Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China; Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China.
Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China.
Int J Nurs Stud. 2023 Aug;144:104527. doi: 10.1016/j.ijnurstu.2023.104527. Epub 2023 May 19.
Preterm complications are now the second leading cause of death in children under five years of age. Colostrum is essential to prevent infection and promote maturation in preterm infants. Guidelines recommend that preterm infants be fed colostrum by the oral and pharyngeal routes as early as possible after birth to provide immune protection; however, due to disease and an uncoordinated sucking and swallowing function, it is challenging to provide colostrum through the oropharyngeal route, which limits the immune protection it provides.
To update the existing meta-analysis, evaluate the effect of oropharyngeal colostrum administration on related outcomes in preterm infants and explore the optimal frequency and duration of oropharyngeal colostrum administration through subgroup analysis.
The Cochrane Library, PubMed, Web of Science, ScienceDirect, and Ovid databases were searched for randomized control trials (RCTs) of oropharyngeal colostrum administration for preterm infants. Two researchers screened the literature strictly according to the inclusion and exclusion criteria and evaluated the quality. Primary data and data from the included literature were extracted. Finally, the data were statistically analyzed by the Review Manager 5.3 software.
A total of 1736 preterm infants were included in 16 RCTs. The meta-analysis showed that the incidence of necrotizing enterocolitis, late-onset sepsis, feeding intolerance, and death was lower, the time to full enteral feeding was shorter, and the day of recovery to birth weight was earlier in the intervention group (oropharyngeal colostrum administration group) than in the control group, and this difference was statistically significant. Subgroup analysis: Frequency of oropharyngeal colostrum administration: The incidence of necrotizing enterocolitis and late-onset sepsis in the once every 4 h group was lower than that in the control group, and the time to complete enteral feeding was shorter. Duration of oropharyngeal colostrum administration: In the 1-3 days group and 4-7 days group, the time to full enteral feeding in the intervention group was shorter. In the 8-10 days group, the incidence of necrotizing enterocolitis and late-onset sepsis was lower in the intervention group.
Oropharyngeal colostrum administration can reduce the incidence of necrotizing enterocolitis, late-onset sepsis, feeding intolerance and mortality, shorten the time to full enteral feeding, and lead to a faster recovery to birth weight in preterm infants. The appropriate oropharyngeal colostrum administration frequency may be 4 h, and the optimal duration may be 8-10 days. Therefore, it is recommended that clinical medical staff implement oropharyngeal colostrum administration for premature infants based on existing evidence.
Oropharyngeal colostrum administration can reduce the incidence of complications in preterm infants and shorten the time to full enteral feeding.
早产儿并发症现已成为五岁以下儿童死亡的第二大主要原因。初乳对于预防早产儿感染和促进其成熟至关重要。指南建议早产儿在出生后尽早通过口腔和咽腔途径摄入初乳，以提供免疫保护；然而，由于疾病和不协调的吸吮和吞咽功能，通过口腔咽腔途径提供初乳具有挑战性，这限制了其提供的免疫保护。
更新现有的荟萃分析，评估口腔咽腔给予初乳对早产儿相关结局的影响，并通过亚组分析探讨口腔咽腔给予初乳的最佳频率和持续时间。
检索 Cochrane 图书馆、PubMed、Web of Science、ScienceDirect 和 Ovid 数据库中关于口腔咽腔给予初乳治疗早产儿的随机对照试验（RCT）。两名研究人员严格按照纳入和排除标准筛选文献，并对质量进行评估。提取原始数据和纳入文献中的数据。最后，使用 Review Manager 5.3 软件进行统计分析。
共有 1736 名早产儿纳入 16 项 RCT。荟萃分析显示，干预组（口腔咽腔给予初乳组）的坏死性小肠结肠炎、晚发性败血症、喂养不耐受和死亡率较低，完全肠内喂养时间较短，恢复至出生体重的天数较早，差异具有统计学意义。亚组分析：口腔咽腔给予初乳的频率：每 4 小时给予一次组的坏死性小肠结肠炎和晚发性败血症发生率较低，完全肠内喂养时间较短。口腔咽腔给予初乳的持续时间：1-3 天组和 4-7 天组，干预组完全肠内喂养时间较短。8-10 天组，干预组的坏死性小肠结肠炎和晚发性败血症发生率较低。
口腔咽腔给予初乳可以降低早产儿坏死性小肠结肠炎、晚发性败血症、喂养不耐受和死亡率的发生率，缩短完全肠内喂养时间，使早产儿更快恢复至出生体重。适当的口腔咽腔给予初乳的频率可能为每 4 小时一次，最佳持续时间可能为 8-10 天。因此，建议临床医务人员根据现有证据对早产儿实施口腔咽腔给予初乳。
口腔咽腔给予初乳可降低早产儿并发症的发生率，并缩短完全肠内喂养的时间。
