School of Nursing, Old Dominion University, Virginia Beach (Dr Cartagena); Department of Nursing, Southern Connecticut State University, New Haven (Dr Penny); University of Texas Health Science Center San Antonio (Dr McGrath); College of Nursing, University of Virginia, Charlottesville (Dr Reyna); College of Nursing, University of Florida, Gainesville (Dr Parker); and College of Health Sciences, Old Dominion University Library, Norfolk, Virginia (Ms McInnis).
Adv Neonatal Care. 2022 Dec 1;22(6):539-549. doi: 10.1097/ANC.0000000000001002. Epub 2022 Aug 1.
Growing evidence supports the superior benefits of exposure to mother's own milk (MOM) in reducing prematurity-related comorbidities. Neonatal exposure to donor human Milk (DHM) is a suitable alternative when MOM is insufficient or unavailable. However, the same protective composition and bioactivity in MOM are not present in DHM. Additional evidence is needed to justify and inform evidence-based practices increasing MOM provision while optimizing adequate use of DHM for premature infants.
A systematic review of the literature was conducted to determine differences in neonatal outcomes among premature infants exposed to predominately MOM versus DHM.
METHODS/SEARCH STRATEGY: Databases including PubMed, CINAHL and Cochrane were searched (2020-2021) using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. Evidence was classified using the John Hopkins evidence-based practice levels and quality of evidence.
Eleven studies met inclusion criteria. Studied neonatal outcomes included ( a ) growth parameters (n = 8), ( b ) neonatal morbidities (n = 6), and ( c ) gut microbiome (n = 4). Overall, evidence suggests DHM exposure is beneficial but not equivalent to MOM feeding. Compared with DHM, greater doses of MOM are ideal to enhance protection primarily related to infant growth, as well as gut microbiome diversity and richness.
Standardized and evidence-based practices are needed to clearly delineate optimal use of DHM without undermining maternal and neonatal staff efforts to support and promote provision of MOM.
Additional evidence from high-quality studies should further examine differences in neonatal outcomes among infants exposed to predominately MOM or DHM in settings using standardized and evidence-based feeding practices.
越来越多的证据支持接触母亲自身的母乳（MOM）可降低早产儿相关合并症的优势。当 MOM 不足或无法获得时，新生儿接触捐赠人乳（DHM）是一种合适的替代方法。然而，DHM 中不存在 MOM 中相同的保护成分和生物活性。需要更多的证据来证明和告知增加 MOM 供应的循证实践，同时优化早产儿对 DHM 的充分利用。
对文献进行系统回顾，以确定暴露于主要 MOM 与 DHM 的早产儿之间新生儿结局的差异。
方法/搜索策略：使用 PRISMA（系统评价和荟萃分析的首选报告项目）指南，在 PubMed、CINAHL 和 Cochrane 等数据库中进行了检索（2020-2021 年）。使用约翰霍普金斯循证实践水平和证据质量对证据进行分类。
11 项研究符合纳入标准。研究的新生儿结局包括：（a）生长参数（n=8）、（b）新生儿发病率（n=6）和（c）肠道微生物组（n=4）。总体而言，DHM 暴露有益，但与 MOM 喂养不同。与 DHM 相比，更多剂量的 MOM 是增强主要与婴儿生长以及肠道微生物组多样性和丰富度相关的保护的理想选择。
需要标准化和循证实践，以明确划定 DHM 的最佳使用方法，而不会破坏母婴和新生儿工作人员支持和促进 MOM 供应的努力。
来自高质量研究的更多证据应进一步研究在使用标准化和循证喂养实践的环境中，主要暴露于 MOM 或 DHM 的婴儿之间新生儿结局的差异。
