The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia.
Harvard College, Cambridge, Massachusetts.
Pediatrics. 2022 Aug 1;150(Suppl 1). doi: 10.1542/peds.2022-057092G.
Fast feed advancement may reduce hospital stay and infection but may increase adverse outcomes in preterm and low birth weight infants. The objective of this study was to assess effects of fast feed advancement (≥30 ml/kg per day) compared with slow feed advancement (<30 ml/kg per day) in preterm and low birth weight infants.
Data sources include Medline, Scopus, Web of Science, CINAHL, and Index Medicus through June 30, 2021. Randomized trials were selected. Primary outcomes were mortality, morbidity, growth, and neurodevelopment. Data were extracted and pooled using random-effects models. The Cochrane Risk of Bias 2 tool was used.
A total of 12 RCTs with 4291 participants were included. At discharge, there was moderate certainty evidence that fast advancement likely slightly reduces the risk of: mortality (relative risk [RR] 0.93, 95% confidence interval [95% CI] 0.73 to 1.18, I2 = 18%, 11 trials, 4132 participants); necrotizing enterocolitis (RR 0.89, 95% CI 0.68 to 1.15, I2 = 0%, 12 trials, 4291 participants); sepsis (RR 0.92, 95% CI 0.83 to 1.03, I2 = 0%, 9 trials, 3648 participants); and feed intolerance (RR 0.92, 95% CI 0.77 to 1.10, I2 = 0%, 8 trials, 1114 participants). Fast feed advancement may also reduce the risk of apnea (RR 0.72, 95% CI 0.47 to 1.12, I2 = 0%, low certainty, 2 trials, 153 participants). Fast feed advancement decreases time to regain birth weight (mean difference [MD] -3.69 days, 95% CI -4.44 to -2.95, I2 = 70%, high certainty, 6 trials, 993 participants,) and likely reduces the duration of hospitalization (MD -3.08 days, 95% CI -4.34 to -1.81, I2 = 77%, moderate certainty, 7 trials, 3864 participants). Limitations include heterogeneity between studies and small sample sizes.
Fast feed advancement reduces time to regain birth weight and likely reduces the length of hospital stay; it also likely reduces the risk of neonatal morbidity and mortality slightly. However, it may increase the risk of neurodevelopmental disability slightly. More studies are needed to understand the long-term effects of fast feed advancement.
快速喂养可以减少早产儿和低体重儿的住院时间和感染率，但可能增加不良结局的风险。本研究旨在评估快速喂养（每天≥30ml/kg）与缓慢喂养（每天<30ml/kg）在早产儿和低体重儿中的效果。
资料来源包括 Medline、Scopus、Web of Science、CINAHL 和 Index Medicus，检索时间截至 2021 年 6 月 30 日。纳入随机试验。主要结局为死亡率、发病率、生长和神经发育。使用随机效应模型提取和汇总数据。使用 Cochrane 偏倚风险 2 工具。
共纳入 12 项 RCT 研究，涉及 4291 名参与者。出院时，有中等确定性证据表明，快速喂养可能略微降低以下风险：死亡率（相对风险 [RR] 0.93，95%置信区间 [95%CI] 0.73 至 1.18，I2 = 18%，11 项试验，4132 名参与者）；坏死性小肠结肠炎（RR 0.89，95%CI 0.68 至 1.15，I2 = 0%，12 项试验，4291 名参与者）；败血症（RR 0.92，95%CI 0.83 至 1.03，I2 = 0%，9 项试验，3648 名参与者）；和喂养不耐受（RR 0.92，95%CI 0.77 至 1.10，I2 = 0%，8 项试验，1114 名参与者）。快速喂养也可能降低呼吸暂停的风险（RR 0.72，95%CI 0.47 至 1.12，I2 = 0%，低确定性，2 项试验，153 名参与者）。快速喂养可以缩短恢复出生体重的时间（平均差 [MD] -3.69 天，95%CI -4.44 至 -2.95，I2 = 70%，高确定性，6 项试验，993 名参与者），并可能缩短住院时间（MD -3.08 天，95%CI -4.34 至 -1.81，I2 = 77%，中等确定性，7 项试验，3864 名参与者）。局限性包括研究间的异质性和样本量小。
快速喂养可以缩短恢复出生体重的时间，并可能缩短住院时间；它还可能略微降低新生儿发病率和死亡率的风险。然而，它可能会略微增加神经发育障碍的风险。需要更多的研究来了解快速喂养的长期影响。
