网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
早期及晚期母乳强化对早产儿生长发育及并发症影响的Meta分析
作者:戴露  邓洪  胡莉鸿  梁道新  尹琳琳  赵婧 
单位:川北医学院附属医院 新生儿科, 四川 南充 637000
关键词:母乳强化 添加时机 早产儿 生长发育 并发症 Meta分析 
分类号:R722.6
出版年·卷·期(页码):2024·52·第一期(36-145)
摘要:

目的:国内外对于何时添加母乳强化剂的标准尚不统一,本文系统性评价早期母乳强化与晚期母乳强化对早产儿生长发育及并发症的影响。方法:通过检索Cochrane图书馆、Embase、PubMed、Web of Science、维普中文科技期刊数据库、万方资源数据库、中国生物医学文献服务系统、中国知网全文期刊数据库,检索关于早产儿在不同时机添加母乳强化剂的随机对照实验,检索时限为建库至2023年6月,2名研究人员进行数据提取、文献筛选和质量评价,采用 RevMan 5.3软件进行Meta分析。结果:共纳入8篇文献,包括812名早产儿,Meta分析结果显示与晚期母乳强化相比,早期进行母乳强化在早期早产儿体重增长[MD=1.73 g·(kg·d)-1, 95%CI(0.94, 2.52)g·(kg·d)-1, P<0.05]、宫外发育迟缓[RR=0.80,95%CI(0.69,0.93),P<0.05]差异有统计学意义;在身长、头围、喂养不耐受的发生率、新生儿坏死性小肠结肠炎(NEC)的发生率、院内感染的发生率、肠外营养时间、恢复出生体重时间、住院时间的差异无统计学意义。结论:目前的证据显示,早期进行母乳强化可能利于早产儿在早期体重增长和减少宫外发育迟缓发生的概率,但对于身长、头围、喂养不耐受的发生率、新生儿坏死性小肠结肠炎的发生率、院内感染的发生率、肠外营养时间、恢复出生体重时间、住院时间的影响很小或者没有影响。

Objective: When to add human milk fortification is not uniformed at home and abroad. This Meta-analysis evaluated the effects of early and late human milk fortification on the growth and complications of premature infants. Methods: We searched Cochrane Library, Embase, PubMed, Web of Science, VIP, Wanfang Data, CBM,CNKI for randomized controlled trials about early versus delayed human milk fortification in premature infants. The retrieval time was from the establishment of each database to June 2023. Two researchers extracted data and assessed their quality, then used RevMan 5.3 for analysis. Results: We included 8 studies about 812 premature infants. The results of Meta-analysis showed that compared with the late fortification group,the early group of body weight growth rate[mean difference [(MD)=1.73 g·(kg·d)-1, 95%CI(0.94, 2.52) g·(kg·d)-1,P<0.05] extrauterine growth restriction [RR=0.80, 95%CI(0.69,0.93),P<0.05] were statistically significant in the early fortification group. There were no significant difference in body length growth rate, head circumference growth rate, incidence rate of necrotizing enterocolitis, incidence of feeding intolerance, nosocomial infection, parenteral nutrition, hospital stay, days to regain birth weight between the two groups. Conclusion: According to the current evidence, early human milk fortification may be beneficial to the body weight growth of premature infants and reduce the probability of extrauterine growth restriction, but has little or no effect on body length growth rate, head circumference growth rate, incidence rate of necrotizing enterocolitis, incidence of feeding intolerance, nosocomial infection, parenteral nutrition, hospital stay, recovery to birth weight.

参考文献:

