ВИКОРИСТАННЯ БІЛКОВОЇ ДОБАВКИ ДЛЯ ЗАБЕЗПЕЧЕННЯ ХАРЧОВИХ ПОТРЕБ ЗНАЧНО НЕДОНОШЕНИХ ДІТЕЙ

D. Dobryanskyy

Анотація


Враховуючи унікальні імунобіологічні властивості грудного молока (ГМ) воно рекомендується якпріоритетнийпродукт харчування передчасно народжених дітей. Проте, вміст поживних речовин в ньому є недостатнім для забезпечення харчових потреб найменших немовлят, а склад – індивідуальним і непостійним, залежачи від терміну гестації і тривалості лактації.Ці особливості зменшують ефективність стандартного збагачення ГМ, яке передбачає додавання визначеної кількості спеціального збагачувача до певногооб’єму молока. Дві нові стратегії збагачення (регульоване та цільове) оптимізують споживання макронутрієнтів і позитивно впливають на фізичний розвиток значно недоношених дітей. Реалізація регульованого збагачення, що є реальним в умовах України, неможлива без використання білкової добавки. З її допомогою можливо оптимізувати споживання білка, що має критичне значення для забезпечення належних темпів постнатального фізичного розвитку.Не всі спеціальні суміші для недоношених немовлят також задовольняють харчові потреби найменших новонароджених, зокрема, в білках. Використання білкової добавки дозволяє коригувати вміст білка у спеціальних сумішах, так само сприяючи покращенню довгострокових результатів їх виходжування. Збагачення збільшує осмоляльність кінцевих продуктів,проте, немає доказів впливу цього на ризик виникнення некротизуючого ентероколіту. У цьому огляді представлено сучасні дані про використання збагачених продуктів у харчуванні значно недоношених дітей, а також обговорюються практичні аспекти застосування білкової добавки.

Ключові слова


збагачення грудного молока; білкова добавка; харчування; значно недоношені немовлята

Повний текст:

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Посилання


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.2 Bai-Horng Su. Optimizing nutrition in preterm infants. Pediatr and Neonatol. 2014;55(1):5–13. doi: http://dx.doi.org/10.1016/j.pedneo.2013.07.003.

.3 Ziegler EE, Carlson SJ, Nelson SE. Interventional strategies to promote appropriate growth. Nestle Nutr Inst Workshop Series. 2013;74:181–192. doi: 10.1159/000348769.

.4 Ehrenkranz RA. Nutrition, growth and clinical outcomes. World Rev Nutr Diet. 2014;110:11–26. doi: 10.1159/000358455.

.5 Dobryanskyy DО. Strategies of feeding which ensure optimized postnatal development of preterm infants. Neonatolohiya, Khirurhiya ta Perynatal’na Medytsyna. 2015;1(15):10-8. (in Ukrainian)

.6 Khanam S, Khan J, Sharma D, Chawla D, Murki S. Nutritional bundle to improve growth outcomes among very low birth weight infants. J Matern Fetal Neonatal Med. 2015;28(15):1851-5. doi: 10.3109/14767058.2014.970528.

.7 Loys CM, Maucort-Boulch D, Guy B, Putet G, Picaud JC, Haÿs S. Extremely low birthweight infants: how neonatal intensive care unit teams can reduce postnatal malnutrition and prevent growth retardation. Acta Paediatr. 2013;102(3):242–8. doi: 10.1111/apa.12092.

.8 Rochow N, Fusch G, Mühlinghaus A, Niesytto C, Straube S, Utzig N, et al. A nutritional program to improve outcome of very low birth weight infants. Clin Nutr. 2012;31(1):124–31. doi: 10.1016/j.clnu.2011.07.004.

.9 Belfort MB, Ehrenkranz RA. Neurodevelopmental outcomes and nutritional strategies in very low birth weight infants. Seminars in Fetal & Neonatal Medicine. 2017;22(1):42-8.

.10 Tudehope D, Fewtrell M, Kashyap S, Udaeta E. Nutritional needs of the micropreterm infant. J Pediatr. 2013;162(Suppl 3):72–80.

