Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Indian Pediatr. 2021 Mar 15;58(3):253-258. Epub 2021 Jan 2.
Off-label fortification of expressed human milk (HM) with infant milk formula (IMF) is common in developing countries, though its benefits and safety are unclear.
To study the effects of IMF fortification of HM on growth of very low birth weight (VLBW) preterm infants.
Systematic review and meta-analysis of randomized and quasi-randomized controlled trials (RCTs).
MEDLINE, EMBASE, CINAHL, CENTRAL and other databases were searched for articles published in English language from inception to December 2019, evaluating the effects of HM fortified with IMF as intervention, compared to unfortified HM or HM fortified with human milk fortifier (HMF).
Five RCTs including 423 VLBW preterm infants.
Feeding with HM fortified with IMF compared to unfortified or HMF-fortified HM.
Primary outcome measure was assessment of growth as weight, length and head circumference (HC) gain velocity. Secondary outcome measures were incidences of feed intolerance (FI), necrotizing enterocolitis (NEC), time to reach full feeds, concentration of nutritional biomarkers, duration of hospital-stay and cost of intervention.
Of the five studies included in the review, pooled effects regarding weight gain velocity (SMD 0.27 g/day; 95% CI 0.08 to 0.62), length gain (MD 0.07cm/week; 95% CI 0.02 to 0.16) and HC gain (MD 0.05 cm/wk; 95% CI 0.01 to 0.11), were not statistically significant. Sensitivity analysis by pooling studies using unfortified milk as comparator yielded a statistically significant result for all growth parameters. Risk of FI or NEC was comparable. Length of hospitalstay was reduced in the intervention group.
A very-low quality evidence suggested that IMF fortification of HM is superior to unfortified milk and may be a safe alternative for HMF for short term growth of VLBW preterm infants.
在发展中国家，将婴儿配方奶粉（IMF）添加到母乳中是一种常见的做法，但它的益处和安全性尚不清楚。
研究添加 IMF 对极低出生体重（VLBW）早产儿生长的影响。
对随机和半随机对照试验（RCT）进行系统评价和荟萃分析。
从开始到 2019 年 12 月，在 MEDLINE、EMBASE、CINAHL、CENTRAL 和其他数据库中搜索以英文发表的文章，评估以添加 IMF 的母乳作为干预措施的效果，与未添加 IMF 的母乳或添加人乳强化剂（HMF）的母乳进行比较。
5 项 RCT 共纳入 423 例 VLBW 早产儿。
与未添加或添加 HMF 的母乳相比，用添加 IMF 的母乳进行喂养。
评估生长速度，包括体重、身长和头围（HC）增加速度。次要结局测量指标包括喂养不耐受（FI）、坏死性小肠结肠炎（NEC）的发生率、达到全肠喂养的时间、营养生物标志物的浓度、住院时间和干预成本。
在纳入的五项研究中，体重增加速度（SMD 0.27g/天；95%CI 0.08 至 0.62）、身长增加（MD 0.07cm/周；95%CI 0.02 至 0.16）和 HC 增加（MD 0.05cm/周；95%CI 0.01 至 0.11）的汇总效果均无统计学意义。对使用未添加 IMF 的母乳作为对照组的研究进行敏感性分析，所有生长参数的结果均具有统计学意义。FI 或 NEC 的风险相似。干预组的住院时间缩短。
极低质量证据表明，IMF 添加到母乳中比未添加 IMF 的母乳更优越，并且可能是 HMF 的短期替代物，可促进 VLBW 早产儿的生长。
