Dodaci masti od ljudskog mlijeka za poticanje rasta nedonoščadi
Abstract
Background
As preterm infants do not experience the nutrient accretion and rapid growth phase of the third trimester of pregnancy, they are vulnerable to postnatal nutritional deficits, including of fat. Consequently, they require higher fat intakes compared to their full term counterparts to achieve adequate growth and development. Human milk fat provides the major energy needs of the preterm infant and also contributes to several metabolic and physiological functions. Although human milk has many benefits for this population, its fat content is highly variable and may be inadequate for their optimum growth and development. This is a 2018 update of a Cochrane Review last published in 2000.
Objectives
To determine whether supplementation of human milk with fat compared with unsupplemented human milk fed to preterm infants improves growth, body composition, cardio‐metabolic, and neurodevelopmental outcomes without significant adverse effects.
Search methods
We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 1), MEDLINE via PubMed (1966 to 08 February 2018), Embase (1980 to 08 February 2018), and CINAHL (1982 to 08 February 2018). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi‐randomised trials.
Selection criteria
Published and unpublished randomised controlled trials were eligible if they used random or quasi‐random methods to allocate preterm infants fed human milk in hospital to supplementation or no supplementation with additional fat.
Data collection and analysis
No new randomised controlled trials matching the selection criteria were found but we extracted data from the previously included trial due to changes in review outcomes from when the protocol was first published. Two reviewers independently abstracted data, assessed trial quality, and the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We planned to perform meta‐analyses using risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, with their respective 95% confidence intervals (CIs). We planned to use a fixed‐effect model and to explore potential causes of heterogeneity via sensitivity analyses.
Main results
One randomised trial involving 14 preterm infants was included. There was no evidence of a clear difference between the fat‐supplemented and unsupplemented groups in in‐hospital rates of growth in weight (MD 0.6 g/kg/day, 95% CI −2.4 to 3.6; 1 RCT, n = 14 infants, very low‐quality evidence), length (MD 0.1 cm/week, 95% CI −0.08 to 0.3; 1 RCT, n = 14 infants, very low‐quality evidence) and head circumference (MD 0.2 cm/week, 95% CI −0.07 to 0.4; 1 RCT n = 14 infants, very low‐quality evidence). There was no clear evidence that fat supplementation increased the risk of feeding intolerance (RR 3.0, 95% CI 0.1 to 64.3; 1 RCT, n = 16 infants, very low‐quality evidence). No data were available regarding the effects of fat supplementation on long‐term growth, body mass index, body composition, neurodevelopmental, or cardio‐metabolic outcomes.
Authors' conclusions
The one included trial suggests no evidence of an effect of fat supplementation of human milk on short‐term growth and feeding intolerance in preterm infants. However, the very low‐quality evidence, small sample size, few events, and low precision diminishes our confidence that these results reflect the true effect of fat supplementation of human milk in preterm infants, and no long‐term outcomes were reported. Further high‐quality research should evaluate the effect on short and long‐term growth, neurodevelopmental and cardio‐metabolic outcomes in the context of the development of multicomponent fortifiers. Optimal dosage, adverse effects, and delivery practices should also be evaluated.
PICO
Plain language summary
Dodaci masti od ljudskog mlijeka za poticanje rasta nedonoščadi
Istraživačko pitanje
U ovom Cochraneovom sustavnom pregledu literature analizirali smo dokaze iz istraživanja u kojima je ispitano da li dodavanje dodatne masti ljudskom mlijeku u prehrani nedonoščadi poboljšava rast, količinu masti u tijelu, pretilost, srčane probleme, visok krvni tlak, i razvoj mozga, bez značajnih nuspojava.
Dosadašnje spoznaje
Prerano rođena djeca pri rođenju imaju manjak masnog tkiva u tijelu. Stoga im je potrebno više masti, u usporedbi s djedom rođenom u terminu, za postizanje odgovarajućeg rasta i razvoja. Mast pruža približno polovicu kalorija u ljudskom mlijeku i podržava rast i razvoj mozga. Iako ljudsko mlijeko ima brojne korisne učinke za prerano rođeno dijete, može sadržavati promjenjive i nedovoljne količine masti za osiguranje odgovarajućeg rasta i razvoja. Nedovoljna opskrba mastima u novorođenčadi koja se hrani ljudskim mlijekom može nepovoljno utjecati na njihov rast i razvoj. Stoga se ljudskom mlijeku može nadodati mast; obično se komercijalno pripremljena mješavina masti dodaje maloj količini (npr. 20 mL) izdojenog mlijeka.
Obilježja uključenih ispitivanja
Uključili smo jedno istraživanje koje sadrži dokaze niske kvalitete; to je istraživanje uključilo samo 14 nedonoščadi. Ovaj Cochrane sustavni pregled obuhvaća istraživanja koja su bili dostupna do veljače 2018.
Ključni rezultati
Dodavanje masti ljudskom mlijeku za hranjenje nedonoščadi nije pokazalo jasne prednosti za kratkotrajno povećanje težine, dužine i rast glave. Nije bilo dokaza da dodatna masnoća povećava rizik od netolerancije na prehranu. Nije bilo podataka koji opisuju učinke dodavanja masti na dugoročni rast, udio masti u tijelu, debljinu, visoku razinu šećera u krvi ili razvoj mozga. Također nije bilo dovoljno podataka za procjenu štetnih učinaka.
Zaključci
Nema dovoljno visoko kvalitetnih dokaza o učincima dodavanja masti ljudskom mlijeku za prehranu nedonoščadi i nisu zabilježeni dugoročni rezultati. Budući da se dodavanje masti ljudskom mlijeku trenutno daje kao dio višestruko pojačane ishrane, buduća istraživanja trebaju istražiti učinak masne komponente na kratkoročni i dugoročni rast, tjelesnu masu, pretilost, visok krvni šećer i razvoj mozga. Također se dodatno treba istražiti koja je ispravna količina i sastav dodatne potrebne masti, nuspojave i najbolji način unosa.
