Evidenzbasierte Ernährung von Frühgeborenen

Für jedes Neugeborene und speziell für Frühgeborene trägt die Ernährung mit Muttermilch zur Reduktion von Morbidität und Mortalität bei und stärkt die Mutter-(Eltern-)Kind-Bindung. Perinatalzentren müssen alles daran setzen, die Eltern auf dem Weg zu einer erfolgreichen Laktation zu unterstützen. Gestärkte Eltern ermöglichen auch im weiteren Verlauf die gute Entwicklung ihres Kindes. Frauenmilchbanken können eine wertvolle Unterstützung in diesem Prozess sein.

Kernaussagen

• Die Ernährung mit Humanmilch reduziert signifikant die Mortalität sowie Kurz- und Langzeitmorbidität von Frühgeborenen.

• Die Entscheidung zur Ernährung mit Muttermilch, Frauenmilch oder Formula unterliegt der Autonomie der Eltern (informed consent).

• Die Ernährung mit Muttermilch muss als Prozess gedacht werden, der bereits vor Geburt beginnt, nach der Geburt aktiv initiiert, kontinuierlich während der stationären Behandlung erhalten werden muss und im Stillen nach der Entlassung mündet.

• Die Laktationsberatung beginnt möglichst schon pränatal und wird dann kontinuierlich während des gesamten Krankenhausaufenthaltes fortgeführt.

• Frauenmilch aus einer Frauenmilchbank kann die eigenen Muttermilchgaben ergänzen, entlastet dabei die Mutter und unterstützt den Stillerfolg.

• Hautkontakt schon im Kreißsaal trägt zum Bindungsaufbau und zur Milchbildung bei.

• Die Milchbildung sollte in den ersten 60 Minuten nach Geburt initiiert werden.

• Ab den ersten Lebensstunden sollte mit eigenem Kolostrum und einer geeigneten Menge Humanmilch enteral ernährt werden.

• Nicht nutritives Saugen beschleunigt das Trinkenlernen und verkürzt den Krankenhausaufenthalt.

• Früher und häufiger Brustkontakt und gleichzeitiges Sondieren verkürzen die Sondenliegedauer und erhöhen die Rate vollgestillter Kinder bei Entlassung.

• Die Fütterung eines Frühgeborenen mit der Flasche erfolgt co- und selbstreguliert.

Schlüsselwörter

Ernährung - Frühgeborene - Muttermilch - Frauenmilchbanken - Bonding - Hautkontakt

