Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Nutr Rev. 2023 Sep 11;81(10):1254-1266. doi: 10.1093/nutrit/nuad002.
Many preterm neonates often cannot be fed enterally and hence do not receive the benefits of colostrum. Oropharyngeal application of colostrum is a novel way of harnessing the immunological benefits of colostrum. Randomized controlled trials (RCTs) investigating the efficacy of this approach have shown variable results.
The aim of this systematic review was to synthesize available data on the effect of oropharyngeal application of colostrum or mother's own milk (CMOM) in preterm infants.
Six electronic databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Cochrane Library) were searched until January 13, 2022. Only RCTs comparing oral application of CMOM with placebo/routine care in preterm infants were eligible. Studies enrolling term neonates or administering enteral feeds were excluded.
Two investigators independently extracted data using a structured proforma.
The Cochrane Risk of Bias 2 tool was used to assess bias. Random-effects meta-analysis was undertaken using RevMan 5.4 software. From 2787 records identified, 17 RCTs enrolling 4106 preterm infants were included. There was no significant difference between groups in incidence of necrotizing enterocolitis (NEC) stage 2 or higher (RR = 0.65; 95%CI, 0.36-1.20; 1089 participants in 12 trials). Application of CMOM significantly reduced the incidence of sepsis (RR = 0.72; 95%CI, 0.56-0.92; 1511 participants in 15 studies) and any stage of NEC (RR = 0.58; 95%CI, 0.37-0.92; 1616 participants in 16 trials). The CMOM group achieved full enteral feeds 1.75 days sooner (95%CI, 0.3-3.2 days; 1580 participants in 14 studies) and had higher weight at discharge (MD = 43.9 g; 95%CI, 3-85 g; 569 participants in 3 studies). There were no statistically significant differences in other outcomes.
Evidence with low to very low certainty suggests CMOM has a beneficial effect on NEC (any stage), sepsis, and time to full enteral feeds. Given its low cost and minimal risk of harm, routine CMOM use may be considered in preterm neonates.
CRD42021262763.
许多早产儿通常无法经肠道喂养，因此无法受益于初乳。口腔应用初乳是利用初乳免疫益处的一种新方法。研究这种方法疗效的随机对照试验（RCT）得出的结果各不相同。
本系统评价的目的是综合现有数据，评估口腔应用初乳或母亲自己的奶（CMOM）在早产儿中的效果。
检索了 6 个电子数据库（MEDLINE、Embase、CINAHL、Scopus、Web of Science 和 Cochrane Library），检索时间截至 2022 年 1 月 13 日。只有比较 CMOM 口腔应用与安慰剂/常规护理在早产儿中效果的 RCT 符合纳入标准。纳入足月新生儿或给予肠内喂养的研究被排除。
两名调查员使用结构化方案独立提取数据。
使用 Cochrane 偏倚风险 2 工具评估偏倚。使用 RevMan 5.4 软件进行随机效应荟萃分析。从 2787 条记录中，纳入了 17 项 RCT，共纳入 4106 名早产儿。两组间 2 期或更高级别的坏死性小肠结肠炎（NEC）发生率无显著差异（RR=0.65；95%CI，0.36-1.20；1089 名参与者，12 项试验）。CMOM 应用显著降低了败血症（RR=0.72；95%CI，0.56-0.92；1511 名参与者，15 项研究）和任何阶段 NEC（RR=0.58；95%CI，0.37-0.92；1616 名参与者，16 项试验）的发生率。CMOM 组更早实现完全肠内喂养（95%CI，0.3-3.2 天；1580 名参与者，14 项研究），出院时体重更高（MD=43.9 g；95%CI，3-85 g；569 名参与者，3 项研究）。其他结局无统计学意义上的差异。
低至极低确定性证据表明，CMOM 对 NEC（任何阶段）、败血症和完全肠内喂养时间有有益影响。鉴于其成本低且潜在危害小，在早产儿中常规使用 CMOM 可能是合理的。
PROSPERO 注册号：CRD42021262763。
