脂肪改良母乳解决术后乳糜胸婴儿乳糜胸腔积液但与生长缓慢相关

　　乳糜胸发生于约3%～5%的心脏手术婴儿。标准治疗需要中断喂养富含长链甘油三酯的母乳，替换成含有中链甘油三酯（MCT）的配方奶。

　　为了确定脂肪改良母乳（MBM）与MCT配方奶相比治疗乳糜胸的有效性，多伦多大学、多伦多儿童医院对2008年1月～2009年12月在多伦多儿童医院接受先天性心脏病手术后诊断为乳糜胸的婴儿开展了一项非随机非盲研究。

　　该研究给予治疗组8例婴儿经过离心去除脂肪层并添加MCT、营养素和必需脂肪酸的改良母乳，以提供约74kcal/100mL能量和1.4g/100mL蛋白质（MBM组）。给予对照组8例婴儿MCT配方奶（MCT组）。根据多伦多儿童医院乳糜胸标准治疗方案，喂养干预在胸管移除后至少持续6周。

　　结果发现，MBM组和MCT组每天的胸腔引流体积和持续时间均无差异。虽然喂养组之间体重增加率（g/d）无统计学显著差异，但是MBM组婴儿年龄越小，年龄别z评分平均体重（P=0.04）和身长（P=0.01）有所减少。

　　因此，虽然脂肪改良母乳解决了乳糜胸，但是该新型治疗广泛应用于临床之前，还需要更大规模试验制定和评价解决生长缓慢的策略。

JPEN J Parenter Enteral Nutr. 2016;40(4):543-51.

Fat-Modified Breast Milk Resolves Chylous Pleural Effusion in Infants With Postsurgical Chylothorax but Is Associated With Slow Growth.

Kocel SL, Russell J, O'Connor DL

University of Toronto, Canada; The Hospital for Sick Children, Toronto, Canada.

BACKGROUND: Chylothorax occurs in ~3%-5% of infants undergoing cardiac surgery. Standard treatment requires discontinuation of breast milk feeding, due to the abundance of long-chain triglycerides and transition to a medium-chain triglyceride (MCT)-based formula.

OBJECTIVE: To determine the effectiveness of fat-modified breast milk (MBM) for the treatment of chylothorax compared with MCT formula.

MATERIALS AND METHODS: Infants diagnosed with chylothorax following surgery for congenital heart disease between January 2008 and December 2009 at The Hospital for Sick Children were eligible for this nonrandomized open-label study. Treatment infants (n = 8) received mother's own milk that had been modified by removing the fat layer via centrifugation and adding MCT, nutrients, and essential fatty acids to provide an estimated 74 kcal/100 mL and 1.4 g/100 mL protein (MBM group). Control infants (n = 8) received an MCT formula (MCT group). The feeding intervention was a minimum of 6 weeks after chest tube removal per The Hospital for Sick Children standard chylothorax treatment protocol.

RESULTS: Daily volume and duration of chest tube drainage were not different between the MBM and MCT groups. While there was no statistically significant difference in rates of weight gain (g/d) between feeding groups, infants in the MBM group, who tended to be younger, experienced a decline in mean weight (P = .04) and length (P = .01) for age z scores.

CONCLUSION: Fat-modified breast milk resolved chylothorax; however, strategies to address poor growth need to be developed and evaluated in larger trials prior to widespread clinical adoption of this novel treatment.

PMID: 25560680

DOI: 10.1177/0148607114566464