母乳喂养儿铁缺乏的影响因素及预防策略

doi:10.11852/zgetbjzz2018-26-06-14

摘要/Abstract

摘要： 母乳喂养对婴儿近期的生长发育、肠道微生态的改善、免疫机能的调节具有显著的促进作用,同时可以促进婴儿远期神经系统发育、降低代谢综合征的风险。帮助母乳喂养的足月儿度过宫内铁储备耗竭后的阶段、降低铁缺乏风险,从而最大程度地发挥母乳喂养的优势是目前的关注热点。本文从母亲相关因素、脐带结扎时间、性别因素、辅食添加及预防性铁剂补充多个方面回顾了母乳喂养儿铁营养状况影响因素的相关研究,分析显示提高母亲铁营养相关知识水平、注重孕期铁元素的补充和膳食指导、延迟断脐可以增加新生儿出生时的铁储备量;积极提倡纯母乳喂养,对生长需求不同的婴儿进行适时、合理的辅食添加,对铁缺乏高危儿进行预防性铁剂补充均可以在不同程度上预防母乳喂养儿出现铁缺乏。

关键词: 母乳喂养, 足月儿, 铁缺乏, 预防

Abstract: Breastfeeding has positive effect on growth,development,and well-being in both a short-term and a long-term perspective,which makes breastfeeding the optimal nutrition for healthy term infants. Current researches focus on maximizing the advantages of breastfeeding through protecting breastfed infants against iron deficiency in the first a few months and reducing the risk of iron deficiency. This paper reviews studies on the factors influencing iron nutrition including maternal factors,umbilical cord clamping time,gender factors,complementary food and preventive iron supplementation. Existed evidence indicates that improving mothers′knowledge on iron nutrition,iron supplementation and dietary guidance during pregnancy,delayed umbilical cord clamping will help increase iron endowment in neonates at birth; Also,exclusive breastfeeding, appropriate complementary foods for infants with different growth needs,and preventive iron supplementation for infants with high risk of iron deficiency can prevent iron deficiency in full term healthy infants.

Key words: breast feeding, full term, iron deficiency, prevention

中图分类号:

R179

李蕴微, 王丹华. 母乳喂养儿铁缺乏的影响因素及预防策略[J]. 中国儿童保健杂志, 2018, 26(6): 630-633.

LI Yun-wei, WANG Dan-hua. Iron deficiency in breast feeding infants: risk factors and prevention[J]. journal1, 2018, 26(6): 630-633.