.11 Wagner J, Hanson C, Anderson-Berry A. Considerations in meeting protein needs of the human milk-fed preterm infant. Adv Neonatal Care. 2014;14(4):281–9. doi: 10.1097/ANC.0000000000000108

.12 Senterre T. Practice of enteral nutrition in very low birth weight and extremely low birth weight infants. In: Koletzko B, Poindexter B, Uauy R, editors. Nutritional care of preterm infants: scientific basis and practical guidelines. Karger: Basel; 2014. р. 201–14.

.13 Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, et al. Enteral nutrient supply for preterm infants: commentary from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. JPGN. 2010;50(1):85-91. doi: 10.1097/MPG.0b013e3181adaee0.

.14 Johnston M, Landers S, Noble L, Szucs K, Viehmann L. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):827-41. doi: 10.1542/peds.2011-3552.

.15 Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries. World Health Organization; 2011. 60 p.

.16 Bhatia J. Human milk and the premature infant. Ann Nutr Metab. 2013;62(Suppl 3):8-14. doi: 10.1159/000351537.

.17 Radmacher PG, Adamkin DH. Radmacher PG. Fortification of human milk for preterm infants. Seminars in Fetal & Neonatal Medicine. 2017;22(1):30-5.

.18 Vohr BR, Poindexter BB, Dusick AM, McKinley LT, Higgins RD, Langer JC, et al. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics. 2007;120(4):953-59.

.19 Quigley MA, Henderson G, Anthony MY, McGuire W. Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2007;17(4):CD002971.

.20 ESPGHAN Committee on Nutrition, Arslanoglu S, Corpeleijn W, Moro G, Braegger C, Campoy C, et al. Donor human milk for preterm infants: current evidence and research directions. JPGN. 2013;57(4):535-42. doi: 10.1097/MPG.0b013e3182a3af0a

.21 Adamkin DH, Radmacher PG. Fortification of human milk in very low birth weight infants (VLBW <1500 g birth weight). Clin. Perinatol. 2014;41(2):405-21. doi: 10.1016/j.clp.2014.02.010.

.22 Ziegler EE. Human milk and human milk fortifiers. In: Koletzko B, Poindexter B, Uauy R, editors. Nutritional care of preterm infants: scientific basis and practical guidelines. Karger: Basel; 2014. p. 215-227.

.23 Arslanoglu S, Moro GE, Ziegler EE, The Wapm Working Group on Nutrition. Optimization of human milk fortification for preterm infants: new concepts and recommendations. J Perinat Med. 2010;38(3):233-38. doi: 10.1515/JPM.2010.073.

.24 Moya F, Sisk PM, Walsh KR, Berseth CL. A new liquid human milk fortifier and linear growth in preterm infants. Pediatrics. 2012;130(4):928-35. doi: 10.1542/peds.2011-3120.

.25 Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr. 2014;14(1):216. doi: 10.1186/1471-2431-14-216.

.26 Henriksen C, Westerberg AC, Ronnestad A, Nakstad B, Veierod MB, Drevon CA, et al. Growth and nutrient intake among very-low-birthweightinfants fed fortified human milk during hospitalisation. Br J Nutr. 2009;102(8):1179-86. doi: 10.1017/S0007114509371755.

.27 Arslanoglu S, Moro GE, Ziegler EE. Preterm infants fed fortified human milk receive less protein than they need. J Perinatol. 2009;29(7):489-92. doi: 10.1038/jp.2009.50.

.28 Ziegler EE. Meeting the nutritional needs of the low-birth-weight infant. Ann Nutr Metab. 2011;58(Suppl 1):8–18. doi: 10.1159/000323381.

.29 Picaud JC, Houeto N, Buffin R, Loys CM, Godbert I, Haÿs S. Additional protein fortification is necessary in extremely low-birth-weight infants fed human milk. JPGN. 2016;63(1):103-5. doi: 10.1097/MPG.0000000000001142.

.30 Koletzko B, Poindexter B, Uauy R. Recommended nutrient intake levels for stable, fully enterally fed very low birth weight infants. In: Koletzko B, Poindexter B, Uauy R, editors. Nutritional care of preterm infants: scientific basis and practical guidelines. Karger: Basel; 2014. р. 297–299.

