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

A Meta-analysis of the effects of early and late human milk fortification on growth and complications of premature infants

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.