Young Lauren, Embleton Nicholas D, McGuire William
Paediatric Intensive Care Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, West Midlands, UK, B4 6NH.
Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust and University of Newcastle, Richardson Road, Newcastle upon Tyne, UK, NE1 4LP.
Cochrane Database Syst Rev. 2016 Dec 13;12(12):CD004696. doi: 10.1002/14651858.CD004696.pub5.
Preterm infants are often growth-restricted at hospital discharge. Feeding nutrient-enriched formula rather than standard formula to infants after hospital discharge might facilitate 'catch-up' growth and might improve development.
To compare the effects of nutrient-enriched formula versus standard formula on growth and development of preterm infants after hospital discharge.
We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (2016, Issue 8) in the Cochrane Library, MEDLINE, Embase and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; to 8 September 2016), as well as conference proceedings and previous reviews.
Randomised and quasi-randomised controlled trials that compared the effects of feeding nutrient-enriched formula (postdischarge formula or preterm formula) versus standard term formula to preterm infants after hospital discharge .
Two review authors assessed trial eligibility and risk of bias and extracted data independently. We analysed treatment effects as described in the individual trials and reported risk ratios and risk differences for dichotomous data, and mean differences (MDs) for continuous data, with respective 95% confidence intervals (CIs). We used a fixed-effect model in meta-analyses and explored potential causes of heterogeneity by performing sensitivity analyses. We assessed quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
We included 16 eligible trials with a total of 1251 infant participants. Trials were of variable methodological quality, with lack of allocation concealment and incomplete follow-up identified as major potential sources of bias. Trials (N = 11) that compared feeding infants with 'postdischarge formula' (energy density about 74 kcal/100 mL) versus standard term formula (about 67 kcal/100 mL) did not find consistent evidence of effects on growth parameters up to 12 to 18 months post term. GRADE assessments indicated that evidence was of moderate quality, and that inconsistency within pooled estimates was the main quality issue.Trials (N = 5) that compared feeding with 'preterm formula' (about 80 kcal/100 mL) versus term formula found evidence of higher rates of growth throughout infancy (weighted mean differences at 12 to 18 months post term: about 500 g in weight, 5 to 10 mm in length, 5 mm in head circumference). GRADE assessments indicated that evidence was of moderate quality, and that imprecision of estimates was the main quality issue.Few trials assessed neurodevelopmental outcomes, and these trials did not detect differences in developmental indices at 18 months post term. Data on growth or development through later childhood have not been provided.
AUTHORS' CONCLUSIONS: Recommendations to prescribe 'postdischarge formula' for preterm infants after hospital discharge are not supported by available evidence. Limited evidence suggests that feeding 'preterm formula' (which is generally available only for in-hospital use) to preterm infants after hospital discharge may increase growth rates up to 18 months post term.
出院时，早产婴儿往往存在生长受限的情况。出院后给婴儿喂食营养强化配方奶而非标准配方奶，可能有助于“追赶性”生长，并可能改善发育情况。
比较营养强化配方奶与标准配方奶对出院后早产婴儿生长发育的影响。
我们采用了Cochrane新生儿综述小组的标准检索策略。这包括检索Cochrane图书馆中的Cochrane对照试验中心注册库（2016年第8期）、MEDLINE、Embase以及护理及相关健康文献累积索引（CINAHL；截至2016年9月8日），以及会议论文集和以往的综述。
随机和半随机对照试验，比较出院后给早产婴儿喂食营养强化配方奶（出院后配方奶或早产配方奶）与标准足月儿配方奶的效果。
两位综述作者独立评估试验的合格性和偏倚风险，并提取数据。我们按照各个试验中的描述分析治疗效果，对于二分数据报告风险比和风险差异，对于连续数据报告平均差异（MDs）及各自的95%置信区间（CIs）。我们在荟萃分析中使用固定效应模型，并通过进行敏感性分析探索异质性的潜在原因。我们使用推荐分级的评估、制定与评价（GRADE）方法在结局层面评估证据质量。
我们纳入了16项合格试验，共有1251名婴儿参与者。试验的方法学质量参差不齐，缺乏分配隐藏和随访不完整被确定为主要的潜在偏倚来源。比较给婴儿喂食“出院后配方奶（能量密度约74千卡/100毫升）”与标准足月儿配方奶（约67千卡/100毫升）的试验（n = 11），未发现关于足月后12至18个月生长参数影响的一致证据。GRADE评估表明证据质量为中等，汇总估计值内的不一致性是主要的质量问题。比较喂食“早产配方奶（约80千卡/100毫升）”与足月儿配方奶的试验（n = 5），发现整个婴儿期生长率较高的证据（足月后12至18个月的加权平均差异：体重约500克；身长5至10毫米；头围5毫米）。GRADE评估表明证据质量为中等，估计值的不精确性是主要的质量问题。很少有试验评估神经发育结局，这些试验未发现足月后18个月发育指标的差异。未提供关于儿童期后期生长或发育的数据。
现有证据不支持出院后给早产婴儿开“出院后配方奶”的建议。有限的证据表明，出院后给早产婴儿喂食“早产配方奶”（通常仅在医院内使用）可能会提高足月后18个月的生长率。