.31 Vlaardingerbroek H, van Goudoever JB, Van Den Akker CH. Initial nutritional management оf the preterm infant. Early Human Development. 2009;85(11):691-5. doi: 10.1016/j.earlhumdev.2009.08.052.

.32 Arslanoglu S, Moro GE, Ziegler EE. Adjustable fortification of human milk fed to preterm infants: does it make a difference? J Perinatol. 2006;26(10):614-21.

.33 Alan S, Atasay B, Cakir U, Yildiz D, Kilic A, Kahvecioglu D, et al. An intention to achieve better postnatal in-hospital-growth for preterm infants: adjustable protein fortification of human milk. Early Hum Dev. 2013;89(12):1017–23. doi: 10.1016/j.earlhumdev.2013.08.015.

.34 Ergenekon E, Soysal Ş, Hirfanoğlu İ, Baş V, Gücüyener K, Turan Ö, et al. Short- and long-term effects of individualized enteral protein supplementation in preterm newborns. Turk J Pediatr. 2013;55(4):365–70.

.35 Rochow N, Fusch G, Choi A, Chessell L, Elliott L, McDonald K, et al. Target fortification of breast milk with fat, protein, and carbohydrates for preterm infants. J Pediatr. 2013;163(4):1001-7. doi: 10.1016/j.jpeds.2013.04.052.

.36 Morlacchi L, Mallardi D, Giannì ML, Roggero P, Amato O, Piemontese P, et al. Is targeted fortification of human breast milk an optimal nutrition strategy for preterm infants? An interventional study. J Transl Med. 2016;14(1):195. doi: 10.1186/s12967-016-0957-y.

.37 O'Neill EF, Radmacher PG, Sparks B, Adamkin D. Creamatocrit analysis of human milk overestimates fat and energy content when compared to a human milk analyzer using mid-infrared spectroscopy. J Pediatr Gastroenterol Nutr. 2013;56(5):569-72. doi: 10.1097/MPG.0b013e31828390e4.

.38 McLeod G, Sherriff J, Hartmann PE, Nathan E, Geddes D, Simmer K. Comparing different methods of human breast milk fortification using measured v. assumed macronutrient composition to target reference growth: a randomised controlled trial. Br J Nutr. 2016;115(3):431–9. doi: 10.1017/S0007114515004614.

.39 Rochow N, Landau-Crangle E, Fusch C. Challenges in breast milk fortification for preterminfants. Curr Opin Clin Nutr Metab Care. 2015;18(3):276–84. doi: 10.1097/MCO.0000000000000167.

.40 Barness LA, Mauer AM, Holliday MA, Anderson AS, Dallman PR, Forbes GB, et al. Commentary on breast-feeding and infant formulas, including proposed standards for formulas. Pediatrics. 1976;57(2):278–85.

.41 Pearson F, Johnson MJ, Leaf AA. Milk osmolality: does it matter? Arch Dis Child Fetal Neonatal Ed. 2013;98(2):166–9. doi: 10.1136/adc.2011.300492.

.42 Perrella SL, Hepworth AR, Simmer KN, Geddes DT. Influences of breastmilk composition on gastric emptying in preterm infants. J Pediatr Gastroenterol Nutr. 2015;60(2):264–71. doi: 10.1097/MPG.0000000000000596.

.43 Choi A, Fusch G, Rochow N, Fusch C. Target fortification of breast milk: predictingthe final osmolality of the feeds. PLoS ONE. 2016;11(2):0148941. doi: 10.1371/journal.pone.0148941.

.44 Rochow N, Jochum F, Redlich A, Korinekova Z, Linnemann K, Weitmann K, et al. Fortification of breast milk in VLBW infants: metabolic acidosis is linked to the composition of fortifiers and altersweight gain and bone mineralization. Clin Nutr. 2011;30(1):99-105. doi: 10.1016/j.clnu.2010.07.016.

.45 Blakeney S, Seale J, Hendrikson H, Whitfield J. Growth faltering in VLBW infants fed breast milk fortified with new sterile liquid fortifier. J Pediatr Gastroenterol Nutr. 2014;59(5):46–7. doi: 10.1097/MPG.0000000000000516.


