母乳添加脂肪補充劑促進早產兒生長
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Published and unpublished randomised controlled trials were eligible if they used random or quasi‐random methods to allocate preterm infants fed human milk in hospital to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
母乳添加脂肪補充劑促進早產兒生長
文獻回顧問題
我們對研究證據進行回顧，以確認在母乳中額外添加脂肪(補充劑)對於早產兒而言，是否可助於生長、體脂肪，肥胖，心臟問題，高血糖和大腦發育且無其他明顯的副作用。
背景
胎兒在第三孕期為生長最快速的時候，同時也於出生前儲存營養。早產兒由於無完整孕期，因此出生時其身體容易缺乏足夠的脂肪量。 因此，與足月嬰兒相比，早產兒需要更高的脂肪攝取量以達到充分的生長及發育。母乳內的脂肪提供約一半的熱量來源，並能促進嬰兒生長及其大腦發育。雖然母乳對於早產兒而言有許多好處，但母乳可能由於其脂肪量不足，而無法促進早產兒達到充分的生長及發育。若以脂肪量不足的母乳哺育的早產兒，可能會對其生長及發育產生不利影響。因此，需額外添加脂肪於母乳中(通常會將少量商業製備的脂肪混合物（例如20毫升）。
研究特性
我們納入了一個證據等級非常低的臨床試驗，其含14位早產兒。此文獻回顧之證據搜集截至2018年2月。
主要成果
對於早產兒而言，在母乳中添加額外脂肪對於其短期體重增加率、身長增加率及頭圍生長率無明顯益處。沒有證據顯示額外脂肪會增加哺餵耐受不良的風險。沒有關於額外添加脂肪對於長期生長，體脂肪，肥胖，高血糖或大腦發育影響的數據。評估副作用的數據也非常有限。
結論
目前尚無足夠的高品質證據證實在母乳中額外添加脂肪對於早產兒之益處與害處，另外尚無長期追蹤的研究報告。 目前額外添加脂肪在母乳的試驗中，其脂肪為綜合強化營養素之其中一部份，未來的試驗應評估脂肪成分對於短期及長期生長，體脂肪，肥胖，高血糖或大腦發育的影響。且應更進一步評估額外添加的脂肪之合適計量及組成、副作用和給予方式。
