Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children of the Ministry of Education, Sichuan University, Chengdu, Sichuan, China.
Arch Dis Child Fetal Neonatal Ed. 2019 Mar;104(2):F128-F136. doi: 10.1136/archdischild-2017-314205. Epub 2018 Jun 15.
To summarise current evidence evaluating the effects of human milk on the risk of bronchopulmonary dysplasia (BPD) in preterm infants.
We searched for studies on human milk and BPD in English and Chinese databases on 26 July 2017. Furthermore, the references of included studies were also screened. The inclusion criteria in this meta-analysis were the following: (1) preterm infants (<37 weeks); (2) human milk; (3) comparing with formula feeding; (4) the outcome included BPD; and (5) the type of study was randomised controlled trial (RCT) or cohort study.
A total of 17 cohort studies and 5 RCTs involving 8661 preterm infants met our inclusion criteria. The ORs and 95% CIs of six groups were as follows: 0.78 (0.68 to 0.88) for exclusive human milk versus exclusive formula group, 0.77 (0.68 to 0.87) for exclusive human milk versus mainly formula group, 0.76 (0.68 to 0.87) for exclusive human milk versus any formula group, 0.78 (0.68 to 0.88) for mainly human milk versus exclusive formula group, 0.83 (0.69 to 0.99) for mainly human milk versus mainly formula group and 0.82 (0.73 to 0.93) for any human milk versus exclusive formula group. Notably, subgroup of RCT alone showed a trend towards protective effect of human milk on BPD but no statistical significance.
Both exclusive human milk feeding and partial human milk feeding appear to be associated with lower risk of BPD in preterm infants. The quality of evidence is low. Therefore, more RCTs of this topic are needed.
总结目前评估人乳对早产儿支气管肺发育不良（BPD）风险影响的证据。
我们于 2017 年 7 月 26 日在英文和中文数据库中搜索了关于人乳和 BPD 的研究，并对纳入研究的参考文献进行了筛选。本荟萃分析的纳入标准如下：（1）早产儿（<37 周）；（2）人乳；（3）与配方奶喂养比较；（4）结局包括 BPD；（5）研究类型为随机对照试验（RCT）或队列研究。
共有 17 项队列研究和 5 项 RCT 纳入了 8661 名早产儿，符合我们的纳入标准。6 组的 OR 值和 95%CI 如下：纯人乳组与纯配方奶组相比为 0.78（0.68 至 0.88），纯人乳组与主要配方奶组相比为 0.77（0.68 至 0.87），纯人乳组与任何配方奶组相比为 0.76（0.68 至 0.87），主要人乳组与纯配方奶组相比为 0.78（0.68 至 0.88），主要人乳组与主要配方奶组相比为 0.83（0.69 至 0.99），任何人乳组与纯配方奶组相比为 0.82（0.73 至 0.93）。值得注意的是，仅 RCT 的亚组显示人乳对 BPD 的保护作用有下降趋势，但无统计学意义。
纯人乳喂养和部分人乳喂养似乎都与早产儿 BPD 风险降低有关。证据质量较低。因此，需要更多的关于这个主题的 RCT。
