日本新生児成育医学会雑誌　第29巻　第1号　53～58頁（2017年）

日本新生児成育医学会雑誌　29(1)：53-58；2017　

受付日：平成27．08．10

受理日：平成28．05．20

NICU での経管栄養法が母乳中の栄養量に与える影響

Influence of Tube Feeding in the Neonatal Intensive Care Unit on the Nutritional Content of Breast Milk

＊1独立行政法人国立病院機構三重中央医療センター　新生児科／小児科, ＊2同　臨床研究部

＊1Department of Pediatrics and Neonatology, National Hospital Organization Miechuo Medical Center
＊2Clinical Research Institute, National Hospital Organization Mie Chuo Medical Center

佐々木直哉＊1・盆野元紀＊1＊2

Naoya SASAKI＊1，Motoki BONNO＊1＊2

Key Words：nutritional management，tube feeding，human milk fortifier

　経管栄養法が母乳中の栄養量に与える影響の有無を検証した。30mLシリンジに100cm延長チューブと4French40cm栄養チューブをつなぎ，母乳検体を15mL/ 時間または30mL/ 時間かけてシリンジポンプで注入し，注入前および注入後に回収された母乳の栄養素の含有量を測定した。乳糖・蛋白質含有量は，注入前後およびシリンジポンプの向きで変化しなかったが，脂肪含有量は，シリンジポンプ横・下向きの場合，上向きと比べて注入前後で約20％減少した。母乳は約63kcal/dL，脂肪含有率約3.5％なので，シリンジポンプを横・下向きにした場合，上向きと比較して，母乳のカロリーの約10％に相当する約6.3kcal/dL：100（g/dL）×3.5/100×0.20×9（kcal/g）を喪失すると考えられた。

Background：Previous publications have reported lipid loss in breast milk during tube feeding. Objective：The objective was to clarify the influence of tube feeding on the nutritional content of breast milk.
Methods：A 30mL syringe was connected to a 4 French-Gauge nasogastric feeding tube using a 100cm extension tube. After filling the syringe with 15 or 30mL of breast milk, the syringe was positioned on an infusion pump and milk was infused for 1 hour. Lipid concentration was measured using the creamatocrit（ CrCt） technique. CrCt values were measured before and after infusion at the following angles of the syringes：upward, horizontal and downward. Lactose and protein content were also measured before and after infusion at each angle.
Results：The rate of CrCt loss was significantly higher when the angle of the syringe was horizontal or downward than when it was upward（ 15mL：26.9±12.3%, 30.2±13.6% and 8.2±10.3%；30mL：28.3±9.3%, 28.5±8.5% and 10.0±15.0% for horizontal, downward, and upward angles, respectively）. Protein and lactose content did not decrease at any angles of the syringes before and after infusion.
Conclusion：Lipid loss in breast milk was about 20% higher during tube feeding using an infusion pump for 1 hour, and approximately 10% more caloric loss occurred when the angle of the syringe was horizontal or downward than when positioned upward.