Publication History

Article published online:
10 September 2022

• Literatur

• 1 WHO. WHO/UNICEF meeting on infant and young child feeding. J Nurse Midwifery 1980; 25: 31-39 DOI: 10.1016/0091-2182(80)90051-8. (PMID: 7376238)
• 2 Miller J, Tonkin E, Damarell RA. et al. A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants. Nutrients 2018; 10: 707 DOI: 10.3390/nu10060707. (PMID: 29857555)
• 3 Patel AL, Johnson TJ, Robin B. et al. Influence of own mother’s milk on bronchopulmonary dysplasia and costs. Arch Dis Child Fetal Neonatal Ed 2017; 102: F256-F261 DOI: 10.1136/archdischild-2016-310898. (PMID: 27806990)
• 4 Hylander MA, Strobino DM, Pezzullo JC. et al. Association of human milk feedings with a reduction in retinopathy of prematurity among very low birthweight infants. J Perinatol 2001; 21: 356-362 DOI: 10.1038/sj.jp.7210548. (PMID: 11593368)
• 5 Patel AL, Johnson TJ, Engstrom JL. et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol 2013; 33: 514-519 DOI: 10.1038/jp.2013.2. (PMID: 23370606)
• 6 Roze JC, Darmaun D, Boquien CY. et al. The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. BMJ Open 2012; 2: e000834 DOI: 10.1136/bmjopen-2012-000834. (PMID: 22492388)
• 7 Vohr BR, Poindexter BB, Dusick AM. et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics 2006; 118: e115-e123 DOI: 10.1542/peds.2005-2382. (PMID: 16818526)
• 8 Autran CA, Kellman BP, Kim JH. et al. Human milk oligosaccharide composition predicts risk of necrotising enterocolitis in preterm infants. Gut 2018; 67: 1064-1070 DOI: 10.1136/gutjnl-2016-312819. (PMID: 28381523)
• 9 Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev 2019; (07) CD002971 DOI: 10.1002/14651858.CD002971.pub5. (PMID: 31322731)
• 10 Pedrini L, Prefumo F, Frusca T. et al. Counselling about the Risk of Preterm Delivery: A Systematic Review. Biomed Res Int 2017; 2017: 7320583 DOI: 10.1155/2017/7320583. (PMID: 28848765)
• 11 Spatz DL, Edwards TM. The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit: Position Statement 3065. Adv Neonatal Care 2016; 16: 254 DOI: 10.1097/ANC.0000000000000313. (PMID: 27391566)
• 12 Bixby C, Baker-Fox C, Deming C. et al. A multidisciplinary quality improvement approach increases breastmilk availability at discharge from the neonatal intensive care unit for the very-low-birth-weight infant. Breastfeed Med 2016; 11: 75-79 DOI: 10.1089/bfm.2015.0141. (PMID: 26901619)
• 13 Mehler K, Hucklenbruch-Rother E, Trautmann-Villalba P. et al. Delivery room skin-to-skin contact for preterm infants-A randomized clinical trial. Acta Paediatr 2020; 109: 518-526 DOI: 10.1111/apa.14975. (PMID: 31423649)
• 14 Vittner D, McGrath J, Robinson J. et al. Increase in Oxytocin From Skin-to-Skin Contact Enhances Development of Parent-Infant Relationship. Biol Res Nurs 2018; 20: 54-62 DOI: 10.1177/1099800417735633. (PMID: 29017336)
• 15 WHO. Immediate “Kangaroo Mother Care” and Survival of Infants with Low Birth Weight 2021. N Engl J Med 2021; 384: 2028-2038 DOI: 10.1056/NEJMoa2026486. (PMID: 34038632)
• 16 Lonnerdal B, Erdmann P, Thakkar SK. et al. Longitudinal evolution of true protein, amino acids and bioactive proteins in breast milk: a developmental perspective. J Nutr Biochem 2017; 41: 1-11 DOI: 10.1016/j.jnutbio.2016.06.001. (PMID: 27771491)
• 17 Nasuf AWA, Ojha S, Dorling J. Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2018; (09) CD011921 DOI: 10.1002/14651858.CD011921.pub2. (PMID: 30191961)
• 18 Lee J, Kim HS, Jung YH. et al. Oropharyngeal colostrum administration in extremely premature infants: an RCT. Pediatrics 2015; 135: e357-e366 DOI: 10.1542/peds.2014-2004. (PMID: 25624376)
• 19 Dimitraki M, Tsikouras P, Manav B. et al. Evaluation of the effect of natural and emotional stress of labor on lactation and breast-feeding. Arch Gynecol Obstet 2016; 293: 317-328 DOI: 10.1007/s00404-015-3783-1. (PMID: 26112355)