[1] 杨小红,储晓彬,朱笑笑,等.母乳喂养咨询门诊的建立与实施效果[J].现代医学,2023,51(2):231-234.
[2] CORMACK B E,EMBLETON N D,VAN GOUDOEVER J B,et al.Comparing apples with apples:it is time for standardized reporting of neonatal nutrition and growth studies[J].Pediatr Res,2016,79(6):810-820.
[3] 蔡威,汤庆娅,王莹,等.中国新生儿营养支持临床应用指南[J].临床儿科杂志,2013,31:1177-1182.
[4] ARSLANOGLU S,BOQUIEN C Y,KING C,et al.Fortification of human milk for preterm infants:update and recommendations of the European Milk Bank Association(EMBA) working group on human milk fortification[J].Front Pediatr,2019,7:76.
[5] YI D Y,KIM S Y.Human breast milk composition and function in human health:from nutritional components to microbiome and microRNAs[J].Nutrients,2021,13(9):3094.
[6] 王茜,韩冬韧,焦颖.母乳及母乳强化剂在早产儿喂养策略及生长发育中作用的研究进展[J].北京医学,2018,40(11):1061-1063.
[7] BROWN J V,LIN L,EMBLETON N D,et al.Multi-nutrient fortification of human milk for preterm infants[J].Cochrane Database Syst Rev,2020,6(6):Cd000343.
[8] BROWN J V,EMBLETON N D,HARDING J E,et al.Multi-nutrient fortification of human milk for preterm infants[J].Cochrane Database Syst Rev,2016(5):Cd000343.
[9] DUTTA S,SINGH B,CHESSELL L,et al.Guidelines for feeding very low birth weight infants[J].Nutrients,2015,7(1):423-442.
[10] ZHU J,DINGESS K A.The functional power of the human milk proteome[J].Nutrients,2019,11(8):1834.
[11] ELIA S,CIARCIÀ M,CINI N,et al.Effect of fortification on the osmolality of human milk[J].Ital J Pediatr,2023,49(1):72.
[12] YAMAKAWA T,ITABASHI K,KUSUDA S.Mortality and morbidity risks vary with birth weight standard deviation score in growth restricted extremely preterm infants[J].Early Hum Dev,2016,92:7-11.
[13] GUPTA V,JOB V,THOMAS N.Effect of fortification and additives on breast milk osmolality[J].Indian Pediatr,2016,53(2):167-169.
[14] ZHANG T,LUO H,WANG H,et al.Association of human milk fortifier and feeding intolerance in preterm infants:a cohort study about fortification strategies in Southwest China[J].Nutrients,2022,14(21):4610.
[15] SHAH S D,NARENDRA DEREDDY M D,JONES T L,et al.Early versus delayed human milk fortification in very low birth weight infants—A randomized controlled trial[J].J Pediatr,2016,174:126-131.e1.
[16] ALIZADEH TAHERI P,SAJJADIAN N,ASGHARYAN FARGI M,et al.Is early breast milk fortification more effective in preterm infants?:a clinical trial[J].J Perinat Med,2017,45(8):953-957.
[17] SULLIVAN S,SCHANLER R J,KIM J H,et al.An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products[J].J Pediatr,2010,156(4):562-567.e1.
[18] 褚锋玮,褚祝飞,周超群.母乳强化剂添加时机对极低出生体质量幼儿生长发育的影响[J].现代实用医学,2021,33(8):1051-1052,1118.
[19] 高琦,张亚娟,田秀英,等.母乳强化剂添加时间对极低出生体质量儿早期生长发育及并发症发生率的影响[J].中华实用儿科临床杂志,2017,32(7):528-531.
[20] 姬婷婷,任文娟,姜泓.早期应用母乳强化剂对极低体质量儿近远期生长发育的效果研究[J].贵州医药,2020,44(3):449-451.
[21] 李文丽.母乳强化剂添加时机对早产低体重儿体格发育和早期发展的影响[J].山西职工医学院学报,2018,28(3):7-10.
[22] 宋宇,周菁鑫,严洁.不同母乳强化时间对低出生体质量早产儿住院期并发症和追赶性生长的影响[J].中国实用护理杂志,2020,36(32):2521-2526.
[23] CLARK R H,THOMAS P,PEABODY J.Extrauterine growth restriction remains a serious problem in prematurely born neonates[J].Pediatrics,2003,111(5 Pt 1):986-990.
[24] LUO D,WAN X,LIU J,et al.Optimally estimating the sample mean from the sample size,median,mid-range,and/or mid-quartile range[J].Stat Methods Med Res,2018,27(6):1785-1805.
[25] WAN X,WANG W,LIU J,et al.Estimating the sample mean and standard deviation from the sample size,median,range and/or interquartile range[J].BMC Med Res Methodol,2014,14:135.
[26] PICCIANO M F.Representative values for constituents of human milk[J].Pediatr Clin North Am,2001,48(1):263-264.
[27] LIN Y H,HSU Y C,LIN M C,et al.The association of macronutrients in human milk with the growth of preterm infants[J].PLoS One,2020,15(3):e0230800.欢迎订阅 欢迎投稿

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 815221 位访问者


 ©《现代医学》编辑部
联系电话:025-83272481;83272479
电子邮件: xdyx@pub.seu.edu.cn

本系统由北京博渊星辰网络科技有限公司设计开发 技术支持电话:010-63361626

苏ICP备09058541