Penambahan lemak kepada susu ibu untuk menggalakkan pertumbuhan bayi pramatang
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Published and unpublished randomised controlled trials were eligible if they used random or quasi‐random methods to allocate preterm infants fed human milk in hospital to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
Penambahan lemak kepada susu ibu untuk menggalakkan pertumbuhan bayi pramatang
Soalan ulasan
Kami mengulas bukti untuk menentukan samada penambahan lemak (suplemen) kepada susu ibu yang diberikan kepada bayi pramatang berbanding tiada penambahan lemak meningkatkan pertumbuhan, lemak badan, obesiti, masalah jantung, gula tinggi dalam darah, dan perkembangan otak, tanpa meninggalkan kesan sampingan yang ketara.
Latar belakang
Bayi pramatang semasa dilahirkan kekurangan simpanan lemak yang mencukupi kerana mereka dilahirkan sebelum simpanan nutrien pada fasa pertumbuhan pesat di trimester ketiga kehamilan berlaku. Akibatnya, mereka memerlukan pengambilan lemak yang lebih tinggi berbanding mereka yang cukup bulan untuk mencapai pertumbuhan dan perkembangan yang mencukupi. Lemak menyumbang kira‐kira separuh daripada kalori dalam susu ibu dan menyokong pertumbuhan dan perkembangan otak. Walaupun susu ibu mempunyai banyak faedah untuk bayi pramatang, susu mungkin mengandungi variabel dan kuantiti lemak yang tidak mencukupi untuk pertumbuhan dan perkembangan. Kekurangan bekalan lemak kepada bayi pramatang yang diberikan susu ibu boleh menjejaskan pertumbuhan dan perkembangan mereka. Oleh itu, lemak tambahan boleh ditambah ke dalam susu ibu, biasanya dengan menambah campuran lemak yang telah disiapkan secara komersial ke dalam sejumlah kecil (contohnya 20 mL) susu perahan.
Ciri‐ciri kajian
Kami telah memasukkan satu kajian dengan bukti berkualiti sangat rendah dan yang melibatkan 14 bayi pramatang. Carian terkini adalah sehingga Februari 2018.
Keputusan utama
Penambahan lemak tambahan kepada susu ibu untuk bayi pramatang tidak menunjukkan kebaikan dalam jangka pendek secara jelas terhadap kadar pertambahan berat badan, pertambahan panjang, dan tumbesaran kepala. Tiada bukti bahawa lemak tambahan meningkatkan risiko tak tolerans terhadap susu. Tiada data yang tersedia mengenai kesan penambahan lemak tambahan terhadap pertumbuhan jangka panjang, lemak badan, obesiti, gula tinggi dalam darah, atau perkembangan otak. Data juga terhad dalam menilai kesan sampingan.
Kesimpulan
Tidak ada bukti berkualiti tinggi yang mencukupi mengenai manfaat dan bahaya penambahan lemak tambahan pada susu manusia terhadap bayi pramatang, dan tiada hasil jangka panjang yang dilaporkan. Oleh kerana penambahan lemak tambahan pada susu ibu kini dilakukan sebagai sebahagian daripada penguatan pelbagai nutrien, kajian‐kajian masa depan harus menilai kesan komponen lemak terhadap pertumbuhan jangka pendek dan jangka panjang, lemak badan, obesiti, gula tinggi dalam darah, atau perkembangan otak. Jumlah dan komposisi lemak tambahan yang diperlukan secara tepat, kesan sampingan, dan amalan bersalin juga harus dinilai.
