Calcium and phosphorus supplementation of human milk for preterm infants

Jane E Harding; Jess Wilson; Julie Brown

doi:10.1002/14651858.CD003310.pub2

Cochrane Database of Systematic Reviews

Leche materna con suplemento de calcio y fósforo para lactantes prematuros

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DOI:

https://doi.org/10.1002/14651858.CD003310.pub2 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

26 febrero 2017see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Neonatología

Copyright:

Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

Jane E Harding

Correspondencia a: Liggins Institute, The University of Auckland, Auckland, New Zealand

[email protected]
Jess Wilson

Liggins Institute, The University of Auckland, Auckland, New Zealand
Julie Brown

Liggins Institute, The University of Auckland, Auckland, New Zealand

Contributions of authors

Jane Harding was an author of the original version of this review. She contributed to the update, interpreted results and provided feedback on versions throughout the process.

Julie Brown was responsible for preparation of drafts of the updated review in 2016. She conducted study selection and data extraction and double‐checked data entry.

Jess Wilson conducted study selection and data extraction and double‐checked data entry.

Sources of support

Internal sources

National Women's Hospital, Auckland, New Zealand.
University of Auckland, Auckland, New Zealand.

External sources

Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA.

Editorial support of the Cochrane Neonatal Review Group has been Federally funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, USA, under Contract No. HHSN275201600005C
National Institute for Health Research, UK.

Editorial support for Cochrane Neonatal has been funded by a UK National Institute of Health Research Grant (NIHR) Cochrane Programme Grant (13/89/12). The views expressed in this publication are those of the review authors and are not necessarily those of the NHS, the NIHR or the UK Department of Health

Declarations of interest

None known.

Acknowledgements

We would like to acknowledge the contributions of Carl Kuschel and Vazhkudai S Kumaran to the first version of this review in 2001 (Kuschel 1998).

Version history

Published

Title

Stage

Authors

Version

2017 Feb 26

Calcium and phosphorus supplementation of human milk for preterm infants

Review

Jane E Harding, Jess Wilson, Julie Brown

https://doi.org/10.1002/14651858.CD003310.pub2

2001 Oct 23

Calcium and phosphorus supplementation of human milk for preterm infants

Review

Carl A Kuschel, Jane E Harding, Vazhkudai S Kumaran

https://doi.org/10.1002/14651858.CD003310

Differences between protocol and review

We have updated the text of this review to reflect new methods of reporting for Cochrane reviews and have included the GRADE assessment and summary of findings Table for the main comparison. We have expanded methodological aspects of the review as per standard Cochrane Neonatal Review Group procedure.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans; Infant, Newborn;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Study flow diagram (2016).

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 1 Weight (g).

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Analysis 1.2

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 2 Length (cm).

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Analysis 1.3

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 3 Head circumference (cm).

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Analysis 1.4

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 4 Serum alkaline phosphatase.

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Analysis 1.5

Comparison 1 Calcium supplementation versus no calcium supplementation, Outcome 5 Osteopenia.

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Summary of findings for the main comparison. Calcium supplementation compared with no calcium supplementation for preterm infants

Calcium supplementation compared with no calcium supplementation for preterm infants
Patient or population: preterm hospitalised infants Setting: hospital setting Intervention: calcium and/or phosphorus supplementation Comparison: no supplement
Outcomes	*Anticipated absolute effects (95% CI)**		Relative effect (95% CI)	Number of participants (studies)	Quality of the evidence (GRADE)	Comments
Outcomes	Risk with no calcium/phosphorus supplementation	Risk with calcium/phosphorus supplementation	Relative effect (95% CI)	Number of participants (studies)	Quality of the evidence (GRADE)	Comments
Weight (g) ‐ weight at 6 weeks	Mean weight (g) ‐ weight at 6 weeks was 2483 g	MD 138.5 g higher (82.16 lower to 359.16 higher)	‐	40 (1 RCT)	⊕⊕⊝⊝ Low^a,b
Length (cm) ‐ length at 6 weeks	Mean length (cm) ‐ length at 6 weeks was 47.04 cm	MD 0.77 cm higher (0.93 lower to 2.47 higher)	‐	40 (1 RCT)	⊕⊕⊝⊝ Low^a,c
Head circumference (cm) ‐ head circumference at 6 weeks	Mean head circumference (cm) ‐ head circumference at 6 weeks was 34.31 cm	MD 0.33 cm higher (0.3 lower to 0.96 higher)	‐	40 (1 RCT)	⊕⊕⊝⊝ Low^a,c
Bone fracture (neonatal) ‐ not measured	‐	‐	‐	‐	‐	This was not a prespecified outcome; included study did not report this outcome
Growth (childhood/adulthood) ‐ not measured	‐	‐	‐	‐	‐	Included study provided no follow‐up into childhood
Bone mineral density (infant/childhood/adulthood) ‐ not measured	‐	‐	‐	‐	‐	Included study provided no follow‐up into childhood
Fracture (childhood/adulthood) ‐ not measured	‐	‐	‐	‐	‐	Included study provided no follow‐up into childhood
*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI) CI: confidence interval; OR: odds ratio; RR: risk ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to the estimate of effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^aRisk of bias: insufficient evidence to judge methods of randomisation, allocation concealment or blinding of personnel ‐ downgraded one level ^bImprecision: wide confidence intervals and data from a single small study ‐ downgraded one level ^cImprecision: evidence from a single small study ‐ downgraded one level

Summary of findings for the main comparison. Calcium supplementation compared with no calcium supplementation for preterm infants

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Comparison 1. Calcium supplementation versus no calcium supplementation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Weight (g) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Weight at 2 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	52.5 [‐155.44, 260.44]
1.2 Weight at 4 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	60.00 [‐151.39, 271.39]
1.3 Weight at 6 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	138.5 [‐82.16, 359.16]
2 Length (cm) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 Length at 2 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	0.34 [‐1.36, 2.04]
2.2 Length at 4 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	0.47 [‐1.20, 2.14]
2.3 Length at 6 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	0.77 [‐0.93, 2.47]
3 Head circumference (cm) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 Head circumference at 2 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	0.19 [‐0.42, 0.80]
3.2 Head circumference at 4 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	0.22 [‐0.39, 0.83]
3.3 Head circumference at 6 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	0.33 [‐0.30, 0.96]
4 Serum alkaline phosphatase Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.1 Serum ALP at 2 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	‐36.35 [‐91.14, 18.44]
4.2 Serum ALP at 4 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	‐34.90 [‐81.23, 11.43]
4.3 Serum ALP at 6 weeks	1	40	Mean Difference (IV, Fixed, 95% CI)	‐56.85 [‐101.27, ‐12.43]
5 Osteopenia Show forest plot	1	40	Risk Ratio (M‐H, Fixed, 95% CI)	0.62 [0.33, 1.15]

Comparison 1. Calcium supplementation versus no calcium supplementation

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Leche materna con suplemento de calcio y fósforo para lactantes prematuros

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