Пристатейна бібліографія ГОСТ


1. Cole T.J., Statnikov Y., Santhakumaran S., Pan H., Modi N. Birth weight and longitudinal growth in infants born below 32 weeks’ gestation: a UK population study. Arch Dis Child Fetal Neonatal Ed. 2014. Vol. 99, № 1. P. 34-40. doi: 10.1136/archdischild-2012-303536. 

2. Bai-Horng Su. Optimizing nutrition in preterm infants. Pediatr and Neonatol. 2014. Vol. 55, Issue 1. P. 5–13. doi: http://dx.doi.org/10.1016/j.pedneo.2013.07.003.

3. Ziegler E.E., Carlson S.J., Nelson S.E. Interventional strategies to promote appropriate growth. Nestle Nutr Inst Workshop Series. 2013. Vol. 74. P. 181–192. doi: 10.1159/000348769.

4. Ehrenkranz R.A. Nutrition, growth and clinical outcomes. World Rev Nutr Diet. 2014. Vol.110. P. 11–26. doi: 10.1159/000358455.

5. Добрянський Д.О. Стратегії харчування, що забезпечують оптимальний фізичний розвиток передчасно народжених немовлят. Неонатологія, хірургія та перинатальна ме¬ди¬цина. 2015. Т. 5, № 1(15). С. 10-18.

6. Khanam S., Khan J., Sharma D., Chawla D., Murki S. Nutritional bundle to improve growth outcomes among very low birth weight infants. J. Matern. Fetal Neonatal Med. 2015. Vol. 28, № 15. P.1851-1855. doi: 10.3109/14767058.2014.970528. 

7. Loys C.M., Maucort-Boulch D., Guy B., Putet G., Picaud J.C., Haÿs S. Extremely low birthweight infants: how neonatal intensive care unit teams can reduce postnatal malnutrition and prevent growth retardation. ActaPaediatr. 2013. Vol.102, № 3. P. 242–248. doi: 10.1111/apa.12092. 

8. Rochow N., Fusch G., Mühlinghaus A., Niesytto C., Straube S., Utzig N., et al. A nutritional program to improve outcome of very low birth weight infants. Clin. Nutr. 2012. Vol. 31, № 1. P.124–131. doi: 10.1016/j.clnu.2011.07.004.

9. Belfort M.B., Ehrenkranz R.A. Neurodevelopmental outcomes and nutritional strategies in very low birth weight infants. Seminars in Fetal & Neonatal Medicine. 2017. Vol. 22, № 1. P. 42-48.

10. Tudehope D., Fewtrell M., Kashyap S., Udaeta E. Nutritional needs of the micropreterm infant. J Pediatr. 2013. Vol.162, Suppl. 3. Р. 72–80.

11. Wagner J., Hanson C., Anderson-Berry A. Considerations in meeting protein needs of the human milk-fed preterm infant. Adv Neonatal Care. 2014. Vol.14., № 4. P. 281–289. doi: 10.1097/ANC.0000000000000108

12. Senterre T. Practice of enteral nutrition in very low birth weight and extremely low birth weight infants. In: Nutritional care of preterm infants: scientific basis and practical guidelines /edit. B. Koletzko, B. Poindexter, R. Uauy. Karger: Basel, 2014. P. 201–214.

13. Agostoni C., Buonocore G., Carnielli V.P., De Curtis M., Darmaun D., Decsi T., et al. Enteral nutrient supply for preterm infants: commentary from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition. JPGN. 2010. Vol. 50, № 1. P.85-91. doi: 10.1097/MPG.0b013e3181adaee0.

14. Johnston M., Landers S., Noble L., Szucs K., Viehmann L. Breastfeeding and the use of human milk. Pediatrics. 2012. Vol.129, № 3. P. 827-841. doi: 10.1542/peds.2011-3552.

15. Guidelines on optimal feeding of low birth-weight infants in low- and middle-income countries. World Health Organization, 2011. 51 p.

16. Bhatia J. Human milk and the premature infant. Ann Nutr Metab. 2013. Vol.62, Suppl 3. P. 8-14. doi: 10.1159/000351537.

