UCL Great Ormond Street Institute of Child Health, London, UK.
University of Missouri-Columbia, Sinclair School of Nursing, Columbia, MO.
Neoreviews. 2022 Aug 1;23(8):e541-e557. doi: 10.1542/neo.23-8-e541.
The field of postdischarge nutrition for preterm infants arose when concerns that using diets suitable for term infants-breastfeeding without fortification or standard formulas-might not meet the postdischarge nutritional needs of infants born preterm, who often exhibited growth restriction and evidence of undernutrition. A decade ago, there were already 27 randomized controlled trials (RCTs) of nutritional supplementation from which an eligible subsample of trials have provided evidence on whether nutritional fortification of human milk or nutrient-enriched formula favorably affects postdischarge growth in these infants. These RCTs also allowed exploration of the quality of growth, bone mineralization, and the ad libitum-fed infant's own regulation of milk volume and nutrient intake. Importantly, such RCTs, augmented by observational data on the links between growth and neurodevelopment, have allowed exploration of the potential impact of postdischarge nutrition on neurocognitive function. However, the interpretation of published data and the implication for practice has proven difficult and contentious. In this review, we examine, and to an extent reanalyze, existing evidence to elucidate its strengths and limitations, with the goal of adding more clarity to the ways in which this sizeable body of clinical scientific research may have a positive impact on the postdischarge nutritional approach to infants born preterm.
早产儿出院后营养领域的出现是因为人们担心，使用适合足月儿的饮食——母乳喂养而不强化或使用标准配方——可能无法满足早产儿出院后的营养需求，这些早产儿往往表现出生长受限和营养不良的迹象。十年前，已经有 27 项营养补充的随机对照试验（RCT），其中一个合格的试验亚组提供了关于人乳强化或营养丰富的配方是否有利于这些婴儿出院后生长的证据。这些 RCT 还允许探索生长质量、骨矿化以及自由喂养婴儿自身对奶量和营养素摄入的调节。重要的是，这些 RCT 以及关于生长与神经发育之间关系的观察数据，允许探索出院后营养对神经认知功能的潜在影响。然而，已发表数据的解释和对实践的影响被证明是困难和有争议的。在这篇综述中，我们检查并在一定程度上重新分析了现有的证据，以阐明其优势和局限性，目的是更清楚地了解这一大规模临床科学研究如何对早产儿出院后营养方法产生积极影响。
