ppharmПедиатрическая фармакологияPediatric pharmacology1727-57762500-3089Издательство «ПедиатрЪ»10.15690/pf.v16i3.2027ppharm-1737Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWОрганизация грудного вскармливания в отделениях реанимации и интенсивной терапии недоношенных детей: дискуссионные вопросыOrganization of breastfeeding in neonatal intensive care units: discussion issueshttps://orcid.org/0000-0002-8717-2539БеляеваИ. А.BelyaevaIrina A.

Беляева Ирина Анатольевна - доктор медицинских наук, профессор РАН, руководитель неонатологической службы ГБУЗ «Морозовская ДГКБ ДЗМ»; профессор кафедры факультетской педиатрии ФГБОУ ВО «РНИМУ им. Н.И. Пирогова».

119049, Москва, 4-й Добрынинский пер., д. 1/9, тел.: +7 (499) 236-31-21

Moscow

irinaneo@mail.ruhttps://orcid.org/0000-0002-2209-7531Намазова-БарановаЛ. С.Namazova-BaranovaLeyla S.

Москва

Moscow

ВолодинН. Н.VolodinNikolai N.

Москва

Moscow

https://orcid.org/0000-0002-8520-2378ПетряйкинаЕ. Е.PetryaykinaElena E.

Москва

Moscow

Морозовская детская городская клиническая больница; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияMorozov Children's City Clinical Hospital; Pirogov Russian National Research Medical UniversityRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Центральная клиническая больница Российской академии наук; Белгородский государственный национальный исследовательский университетРоссияPirogov Russian National Research Medical University; Central Clinical Hospital of the Russian Academy of Sciences; Belgorod State UniversityRussian FederationНациональный медицинский исследовательский центр детской гематологии, онкологии и иммунологии имени Дмитрия РогачёваРоссияDmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and ImmunologyRussian Federation201907092019163152158Copyright © Беляева И.А., Намазова-Баранова Л.С., Володин Н.Н., Петряйкина Е.Е., 20192019Беляева И.А., Намазова-Баранова Л.С., Володин Н.Н., Петряйкина Е.Е.Belyaeva I.A., Namazova-Baranova L.S., Volodin N.N., Petryaykina E.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pedpharma.ru/jour/article/view/1737

Приоритетность обеспечения грудного вскармливания при выхаживании недоношенных младенцев не подвергается сомнению. Для детей, родившихся преждевременно, вскармливание грудным молоком обеспечивает двойной эффект, снижая риск как ближайших, так и отдаленных последствий, связанных с недоношенностью. В этой связи на международном уровне предпринимаются чрезвычайные шаги по поощрению и поддержке вскармливания новорожденных грудным молоком, в том числе в отделениях интенсивной терапии. Собственное молоко матери является первым выбором для кормления недоношенного ребенка. В последние годы обсуждаются проблемы качества и безопасности сцеженного грудного молока — как пастеризованного, так и свежего — для новорожденных пациентов отделений реанимаций и интенсивной терапии. Авторы указывают, что процедуры обработки и условия хранения сцеженного грудного молока существенно различаются, отсутствуют единые критерии его микробиологической безопасности. Все это ограничивает использование сцеженного грудного молока, прежде всего у недоношенных новорожденных. Помимо опасности бактериального инфицирования, в отношении недоношенных младенцев обсуждается риск заражения цитомегаловирусом (ЦМВ) при использовании свежего молока ЦМВ-серопозитивной матери. В обзоре рассматриваются критерии риска инфицирования детей ЦМВ и показания к избирательной обработке грудного молока для инактивации вероятного патогена.

The priority of breastfeeding in the care of premature infants is not in doubt. For preterm babies, breastfeeding provides a dual effect, reducing the risk of both immediate and long-term effects associated with prematurity. In this regard, extraordinary efforts are being made at the international level to promote and support breast-feeding of newborns, including in intensive care units. Mother’s own milk is the first choice for feeding a premature baby. In recent years, the problems of quality and safety of expressed breast milk — both pasteurized and fresh — for newborn patients of intensive care units are discussed. The authors point out that the treatment procedures and storage conditions of expressed breast milk differ significantly; there are no common criteria for its microbiological safety, which limits the use of this unique product, especially in premature infants. In addition to the risk of bacterial infection, the risk of infection with cytomegalovirus (CMV) when using fresh milk from a CMV — seropositive mother is discussed for premature infants. The review examines the criteria for the risk of CMV infection in children and indications for selective treatment of breast milk for inactivation of a probable pathogen.

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The authors declare that there are no conflicts of interest present.