供体人乳对极低出生体重儿住院时间的影响：系统评价和荟萃分析。
The effect of donor human milk on the length of hospital stay in very low birthweight infants: a systematic review and meta-analysis.
机构信息
Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China.
Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
出版信息
Int Breastfeed J. 2020 Oct 28;15(1):89. doi: 10.1186/s13006-020-00332-6.
BACKGROUND
Donor human milk (DHM) is an alternative to preterm infant formula if the mother's own milk is not available. Since the lactation period and preservation treatment of DHM are different from those of mother's own milk, we aimed to determine the reduction in the length of hospital stay by DHM compared to preterm infant formula.
METHODS
In this systematic review, we searched PubMed/MEDLINE, EMBASE, and the Cochrane Library to retrieve studies on the impact of DHM on the clinical outcomes of preterm infants published before 1 November 2019. The study included very low birthweight (VLBW) infants taking either DHM or infant formula with data on the length of hospital stay. Data were analysed using Review Manager 5.3 software.
RESULTS
The literature search yielded 136 articles, and four randomised controlled trials (RCTs) and eight observational studies met the inclusion criteria. A meta-analysis of the RCTs (N = 725) showed no reduction in the length of hospital stay in both the DHM and infant formula groups (- 0.22 days; 95% CI -6.38, 5.95 days), whereas that of the eight observational studies (N = 2496) showed a significant reduction in the length of hospital stay in the DHM group (- 11.72 days; 95% CI -22.07, - 1.37 days). A subgroup analysis of the RCTs revealed that the incidence of necrotising enterocolitis (NEC) was significantly lower in the DHM group when the analysis included high-quality RCTs (RR = 0.32; 95% CI 0.15, 0.69).
CONCLUSIONS
This systematic review of RCTs showed that DHM neither prolonged nor shortened the length of hospital stay in VLBW infants compared to preterm infant formula; however, it reduced the incidence of NEC, further validating the protective role of DHM in the health and safety of VLBW infants.
背景
如果母亲自身的乳汁无法获得，捐赠人乳（DHM）是早产儿配方奶粉的替代物。由于 DHM 的泌乳期和保存处理与母亲自身的乳汁不同，我们旨在确定与早产儿配方奶粉相比，DHM 可缩短住院时间。
方法
在本次系统评价中，我们检索了 PubMed/MEDLINE、EMBASE 和 Cochrane 图书馆，以检索 2019 年 11 月 1 日之前发表的关于 DHM 对早产儿临床结局影响的研究。该研究纳入了接受 DHM 或婴儿配方奶粉的极低出生体重（VLBW）婴儿，且有关于住院时间的数据。使用 Review Manager 5.3 软件进行数据分析。
结果
文献检索得到 136 篇文章，有 4 项随机对照试验（RCT）和 8 项观察性研究符合纳入标准。对 RCT （N=725）的荟萃分析显示，DHM 组和婴儿配方奶粉组的住院时间均无缩短（-0.22 天；95%CI-6.38，5.95 天），而 8 项观察性研究（N=2496）的荟萃分析显示，DHM 组的住院时间明显缩短（-11.72 天；95%CI-22.07，-1.37 天）。RCT 的亚组分析显示，当分析包括高质量 RCT 时，DHM 组的坏死性小肠结肠炎（NEC）发生率显著降低（RR=0.32；95%CI 0.15，0.69）。
结论
本次对 RCT 的系统评价显示，与早产儿配方奶粉相比，DHM 既不会延长也不会缩短 VLBW 婴儿的住院时间；然而，它降低了 NEC 的发生率，进一步证实了 DHM 在保护 VLBW 婴儿健康和安全方面的作用。
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