McGuire W, Anthony M Y
Tayside Institute of Child Health, Ninewells Hospital and Medical School, Dundee, UK, DD1 9SY.
Cochrane Database Syst Rev. 2001(4):CD002971. doi: 10.1002/14651858.CD002971.
Term (mature) human breast milk, compared with artificial formula milks, may provide insufficient nutrition for growth and development in preterm or low birth weight infants. However, human milk may confer advantages to infants in terms of a decreased incidence of adverse outcomes.
To determine if formula milk compared with term human breast milk leads to improved growth and development without significant adverse effects in low birth weight or preterm infants.
The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE and previous reviews including cross references.
Randomised controlled trials comparing feeding with formula milk versus term human milk in low birth weight or preterm infants.
Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk, risk difference and weighted mean difference.
Six trials, all initiated more than 20 years ago, fulfilled the pre-specified inclusion criteria. Four small trials compared feeding with standard calorie formula milk versus unfortified term human milk. Two trials compared feeding with calorie-enriched formula milk versus unfortified term human milk. No trials comparing feeding with formula milk versus nutrient-fortified term human milk were found. Only one trial reported longer term follow up of growth and development. In preterm and low birth weight infants, enteral feeding with formula milk compared with unfortified term human milk resulted in a greater rate of growth in the short term. We did not find a statistically significant difference in the incidence of necrotising enterocolitis, but this was evaluated as a pre-defined outcome in only one trial. The single trial that evaluated longer-term outcomes did not find evidence of an effect on longer-term growth and neurodevelopment.
REVIEWER'S CONCLUSIONS: In preterm and low birth weight infants, feeding with formula milk, compared with unfortified term human milk, leads to a greater rate of growth in the short term. The limited data available do not allow definite conclusions on whether adverse outcomes, including necrotising enterocolitis, are increased in infants who receive formula milk compared with term human milk. There are no data from randomised trials on the comparison of feeding with formula milk versus nutrient-fortified breast milk. This limits the implications for practice of this review as nutrient fortification of breast milk is now a common practice in neonatal care. Future trials may compare growth, development and adverse outcomes in infants who receive adapted "preterm" formula milks versus nutrient-fortified human breast milk.
与人工配方奶相比，足月（成熟）人乳可能无法为早产或低出生体重婴儿的生长发育提供足够的营养。然而，人乳在降低不良结局发生率方面可能对婴儿具有优势。
确定与足月人乳相比，配方奶喂养是否能使低出生体重或早产婴儿生长发育更好且无显著不良影响。
采用Cochrane新生儿综述小组的标准检索策略。这包括对Cochrane对照试验注册库、MEDLINE、EMBASE以及以往综述（包括交叉参考文献）进行电子检索。
比较低出生体重或早产婴儿配方奶喂养与足月人乳喂养的随机对照试验。
使用Cochrane新生儿综述小组的标准方法提取数据，每位作者分别评估试验质量和提取数据，并使用相对风险、风险差值和加权均数差值进行数据合成。
六项试验均在20多年前启动，符合预先设定的纳入标准。四项小型试验比较了标准热量配方奶喂养与未强化的足月人乳喂养。两项试验比较了高热量配方奶喂养与未强化的足月人乳喂养。未发现比较配方奶喂养与营养强化足月人乳喂养的试验。只有一项试验报告了对生长发育的长期随访。在早产和低出生体重婴儿中，与未强化的足月人乳相比，配方奶肠内喂养在短期内导致更高的生长速率。我们未发现坏死性小肠结肠炎发生率有统计学显著差异，但仅在一项试验中将其作为预先定义的结局进行了评估。评估长期结局的单一试验未发现对长期生长和神经发育有影响的证据。
在早产和低出生体重婴儿中，与未强化的足月人乳相比，配方奶喂养在短期内导致更高的生长速率。现有有限数据无法就接受配方奶喂养的婴儿与足月人乳喂养的婴儿相比不良结局（包括坏死性小肠结肠炎）是否增加得出明确结论。没有关于配方奶喂养与营养强化母乳比较的随机试验数据。这限制了本综述对实践的影响，因为母乳营养强化目前在新生儿护理中是常见做法。未来试验可比较接受适应性“早产”配方奶喂养的婴儿与营养强化人乳喂养的婴儿的生长、发育和不良结局。