• 20 Morelius E, Ortenstrand A, Theodorsson E. et al. A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Hum Dev 2015; 91: 63-70 DOI: 10.1016/j.earlhumdev.2014.12.005. (PMID: 25545453)
• 21 Parker LA, Sullivan S, Krueger C. et al. Association of timing of initiation of breastmilk expression on milk volume and timing of lactogenesis stage II among mothers of very low-birth-weight infants. Breastfeed Med 2015; 10: 84-91 DOI: 10.1089/bfm.2014.0089. (PMID: 25659030)
• 22 Ohyama M, Watabe H, Hayasaka Y. Manual expression and electric breast pumping in the first 48 h after delivery. Pediatr Int 2010; 52: 39-43 DOI: 10.1111/j.1442-200X.2009.02910.x. (PMID: 19519669)
• 23 Morton J, Hall JY, Wong RJ. et al. Combining hand techniques with electric pumping increases milk production in mothers of preterm infants. J Perinatol 2009; 29: 757-764 DOI: 10.1038/jp.2009.87. (PMID: 19571815)
• 24 Hill PD, Aldag JC, Chatterton RT. et al. Primary and secondary mediators’ influence on milk output in lactating mothers of preterm and term infants. J Hum Lact 2005; 21: 138-150 DOI: 10.1177/0890334405275403. (PMID: 15886340)
• 25 Hill PD, Aldag JC, Chatterton RT. et al. Comparison of milk output between mothers of preterm and term infants: the first 6 weeks after birth. J Hum Lact 2005; 21: 22-30 DOI: 10.1177/0890334404272407. (PMID: 15681632)
• 26 Corpeleijn WE, Kouwenhoven SM, Paap MC. et al. Intake of own mother’s milk during the first days of life is associated with decreased morbidity and mortality in very low birth weight infants during the first 60 days of life. Neonatology 2012; 102: 276-281 DOI: 10.1159/000341335. (PMID: 22922675)
• 27 Arslanoglu S, Ziegler EE, Moro GE. et al. Donor human milk in preterm infant feeding: evidence and recommendations. J Perinat Med 2010; 38: 347-351 DOI: 10.1515/jpm.2010.064. (PMID: 20443660)
• 28 Arslanoglu S, Moro GE, Bellu R. et al. Presence of human milk bank is associated with elevated rate of exclusive breastfeeding in VLBW infants. J Perinat Med 2013; 41: 129-131 DOI: 10.1515/jpm-2012-0196. (PMID: 23241582)
• 29 Hamprecht K, Maschmann J, Vochem M. et al. Epidemiology of transmission of cytomegalovirus from mother to preterm infant by breastfeeding. Lancet 2001; 357: 513-518 DOI: 10.1016/S0140-6736(00)04043-5. (PMID: 11229670)
• 30 Klotz D, Jansen S, Gebauer C. et al. Handling of Breast Milk by Neonatal Units: Large Differences in Current Practices and Beliefs. Front Pediatr 2018; 6: 235 DOI: 10.3389/fped.2018.00235. (PMID: 30234076)
• 31 Haiden N, Wald M, Berger A. Prävention von CMV-Infektionen bei Frühgeborenen (< 28 +0 SSW oder einem Geburtsgewicht < 1000 g) durch Muttermilch – Update 2018. Monatsschr Kinderheilkd 2019; 167: 323-328
• 32 Sun H, Han S, Cheng R. et al. Testing the feasibility and safety of feeding preterm infants fresh mother’s own milk in the NICU: A pilot study. Sci Rep 2019; 9: 941 DOI: 10.1038/s41598-018-37111-7. (PMID: 30700726)
• 33 Aksoy HT, Guzoglu N, Eras Z. et al. The association of early postnatal weight loss with outcome in extremely low birth weight infants. Pediatr Neonatol 2019; 60: 192-196 DOI: 10.1016/j.pedneo.2018.06.003. (PMID: 30055960)
• 34 Tyson JE, Kennedy KA. Trophic feedings for parenterally fed infants. Cochrane Database Syst Rev 2005; (03) CD000504 DOI: 10.1002/14651858.CD000504.pub2. (PMID: 16034854)
• 35 Oddie SJ, Young L, McGuire W. Slow advancement of enteral feed volumes to prevent necrotising enterocolitis in very low birth weight infants. Cochrane Database Syst Rev 2021; (08) CD001241 DOI: 10.1002/14651858.CD001241.pub8. (PMID: 34427330)
• 36 SIFT Investigators Group. Early enteral feeding strategies for very preterm infants: current evidence from Cochrane reviews. Arch Dis Child Fetal Neonatal Ed 2013; 98: F470-F472 DOI: 10.1136/archdischild-2012-303260.
