentile values of the body weight of newborn infants.  Geburtshilfe Frauenheilkd. 1996;  56 550-558
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Dobbing J, Sands J. Comparative aspects of the brain growth spurt.  Early Hum Dev. 1979;  3 79-83
    CrossrefPubMedGoogle Scholar
  • 9 Dusick A M, Poindexter B B, Ehrenkranz R A, Lemons J A. Growth failure in the preterm infant: can we catch up?.  Semin Perinatol. 2003;  27 302-310
    CrossrefPubMedGoogle Scholar
  • 10 Georgieff M K, Mills M M, Lindeke L, Iverson S, Johnson D E, Thompson T R. Changes in nutritional management and outcome of very-low-birth-weight infants.  Am J Dis Child. 1989;  143 82-85
    PubMedGoogle Scholar
  • 11 Anderson G H. The effect of prematurity on milk composition and its physiological basis.  Fed Proc. 1984;  43 2438-2442
    PubMedGoogle Scholar
  • 12 Lemons J A, Moye L, Hall D, Simmons M. Differences in the composition of preterm and term human milk during early lactation.  Pediatr Res. 1982;  16 113-117
    PubMedGoogle Scholar
  • 13 Kashyap S, Schulze K F, Forsyth M, Dell R B, Ramakrishnan R, Heird W C. Growth, nutrient retention, and metabolic response of low-birth-weight infants fed supplemented and unsupplemented preterm human milk.  Am J Clin Nutr. 1990;  52 254-262
    PubMedGoogle Scholar
  • 14 Polberger S K, Axelsson I A, Raiha N C. Growth of very low birth weight infants on varying amounts of human milk protein.  Pediatr Res. 1989;  25 414-419
    PubMedGoogle Scholar
  • 15 Moro G, Fulconis F, Minoli I, Pohlandt F, Raiha 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 Paediatr Scand. 1989;  78 18-22
    PubMedGoogle Scholar
  • 16 Pohlandt F. Bone mineral deficiency as the main factor of dolichocephalic head flattening in very-low-birth-weight infants.  Pediatr Res. 1994;  35 701-703
    CrossrefPubMedGoogle Scholar
  • 17 Pohlandt F. Hypothesis: myopia of prematurity is caused by postnatal bone mineral deficiency.  Eur J Pediatr. 1994;  153 234-236
    CrossrefPubMedGoogle Scholar
  • 18 Kuschel C A, Harding J E. Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane Database Syst Rev 2004: CD000343
    Google Scholar
  • 19 Saigal S, Szatmari P, Rosenbaum P, Campbell D, King S. Cognitive abilities and school performance of extremely low birth weight children and matched term control children at age 8 years: a regional study.  J Pediatr. 1991;  118 751-760
    PubMedGoogle Scholar
  • 20 Hack M, Taylor H G, Drotar D. et al . Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s.  Jama. 2005;  294 318-325
    CrossrefPubMedGoogle Scholar
  • 21 Anderson P, Doyle L W. Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s.  Jama. 2003;  289 3264-3272
    CrossrefPubMedGoogle Scholar
  • 22 Callen J, Pinelli J. A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants.  Adv Neonatal Care. 2005;  5 72-88 ,  quiz 89 - 92
    PubMedGoogle Scholar
  • 23 Georgieff M K, Innis S M. Controversial nutrients that potentially affect preterm neurodevelopment: Essential fatty acids and iron.  Pediatr Res. 2005;  57 99 R-103 R
    PubMedGoogle Scholar
  • 24 Fewtrell M S, Abbott R A, Kennedy K. et al . Randomized, double-blind trial of long-chain polyunsaturated fatty acid supplementation with fish oil and borage oil in preterm infants.  The Journal of Pediatrics. 2004;  144 471-479
    CrossrefPubMedGoogle Scholar
  • 25 Lucas A, Morley R, Cole T J, Lister G, Leeson-Payne C. Breast milk and subsequent intelligence quotient in children born preterm.  Lancet. 1992;  339 261-264
    CrossrefPubMedGoogle Scholar
  • 26 Lucas A, Morley R, Cole T J, Gore S M. A randomised multicentre study of human milk versus formula and later development in preterm infants.  Arch Dis Child Fetal Neonatal Ed. 1994;  70 F 141-F 146
    PubMedGoogle Scholar
  • 27 Pinelli J, Saigal S, Atkinson S A. Effect of breastmilk consumption on neurodevelopmental outcomes at 6 and 12 months of age in VLBW infants.  Adv Neonatal Care. 2003;  3 76-87
    PubMedGoogle Scholar
