Организация грудного вскармливания в отделениях реанимации и интенсивной терапии недоношенных детей: дискуссионные вопросы

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.

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