• 37 Cobb BA, Carlo WA, Ambalavanan N. Gastric residuals and their relationship to necrotizing enterocolitis in very low birth weight infants. Pediatrics 2004; 113: 50-53 DOI: 10.1542/peds.113.1.50. (PMID: 14702446)
• 38 Arslanoglu S, Boquien CY, King C. et al. Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification. Front Pediatr 2019; 7: 76 DOI: 10.3389/fped.2019.00076. (PMID: 30968003)
• 39 Lucas A, Boscardin J, Abrams SA. Preterm Infants Fed Cow’s Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother’s Own Milk. Breastfeed Med 2020; 15: 297-303 DOI: 10.1089/bfm.2019.0133. (PMID: 32239968)
• 40 Jensen GB, Ahlsson F, Domellof M. et al. Nordic study on human milk fortification in extremely preterm infants: a randomised controlled trial-the N-forte trial. BMJ Open 2021; 11: e053400 DOI: 10.1136/bmjopen-2021-053400. (PMID: 34815288)
• 41 Boyle EM, Johnson S, Manktelow B. et al. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study. Arch Dis Child Fetal Neonatal Ed 2015; 100: F479-F485 DOI: 10.1136/archdischild-2014-307347. (PMID: 25834169)
• 42 Academy of Breastfeeding Medicine. ABM clinical protocol #10: breastfeeding the late preterm infant (34(0/7) to 36(6/7) weeks gestation) (first revision June 2011). Breastfeed Med 2011; 6: 151-156 DOI: 10.1089/bfm.2011.9990.
• 43 Shaker CS. Infant-Guided, Co-Regulated Feeding in the Neonatal Intensive Care Unit. Part II: Interventions to Promote Neuroprotection and Safety. Semin Speech Lang 2017; 38: 106-115 DOI: 10.1055/s-0037-1599108. (PMID: 28324900)
• 44 Shaker CS. Infant-Guided, Co-Regulated Feeding in the Neonatal Intensive Care Unit. Part I: Theoretical Underpinnings for Neuroprotection and Safety. Semin Speech Lang 2017; 38: 96-105 DOI: 10.1055/s-0037-1599107. (PMID: 28324899)
• 45 Furman L, Minich N, Hack M. Correlates of lactation in mothers of very low birth weight infants. Pediatrics 2002; 109: e57 DOI: 10.1542/peds.109.4.e57. (PMID: 11927730)
• 46 Foster JP, Psaila K, Patterson T. Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Cochrane Database Syst Rev 2016; (10) CD001071 DOI: 10.1002/14651858.CD001071.pub3. (PMID: 27699765)
• 47 Kaya V, Aytekin A. Effects of pacifier use on transition to full breastfeeding and sucking skills in preterm infants: a randomised controlled trial. J Clin Nurs 2017; 26: 2055-2063 DOI: 10.1111/jocn.13617. (PMID: 27754572)
• 48 Kamitsuka MD, Nervik PA, Nielsen SL. et al. Incidence of Nasogastric and Gastrostomy Tube at Discharge Is Reduced after Implementing an Oral Feeding Protocol in Premature (< 30 weeks) Infants. Am J Perinatol 2017; 34: 606-613 DOI: 10.1055/s-0037-1601443. (PMID: 28376549)
• 49 Gianni ML, Bezze E, Colombo L. et al. Complementary Feeding Practices in a Cohort of Italian Late Preterm Infants. Nutrients 2018; 10: 1861 DOI: 10.3390/nu10121861. (PMID: 30513799)
• 50 Morag I, Hendel Y, Karol D. et al. Transition From Nasogastric Tube to Oral Feeding: The Role of Parental Guided Responsive Feeding. Front Pediatr 2019; 7: 190 DOI: 10.3389/fped.2019.00190. (PMID: 31143759)
• 51 Fontana C, Menis C, Pesenti N. et al. Effects of early intervention on feeding behavior in preterm infants: A randomized controlled trial. Early Hum Dev 2018; 121: 15-20 DOI: 10.1016/j.earlhumdev.2018.04.016. (PMID: 29730130)
• 52 Collins CT, Gillis J, McPhee AJ. et al. Avoidance of bottles during the establishment of breast feeds in preterm infants. Cochrane Database Syst Rev 2016; (10) CD005252 DOI: 10.1002/14651858.CD005252.pub4. (PMID: 27756113)
• 53 Nyqvist KH, Rubertsson C, Ewald U. et al. Development of the Preterm Infant Breastfeeding Behavior Scale (PIBBS): a study of nurse-mother agreement. J Hum Lact 1996; 12: 207-219 DOI: 10.1177/089033449601200318. (PMID: 9025428)