極低出生體重兒接受口咽滴注初乳對發育之成效

Effects of Oropharyngeal Colostrum on the Growth Extremely Low Birth Weight Infants

極低出生體重兒是罹患壞死性腸炎的高風險族群，因此學者建議應以母乳作為提供營養的首選。而早產兒母親的初乳較足月產婦含更高濃度的免疫保護因子，然而，極低出生體重兒卻因先天發育的不成熟，使其在出生初期並無法順利進食母親初乳，故陸續有研究探討透過口咽滴注初乳做為預防壞死性腸炎的可行性。本研究目的即選取已發表的隨機對照試驗與世代研究進行系統性文獻回顧，藉以統整口咽滴注初乳介入極低出生體重兒照護之實證。搜尋1998年至2018年11月前發表的中英文文獻，搜尋資料庫包括PubMed、The Cochrane Library、Medline、ProQuest、華藝線上圖書館，最後共得7篇研究。研究結果發現，極低出生體重兒採口咽滴注初乳對增進分泌型免疫球蛋白及乳鐵蛋白、改善敗血症及壞死性腸炎成效目前研究結果仍分歧，而對於提升出院後母乳哺餵率、較早達全腸道餵食、較快可開始接受餵食及體重成長則有潛在益處，且口腔滴注初乳亦會影響早產兒口腔內微生物群變化，但此些正面結果皆僅來自於單篇研究發現。建議可將口咽滴注初乳列為極低出生體重兒之臨床照護參考，但未來仍需仰賴大型、嚴謹之研究繼續進行驗證。

Extremely low-birth-weight (ELBW) infants are at a high risk for necrotizing enterocolitis (NEC), which recommends human milk as the priority nutritional choice. Especially, preterm milk contains higher levels of immune protective factors compared with milk from mothers delivering at term. Unfortunately, the clinical instability precludes enteral feedings on the first days after birth for ELBW infants, whereas previous studies explored the alternative methods for oropharyngeal mother's colostrum administration. The study aimed to perform a systematic review of randomized controlled trials and cohort studies to summarize the effects of oropharyngeal mother's colostrum administration on the immunologic effects and growth of ELBW infants. This review focused on the studies published between Jan 1998 and Nov 2018. The following databases were searched: PubMed, The Cochrane Library, MEDLINE, ProQuest, and Airiti Library. Seven studies met the inclusion criteria. Inconsistent results showed that the oropharyngeal mother's colostrum administration may provide a number of benefits for ELBW infants. These benefits include increased secretory immunoglobulin A, lactoferrin, and improved sepsis and NEC. Specifically, single reports have shown that oropharyngeal mother's colostrum administration may increase the rate of breast milk feeding through discharge, earlier attainment of full enteral feeds and oral feeds, improved growth, and influenced the colonization of the oral cavity. Oropharyngeal mother's colostrum administration could be used as a reference for clinical practice in attending to ELBW infants. Additional large and rigorous studies need to verify these results.