17. Radmacher P.G., Adamkin D.H. Fortification of human milk for preterm infants. Seminars in Fetal & Neonatal Medicine. 2017. Vol. 22, № 1. P. 30-35.

18. Vohr B.R., Poindexter B.B., Dusick A.M., McKinley L.T., Higgins R.D., Langer J.C., et al. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics. 2007. Vol.120, № 4. P. 953-959.

19. Quigley M.A, Henderson G., Anthony M.Y., McGuire W. Formula milk versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst. Rev. 2014. Vol.17, № 4. CD002971. 

20. ESPGHAN Committee on Nutrition, Arslanoglu S., Corpeleijn W., Moro G., Braegger C., Campoy C., et al. Donor human milk for preterm infants: current evidence and research directions. JPGN. 2013. Vol. 57. № 4. P. 535-542. doi: 10.1097/MPG.0b013e3182a3af0a

21. Adamkin D.H., Radmacher P.G. Fortification of human milk in very low birth weight infants (VLBW <1500 g birth weight). Clin.Perinatol. 2014. Vol. 41. № 2. P. 405-421. doi: 10.1016/j.clp.2014.02.010.

22. Ziegler E.E. Human milk and human milk fortifiers. Nutritional care of preterm infants: scientific basis and practical guidelines In: Nutritional care of preterm infants: scientific basis and practical guidelines /edit. B. Koletzko, B. Poindexter, R. Uauy. Karger: Basel, 2014. P. 215-227.

23. Arslanoglu S, Moro GE, Ziegler EE, The Wapm Working Group on Nutrition. Optimization of human milk fortification for preterm infants: new concepts and recommendations. J Perinat Med. 2010. Vol. 38. № 3. P. 233-238. doi: 10.1515/JPM.2010.073.

24. Moya F., Sisk P.M., Walsh K.R., Berseth C.L. A new liquid human milk fortifier and linear growth in preterm infants. Pediatrics. 2012. Vol.130. № 4. P. 928-935. doi: 10.1542/peds.2011-3120. 

25. Gidrewicz D.A., Fenton T.R. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr. 2014. Vol.14. № 1. P.216-230. doi: 10.1186/1471-2431-14-216.

26. Henriksen C, Westerberg AC, Ronnestad A, Nakstad B, Veierod MB, Drevon CA, et al. Growth and nutrient intake among very-low-birthweightinfants fed fortified human milk during hospitalization. Br J Nutr. 2009. Vol.102, № 8. P.1179-1186. doi: 10.1017/S0007114509371755.

27. Arslanoglu S., Moro G.E., Ziegler E.E. Preterm infants fed fortified human milk receive less protein than they need. J. Perinatol. 2009. Vol.29, № 7. P.489-492. doi: 10.1038/jp.2009.50.

28. Ziegler E.E. Meeting the nutritional needs of the low-birth-weight infant. Ann Nutr Metab. 2011. Vol. 58, Suppl 1. P.8–18. doi: 10.1159/000323381.

29. Picaud J.C., Houeto N., Buffin R., Loys C.M., Godbert I., Haÿs S. Additional protein fortification is necessary in extremely low-birth-weight infants fed human milk. JPGN. 2016. Vol. 63. № 1. P.103-105. doi: 10.1097/MPG.0000000000001142.

30. Koletzko B., Poindexter B., Uauy R. Recommended nutrient intake levels for stable, fully enterally fed very low birth weight infants. In: Nutritional care of preterm infants: scientific basis and practical guidelines /edit. B. Koletzko, B. Poindexter, R. Uauy. Karger: Basel, 2014. P. 297–299.

31. Vlaardingerbroek H., van Goudoever J.B., Van Den Akker C.H. Initial nutritional management оf the preterm infant. Early Human Development. 2009. Vol. 85, № 11. P. 691-695. doi: 10.1016/j.earlhumdev.2009.08.052.

32. Arslanoglu S., Moro G.E., Ziegler E.E. Adjustable fortification of human milk fed to preterm infants: does it make a difference? J. Perinatol. 2006. Vol. 26, № 10. P.614-621.