参考文献

[1] WHO.Worldwide prevalence of anaemia 1993-2005 [R].Geneve: Wolrd Health Organization,2008.
[2] Pita GM,Jimenez S,Basabe B,et al.Anemia in children under five years old in Eastern Cuba,2005-2011 [J].Medicc Rev,2014,16(1):16-23.
[3] Finkelstein JL,O′Brien KO,Abrams SA,et al.Infant iron status affects iron absorption in Peruvian breastfed infants at 2 and 5 mo of age [J].Am J Clin Nutr,2013,98(6): 1475-1484.
[4] Zhang Y,Jin L,Liu JM,et al.Maternal Hemoglobin concentration during gestation and risk of anemia in infancy: secondary analysis of a randomized controlled trial [J].Pediatr,2016,175:106-110.
[5] Wang J,Wang H,Chang S,et al.The influence of malnutrition and micronutrient status on anemic risk in children under 3 years old in poor areas in china[J].PLoS One,2015,10(10): e0140840.
[6] Abe SK,Balogun OO,Ota E,et al.Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby [J].Cochrane Database Syst Rev,2016,(2):Cd010647.
[7] Cai C,Eck P,Friel JK.Gene expression profiles suggest iron transport pathway in the lactating human epithelial cell [J].J Pediatr Gastroenterol Nutr,2017,64(3):460-464.
[8] Klein LD,Breakey AA,Scelza B,et al.Concentrations of trace elements in human milk: Comparisons among women in Argentina,Namibia,Poland,and the United States [J].PLoS One,2017,12(8): e0183367.
[9] Cai C,Harding SV.Breast milk iron concentrations may be lower than previously reported: implications for exclusively breastfed infants[J].Matern Pediatr Nutr,2015,2(1):104-107.
[10] Ziegler EE,Nelson SE,Jeter JM.Iron stores of breastfed infants during the first year of life [J].Nutrients,2014,6(5):2023-2034.
[11] 徐康,张翠梅,黄连红,等.6～12月龄婴儿缺铁性贫血的危险因素分析及对神经心理发育的影响 [J].中国当代儿科杂志,2015,(8):830-836.
[12] Metallinos-Katsaras E,Colchamiro R,Edelstein S,et al.Household food security status is associated with anemia risk at age 18 months among low-income infants in massachusetts[J].J Acad Nutr Diet,2016,116(11):1760-1766.
[13] Hutton EK,Hassan ES.Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials [J].JAMA,2007,297(11): 1241-1252.
[14] Chaparro CM,Neufeld LM,Tena Alavez G,et al.Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial [J].Lancet,2006,367(9527):1997-2004.
[15] Rabe H,Diaz-Rossello J L,Duley L,et al.Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes [J].Cochrane Database Syst Rev,2012,(8):CD003248.
[16] WHO.Optimal timing of cord clamping for the prevention of iron deiciency anaemia in infants[M/OL].Wolrd Health Organization,Geneva:Switzerland: WHO http://www who int/elena/titles/cord_clamping/en,2014.
[17] Committee on Obstetric,P.Committee Opinion No.684: Delayed Umbilical Cord Clamping After Birth [J].Obstet Gynecol,2017,129(1):e5-e10.
[18] American Academy of Pediatrics.Delayed Umbilical Cord Clamping After Birth[J].Pediatrics,2017,139(6):e20170957
[19] WHO,UNICEF.Global strategy for infant and young child feeding[M].Geneva: World Health Organization,2003.
[20] Kramer M S,Kakuma R.Optimal duration of exclusive breastfeeding [J].Cochrane Database Syst Rev,2012,(8): CD003517.
[21] Smith HA,Becker GE.Early additional food and fluids for healthy breastfed full-term infants [J].Cochrane Database Syst Rev,2016,(8):CD006462.
[22] Qasem W,Fenton T,Friel J.Age of introduction of first complementary feeding for infants: a systematic review [J].BMC Pediatr,2015,15(1):107-117.
[23] Olaya GA,Lawson M,Fewtrell MS.Efficacy and safety of new complementary feeding guidelines with an emphasis on red meat consumption: a randomized trial in Bogota,Colombia [J].Am J Clin Nutr,2013,98(4): 983-993.
[24] Uyoga MA,Karanja S,Paganini D,et al.Duration of exclusive breastfeeding is a positive predictor of iron status in 6- to 10-month-old infants in rural Kenya [J].Matern Child Nutr,2016,[Epub ahead of print].
[25] Andersson O,Domellof M,Andersson D,et al.Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months: a randomized clinical trial [J].JAMA Pediatr,2014,168(6): 547-554.
[26] 王月娇,吴芹,杨丽琛,等.预防性铁补充对母乳喂养婴儿铁营养状况的影响[J].中华预防医学杂志,2012,46(4):299-302.
[27] Ziegler EE,Nelson SE,Jeter JM.Iron supplementation of breastfed infants from an early age [J].Am J Clin Nutr,2009,89(2):525-532.
[28] Domellof M, Cohen RJ,Dewey KG,et al.Iron supplementation of breast-fed Honduran and Swedish infants from 4 to 9 months of age [J].J Pediatr,2001,138(5):679-687.
[29] Cai,C,Granger M,Eck P,et al.Effect of daily iron supplementation in healthy exclusively breastfed infants: a systematic review with meta-analysis[J].Breastfeed Med,2017,[Epub ahead of print].