Aktualne zalecenia dotyczące karmienia naturalnego noworodków urodzonych przedwcześnie z uwzględnieniem wzmacniania mleka kobiecego

Current recommendations regarding the natural nutrition of premature newborns including fortification of human milk

Barbara Królak-Olejnik, Matylda Czosnykowska-Łukacka, Igor Olejnik

1 Katedra i Klinika Neonatologii Uniwersytetu Medycznego we Wrocławiu
2 Uniwersytecki Szpital Kliniczny we Wrocławiu
3 Katedra i Klinika Transplantacji Szpiku, Onkologii i Hematologii Dziecięcej Uniwersytetu Medycznego we Wrocławiu

Barbara Królak-Olejnik
Katedra i Klinika Neonatologii Uniwersytetu Medycznego,
Uniwersytecki Szpital Kliniczny
ul. Borowska 213, 50–556 Wrocław
Tel.: 71 733 15 00, Fax: 71 733 15 09

Wpłynęło: 20.09.2019
Zaakceptowano: 22.10.2019
Opublikowano on-line: 13.11.2019

Cytowanie / Citation

Królak-Olejnik B, Czosnykowska-Łukacka M, Olejnik I. Aktualne zalecenia dotyczące karmienia naturalnego noworodków urodzonych przedwcześnie z uwzględnieniem wzmacniania mleka kobiecego.
Postępy Neonatologii 2019;25(2):81–87
doi: 10.31350/postepyneonatologii/2019/2/PN2019017

Wersja elektroniczna / Article ePDF

Streszczenie:
Karmienie piersią jest najwłaściwszym sposobem żywienia noworodków i niemowląt, także chorych i urodzonych przedwcześnie. Często jednak na oddziale intensywnej terapii i patologii noworodka pacjent jest karmiony odciągniętym mlekiem własnej mamy za pomocą sondy. Natomiast w początkowym okresie stymulacji laktacji, a także jeśli są przeciwwskazania lub stan matki uniemożliwia pozyskiwanie mleka, zaleca się stosowanie mleka kobiecego z Banku. Dawczyniami najczęściej są kobiety w okresie stabilnej laktacji, wielokrotnie rodzące w terminie porodu. Niestety, mleko kobiet, które urodziły przedwcześnie, a tym bardziej w terminie porodu, nie zapewnia wystarczającej ilości składników odżywczych, zwłaszcza dla noworodków ekstremalnie niedojrzałych, urodzonych przedwcześnie. Podstawowym celem terapii żywieniowej jest prawidłowe wzrastanie i rozwój. Zatem wzmacnianie mleka kobiecego (HM) powinno być dostosowane do potrzeb żywieniowych każdego noworodka. Jak wzmacniać mleko, kiedy rozpocząć i zakończyć, co monitorować? W pracy omówiono wzmacniacze mleka kobiecego stosowane na świecie oraz dostępne w Polsce, a także metody wzmacniania. Przedstawiono najnowsze badania i dokonano przeglądu literatury w tej dziedzinie. W podsumowaniu zaprezentowano aktualne rekomendacje w tym zakresie.

Słowa kluczowe: noworodek urodzony przedwcześnie, żywienie, mleko kobiece, wzmacnianie

Abstract:
Breastfeeding is the most appropriate way of feeding both newborns and infants, including sick and premature babies. However, in the neonatal intensive care and pathology department, the baby is often fed by tube and breastmilk of its own mother. However, in the initial period of stimulation of lactation as well as in the event of contraindications or conditions making mother’s milk collection impossible, it is recommended to use human milk (HM) from the Donor Milk Bank. Donors are usually mothers during stable lactation. Unfortunately, human milk (premature and timely) does not provide enough nutrients, especially for infants of VLBW. The main goal of nutritional therapy is proper infants’ growth and development. Therefore, human milk fortification should be adapted to the nutritional needs of each newborn infant. How to fortificate the milk, when to start and finish, what should be monitored? Available human milk fortifiers, methods of fortification and the latest research and literature reviews in this field were reported on. In summary, current recommendations in this area were presented.

Key words: premature, nutrition, human milk, fortification

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Konflikt interesów: nie zgłoszono.
Potential conflicts of interest: no conflicts.

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