33. Alan S., Atasay B., Cakir U., Yildiz D., Kilic A., Kahvecioglu D., et al. An intention to achieve better postnatal in-hospital-growth for preterm infants: adjustable protein fortification of human milk. Early Hum Dev. 2013. Vol. 89, № 12. P.1017–1023. doi: 10.1016/j.earlhumdev.2013.08.015.

34. Ergenekon E., Soysal Ş., Hirfanoğlu İ., Baş V., Gücüyener K., Turan Ö., et al. Short- and long-term effects of individualized enteral protein supplementation in preterm newborns. Turk J Pediatr. 2013. Vol. 55, № 4. P. 365–370.

35. Rochow N., Fusch G., Choi A., Chessell L., Elliott L., McDonald K., et al. Target fortification of breast milk with fat, protein, and carbohydrates for preterm infants. J Pediatr. 2013. Vol.163, № 4. P.1001-1007. doi: 10.1016/j.jpeds.2013.04.052.

36. Morlacchi L., Mallardi D., Giannì M.L., Roggero P., Amato O., Piemontese P., et al. Is targeted fortification of human breast milk an optimal nutrition strategy for preterm infants? An interventional study. J Transl Med. 2016. Vol.14, № 1. P.195. doi: 10.1186/s12967-016-0957-y.

37. O'Neill E.F., Radmacher P.G., Sparks B., Adamkin D. Creamatocrit analysis of human milk overestimates fat and energy content when compared to a human milk analyzer using mid-infrared spectroscopy. J Pediatr Gastroenterol Nutr. 2013. Vol. 56, № 5. P. 569-573. doi: 10.1097/MPG.0b013e31828390e4.

38. McLeod G., Sherriff J., Hartmann P.E., Nathan E., Geddes D., Simmer K. Comparing different methods of human breast milk fortification using measured v. assumed macronutrient composition to target reference growth: a randomised controlled trial. British Journal of Nutrition. 2016. Vol.115. № 3. P. 431–439. doi: 10.1017/S0007114515004614.

39. Rochow N., Landau-Crangle E., Fusch C. Challenges in breast milk fortification for preterminfants. Curr Opin Clin Nutr Metab Care. 2015. Vol.18, № 3. P. 276–284. doi: 10.1097/MCO.0000000000000167.

40. Barness L.A., Mauer A.M., Holliday M.A., Anderson A.S., Dallman P.R., Forbes G.B., et al. Commentary on breast-feeding and infant formulas, including proposed standards for formulas. Pediatrics. 1976. Vol.57, № 2. P.278–285.

41. Pearson F., Johnson M.J., Leaf A.A. Milk osmolality: does it matter? Arch Dis Child Fetal Neonatal Ed. 2013. Vol.98, № 2. P.166–169. doi: 10.1136/adc.2011.300492.

42. Perrella S.L., Hepworth A.R., Simmer K.N., Geddes D.T. Influences of breastmilk composition on gastric emptying in preterm infants. J Pediatr Gastroenterol Nutr. 2015. Vol. 60, № 2. P.264–271. doi: 10.1097/MPG.0000000000000596.

43. Choi A., Fusch G., Rochow N., Fusch C. Target fortification of breast milk: predictingthe final osmolality of the feeds. PLoS ONE. 2016. Vol. 11, № 2. P. 0148941. doi:10.1371/journal.pone.0148941.

44. Rochow N., Jochum F., Redlich A., Korinekova Z., Linnemann K., Weitmann K., et al. Fortification of breast milk in VLBW infants: metabolic acidosis is linked to the composition of fortifiers and altersweight gain and bone mineralization. Clin Nutr. 2010. Vol. 30, № 1. P. 99-105. doi: 10.1016/j.clnu.2010.07.016.

45. Blakeney S., Seale J., Hendrikson H., Whitfield J. Growth faltering in VLBW infants fed breast milk fortified with new sterile liquid fortifier. J Pediatr Gastroenterol Nutr. 2014. Vol. 59, № 5. P.46–47. doi: 10.1097/MPG.0000000000000516.





DOI: https://doi.org/10.24061/2413-4260.VII.1.23.2017.17

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