不同母乳强化方法对早产儿生长发育影响的Meta分析

Effects of different breast milk fortifier methods on growth and development of preterm infants: a meta-analysis

目的评价不同方式母乳强化(human milk fortifier,HMF)喂养对早产儿生长发育的影响。方法计算机检索PubMed、Embase、Clinicaltrial、Cochrane图书馆和中国生物医学文献、中国知网、万方、维普、中华医学期刊全文数据库建库至2022年12月1日收录的文献,纳入研究对象为胎龄<37周、母乳强化喂养的随机对照研究(randomized controlled study,RCT),采用Cochrane偏倚分析工具对纳入文献质量进行评价,应用RevMan5.3软件进行Meta分析,对比个体强化和标准强化、目标强化和调整强化母乳喂养对早产儿体重、身长、头围生长速率,以及支气管肺发育不良、骨质减少、喂养不耐受、坏死性小肠结肠炎的影响。结果共纳入11篇RCT,10篇为中低偏倚,1篇偏倚风险较高。Meta分析结果显示,与标准强化相比,个体强化可提高早产儿体重增长速率(SMD=0.87,95%CI 0.36~1.38,P<0.001),对身长和头围增长速率的影响差异无统计学意义(SMD=0.64,95%CI-0.07~1.34,P=0.08;SMD=0.58,95%CI-0.06~1.22,P=0.08);个体强化可降低喂养不耐受和坏死性小肠结肠炎发生率(RR=0.45,95%CI 0.22~0.89,P=0.02;RR=0.32,95%CI 0.13~0.78,P=0.01),对支气管肺发育不良发生率的影响差异无统计学意义(RR=0.93,95%CI 0.76~1.20,P=0.67)。有2篇RCT比较了目标强化与调整强化早产儿的生长发育指标,但未得到一致结果。仅1篇RCT结果显示目标强化组骨质减少发生率和调整强化组差异无统计学意义(P>0.05)。结论相对于标准强化,个体强化母乳喂养能更好地促进早产儿早期生长发育,但目标强化和调整强化对早产儿生长发育的影响差异不显著。

Objective To evaluate the impact of different methods of human milk fortifier(HMF)on the growth and development of preterm infants.Methods Computer searches were conducted in PubMed,Embase,Clinicaltrials,Cochrane Library,China National Knowledge Infrastructure,Wanfang Data,VIP Database,and China National Full-text Database for biomedical literature from database inception to December 1,2022.The inclusion criteria encompassed randomized controlled studies(RCTs)involving infants with a gestational age of less than 37 weeks who were subjected to HMF.The quality of included studies was assessed using the Cochrane bias analysis tool.Meta-analyses were performed using RevMan 5.3 software to compare individual fortification with standard fortification,targeted fortification with adjusted fortification of breast milk,and their effects on preterm infant weight gain,length,head circumference growth rates,as well as the incidence of bronchopulmonary dysplasia,osteopenia,feeding intolerance,and necrotizing enterocolitis.Results A total of 11 RCTs were included,with 10 having low to moderate bias risk and 1 having a high bias risk.The results of meta-analysis showed that compared to standard fortification,individual fortification led to an increase in the weight gain rate of preterm infants(SMD=0.87,95%CI 0.36-1.38,P<0.001),with no statistically significant differences observed in the effects on length and head circumference growth rates(SMD=0.64,95%CI-0.07-1.34,P=0.08;SMD=0.58,95%CI-0.06-1.22,P=0.08).The incidence of feeding intolerance and necrotizing enterocolitis in the individual intensive group was lower than that in the standard intensive group(RR=0.45,95%CI 0.22-0.89,P=0.02;RR=0.32,95%CI 0.13-0.78,P=0.01),but no statistically significant difference in the incidence of bronchopulmonary dysplasia(RR=0.93,95%CI 0.76-1.20,P=0.67).Only two studies compared targeted fortification with adjusted fortification for growth and development outcomes in preterm infants,but the results were not consistent.Only one RCT showed no statistically significant difference in the incidence of osteopenia between the targeted fortification and adjusted fortification groups.Conclusions Compared with standard fortification,individual intensive breastfeeding appears to promote the early growth and development of preterm infants.However,the effect of targeted and adjustable fortification on the growth and development of preterm infants is not significantly different.