Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
DBT and Wellcome India Alliance Clinical and Public Health Fellow, Hyderabad, India.
Pediatrics. 2022 Aug 1;150(Suppl 1). doi: 10.1542/peds.2022-057092I.
Iron is needed for growth and development of infants globally, but preterm and low birth weight (LBW) infants are at risk for severe iron deficiencies. To assess the effect of enteral iron supplementation on mortality, morbidity, growth, and neurodevelopment outcomes in preterm or LBW infants fed human milk. Secondary objectives were to assess the effect on biomarkers and dose and timing.
Data sources include PubMed, Embase and Cochrane Library databases to March 16, 2021. Study Selection includes controlled or quasi experimental study designs. Two reviewers independently extracted data.
Eight trials (eleven reports; 1093 participants, 7 countries) were included. No trials reported mortality. At latest follow-up, there was little effect on infection (very low certainty evidence, 4 studies, 401 participants, relative risk [RR] 0.98, 95% confidence interval [95% CI] 0.56 to 1.73, I2 = 0.00%) and necrotising enterocolitis (3 studies, 375 participants, RR 1.47, 95% CI 0.68 to 3.20, I2 = 0.00%). There was an increase in linear growth (length) (moderate certainty evidence, 3 studies, 384 participants, mean difference 0.69 cm, 95% CI 0.01 to 1.37, I2 = 0%) but little effect on weight, head circumference, or cognitive development. There was an improvement in anemia (moderate certainty evidence, 2 studies, 381 participants, RR 0.25, 95% CI 0.10 to 0.62, I2 = 0.00%) but no effect on serum ferritin. Limitations include heterogeneity in the included studies.
There are important benefits for human milk-fed preterm and LBW infants from enteral iron supplementation. However, more randomized control trials are required to improve the certainty of evidence.
铁是全球婴儿生长和发育所必需的，但早产儿和低出生体重（LBW）婴儿有严重缺铁的风险。评估肠内铁补充对母乳喂养早产儿或 LBW 婴儿的死亡率、发病率、生长和神经发育结局的影响。次要目标是评估对生物标志物和剂量及时间的影响。
数据来源包括 PubMed、Embase 和 Cochrane Library 数据库，检索时间截至 2021 年 3 月 16 日。研究选择包括对照或准实验研究设计。两位审查员独立提取数据。
纳入了 8 项试验（11 份报告；1093 名参与者，7 个国家）。没有试验报告死亡率。在最新随访时，感染的影响很小（极低确定性证据，4 项研究，401 名参与者，相对风险 [RR] 0.98，95%置信区间 [95%CI] 0.56 至 1.73，I2 = 0.00%）和坏死性小肠结肠炎（3 项研究，375 名参与者，RR 1.47，95%CI 0.68 至 3.20，I2 = 0.00%）。线性生长（长度）有增加（中等确定性证据，3 项研究，384 名参与者，平均差异 0.69cm，95%CI 0.01 至 1.37，I2 = 0%），但体重、头围或认知发育影响较小。贫血改善（中等确定性证据，2 项研究，381 名参与者，RR 0.25，95%CI 0.10 至 0.62，I2 = 0.00%），但血清铁蛋白无影响。局限性包括纳入研究的异质性。
肠内铁补充对母乳喂养的早产儿和 LBW 婴儿有重要的益处。然而，需要更多的随机对照试验来提高证据的确定性。