  • 28 Anderson J W, Johnstone B M, Remley D T. Breast-feeding and cognitive development: a meta-analysis.  Am J Clin Nutr. 1999;  70 525-535
    PubMedGoogle Scholar
  • 29 Chien P F, Howie P W. Breast milk and the risk of opportunistic infection in infancy in industrialized and non-industrialized settings.  Adv Nutr Res. 2001;  10 69-104
    PubMedGoogle Scholar
  • 30 Hanson L A, Korotkova M, Lundin S. et al . The transfer of immunity from mother to child.  Ann NY Acad Sci. 2003;  987 199-206
    CrossrefPubMedGoogle Scholar
  • 31 Odijk J, Kull I, Borres M P. et al . Breastfeeding and allergic disease: a multidisciplinary review of the literature (1966-2001) on the mode of early feeding in infancy and its impact on later atopic manifestations.  Allergy. 2003;  58 833-843
    CrossrefPubMedGoogle Scholar
  • 32 Hylander M A, Strobino D M, Dhanireddy R. Human milk feedings and infection among very low birth weight infants.  Pediatrics. 1998;  102 e 38
    PubMedGoogle Scholar
  • 33 Lucas A, Brooke O G, Morley R, Cole T J, Bamford M F. Early diet of preterm infants and development of allergic or atopic disease: randomised prospective study.  Bmj. 1990;  300 837-840
    PubMedGoogle Scholar
  • 34 Lucas A, Cole T J. Breast milk and neonatal necrotising enterocolitis.  Lancet. 1990;  336 1519-1523
    Google Scholar
  • 35 Hamprecht K, Maschmann J, Vochem M, Dietz K, Speer C P, Jahn G. Epidemiology of transmission of cytomegalovirus from mother to preterm infant by breastfeeding.  The Lancet. 2001;  357 513-518
    CrossrefPubMedGoogle Scholar
  • 36 Bell E H, Geyer J, Jones L. A structured intervention improves breastfeeding success for ill or preterm infants.  MCN Am J Matern Child Nurs. 1995;  20 309-314
    PubMedGoogle Scholar
  • 37 Whitelaw A, Heisterkamp G, Sleath K, Acolet D, Richards M. Skin to skin contact for very low birthweight infants and their mothers.  Arch Dis Child. 1988;  63 1377-1381
    PubMedGoogle Scholar
  • 38 Klaus M. Mother and infant: Early emotional ties.  Pediatrics. 1998;  102 e 1244
    PubMedGoogle Scholar
  • 39 Furman L, Minich N, Hack M. Correlates of lactation in mothers of very low birth weight infants.  Pediatrics. 2002;  109 e 57
    PubMedGoogle Scholar
  • 40 Hill P D, Aldag J C, Chatterton R T. Effects of pumping style on milk production in mothers of non-nursing preterm infants.  J Hum Lact. 1999;  15 209-216
    PubMedGoogle Scholar
  • 41 Mizuno K, Ueda A. The maturation and coordination of sucking, swallowing, and respiration in preterm infants.  J Pediatr. 2003;  142 36-40
    CrossrefPubMedGoogle Scholar
  • 42 Pinelli J, Symington A. Non-nutritive sucking for promoting physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev 2005: CD001071
    Google Scholar
  • 43 Kinderheilkunde / Ernährungskommission SGf . Empfehlungen für die Säuglingsernährung.  Schweiz Ärztez. 1993;  74 1613-1614
    PubMedGoogle Scholar
  • 44 Haschke F. The Nutrition Commission of the Austrian Society of Pediatrics . [Nutrition in the 1st days of life].  Padiatr Padol. 1989;  24 189-194
    PubMedGoogle Scholar
  • 45 Nutrition Committee, Canadian Paediatric Society . Nutrient needs and feeding of premature infants.  Cmaj. 1995;  152 1765-1785
    PubMedGoogle Scholar
  • 46 Heird W C, Kashyap S. Protein and energy requirements of low birth weight infants.  Acta Paediatr Scand Suppl. 1989;  351 13-23
    PubMedGoogle Scholar
  • 47 Mimouni F, Campaigne B, Neylan M, Tsang R C. Bone mineralization in the first year of life in infants fed human milk, cow-milk formula, or soy-based formula.  J Pediatr. 1993;  122 348-354
    PubMedGoogle Scholar

S. Herber-Jonat

Klinikum der Universität München · Perinatalzentrum Großhadern der Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital · Klinik und Poliklinik für Frauenheilkunde und Geburthilfe - Großhadern

Marchioninistraße 15

81377 München

Phone: 00 49 / 89 / 70 95 28 07

Fax: 00 49 / 89 / 70 95 58 07

Email: susanne.herber-jonat@med.uni-muenchen.de

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