益生菌和治疗添加剂对巴氏消毒供体母乳渗透压的影响

摘要(中文译文)

本研究旨在探讨巴氏消毒捐赠人乳（PDHM）在添加益生菌及新生儿常用添加剂后渗透压的变化。由一名对研究中所用益生菌和添加剂不知情的技术人员，使用校准渗透压仪在10分钟时测定PDHM的渗透压。在5 mL PDHM中加入四种不同益生菌及常用添加剂后测定渗透压，添加剂包括咖啡因、头孢氨苄、多潘立酮、埃索美拉唑、氟康唑、呋塞米、布洛芬、兰索拉唑、左乙拉西坦、对乙酰氨基酚、苯巴比妥、西地那非和熊去氧胆酸，均以治疗剂量分别给药。口服碘化非离子型造影剂（Omnipaque）与无菌水按1：2和1：4稀释后测定渗透压。计算为使渗透压保持在欧洲儿科胃肠病学、肝病学和营养学会（ESPGHAN）推荐的450 mOsm/kg以下，每种添加剂所需加入的PDHM体积。PDHM的平均渗透压为256 mOsm/kg，与大多数添加剂复配后超过450 mOsm/kg。纯添加剂的渗透压范围为161至>2000 mOsm/kg。除咖啡因、头孢氨苄、埃索美拉唑、氟康唑、呋塞米、兰索拉唑和西地那非外，大多数添加剂均使PDHM渗透压显著升高至超过推荐的450 mOsm/kg。益生菌引起的渗透压升高幅度最大，达1723 mOsm/kg（范围260-1723 mOsm/kg）。多潘立酮、布洛芬、左乙拉西坦、对乙酰氨基酚、苯巴比妥和熊去氧胆酸使渗透压升高至超过450 mOsm/kg。碘化非离子型造影剂（Omnipaque）与无菌水按1：4比例稀释后渗透压为461 mOsm/kg。向PDHM中添加益生菌会升高渗透压，需要适当稀释以维持在推荐的450 mOsm/kg以下。多潘立酮、布洛芬、左乙拉西坦、对乙酰氨基酚、苯巴比妥和熊去氧胆酸等治疗性添加剂也会升高PDHM的渗透压，需要适当稀释。未来研究应侧重于开发渗透压更低的益生菌和添加剂，以提高新生儿的安全性。

Abstract

This study aims to examine changes in the osmolality of pasteurized donor human milk (PDHM) following the addition of probiotics and commonly used neonatal additives. The osmolality of PDHM was measured at 10 minutes using a calibrated osmometer by a technician blinded to the probiotics and additives used in the study. The osmolality of 5 mL of PDHM was measured after the addition of four different probiotics and commonly used additives, including caffeine, cephalexin, domperidone, esomeprazole, fluconazole, furosemide, ibuprofen, lansoprazole, levetiracetam, paracetamol, phenobarbitone, sildenafil, and ursodeoxycholic acid, administered separately in therapeutic doses. The osmolality of the oral iodinated non-ionic contrast agent (Omnipaque) was measured after 1:2 and 1:4 dilution with sterile water. The volume of PDHM required to be added to each additive to keep the osmolality below 450 mOsm/kg, as recommended by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), was calculated. The mean osmolality of PDHM was 256 mOsm/kg, which, on reconstitution with most additives, exceeded 450 mOsm/kg. The osmolality of pure additives ranged from 161 to >2000 mOsm/kg. There was a significant increase in the osmolality of PDHM beyond the recommended 450 mOsm/kg with most additives, except caffeine, cephalexin, esomeprazole, fluconazole, furosemide, lansoprazole, and sildenafil. A maximum increase in osmolality to 1723 mOsm/kg (range 260-1723 mOsm/kg) was observed with probiotics. Domperidone, ibuprofen, levetiracetam, paracetamol, phenobarbitone, and ursodeoxycholic acid increased the osmolality beyond 450 mOsm/kg. The osmolality of the iodinated non-ionic contrast agent (Omnipaque), when diluted with sterile water in a 1:4 ratio, was 461 mOsm/kg. The addition of probiotics to PDHM increases osmolality and requires appropriate dilution to maintain levels below the recommended 450 mOsm/kg. Therapeutic additives such as domperidone, ibuprofen, levetiracetam, paracetamol, phenobarbitone, and ursodeoxycholic acid also increase the osmolality of PDHM and require appropriate dilution. Future research should focus on developing probiotics and additives with lower osmolality to improve safety in neonates.

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