巴氏杀菌捐赠人乳应用标准的多样性：美国新生儿重症监护病房主管调查研究
对捐赠人乳（DHM）的使用日益增加，但对其应用标准的制定并不完善。
为了得到DHM在美国新生儿重症监护病房（NICU）应用政策的细节，康涅狄格儿童医学中心、康涅狄格大学医学院、康涅狄格人乳研究中心、波士顿大学医学院、波士顿医疗中心在互联网上对3级和4级NICU主管进行了34项问题的调查。调查对象不仅对NICU的特点和关于DHM应用的政策细节进行了回答，同时对DHM应用政策中的标准进行了描述。利用双变量和多变量分析以确定DHM应用相关性NICU特点。
结果有153份（33%）问卷被回应，关于DHM应用的有91份（59%）。以下NICU较可能使用DHM：每年收住出生体重＜1500g婴儿的人数超过100的NICU（比值比：2.2，95%置信区间：1.1～4.7）和参加佛蒙特牛津网络的NICU（比值比：4.6；95%置信区间：1.8～11.6）。在有书面政策的72家NICU中，DHM的应用标准中要求出生体重＜1000g到＜1800g不等，胎龄＜28到＜34周不等，但在多数情况下，并没有按制定标准执行。关于DHM治疗疗程的政策也不尽相同。
因此，在美国3级和4级NICU中，关于DHM应用的标准呈多样性。DHM较常用于有较多低出生体重儿的NICU和参加佛蒙特牛津网络的NICU。需要进一步研究确定在NICU中DHM应用的成本收益和短期、长期结局之间的关系，特别是在除了预防坏死性结肠炎以外其他情况的应用。
JPEN J Parenter Enteral Nutr. 2016;40(3):326-33.
Variability of Criteria for Pasteurized Donor Human Milk Use: A Survey of U.S. Neonatal Intensive Care Unit Medical Directors.
Hagadorn JI, Brownell EA, Lussier MM, Parker MG, Herson VC.
Connecticut Children's Medical Center, Hartford, Connecticut; University of Connecticut School of Medicine, Farmington, Connecticut; Connecticut Human Milk Research Center, Hartford, Connecticut; Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
BACKGROUND: Use of donor human milk (DHM) is increasing, but criteria for its use are not well defined.
MATERIALS AND METHODS: We conducted a 34-question Internet-based survey of medical directors of U.S. level 3 and level 4 neonatal intensive care units (NICUs), with the goal of describing specifics of policies developed to guide DHM use in U.S. NICUs. Respondents reported NICU characteristics and details of policies concerning DHM use. Policy-specified criteria for DHM use, if any, were described. Bivariate and multivariate analyses were used to identify NICU characteristics associated with DHM use.
RESULTS: Respondents returned 153 (33%) surveys, with use of DHM reported by 91 (59%). Donor human milk use was more likely with more than 100 annual admissions <1500 g at birth (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.1-4.7) and with Vermont-Oxford Network participants (OR, 4.6; 95% CI, 1.8-11.6). Among 72 NICUs reporting a written policy, criteria for providing DHM required birth weights varying from <1000 to <1800 g and/or gestational ages from <28 to <34 completed weeks, but criteria were reportedly waived in many circumstances. Policies regarding duration of DHM therapy were similarly varied.
CONCLUSIONS: Criteria for initiating and continuing DHM vary widely among U.S. level 3 and level 4 NICUs. Donor human milk use is more frequent in NICUs with many very low-birth-weight admissions and among Vermont-Oxford Network participants. Further research is needed to define short- and long-term outcomes and cost benefits of DHM use in subgroups of NICU patients, particularly for uses other than necrotizing enterocolitis prevention.
KEYWORDS: donor human milk; prematurity; very low birth weight
PMID: 25267184
DOI: 10.1177/0148607114550832
