Liggins Institute, University of Auckland, Auckland, New Zealand.
Neonatal Unit, Kidz First, Middlemore Hospital, Auckland, New Zealand.
JPEN J Parenter Enteral Nutr. 2024 Jan;48(1):11-26. doi: 10.1002/jpen.2568. Epub 2023 Nov 14.
There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation. We aimed to assess the quality of nutrition guidelines for preterm infants, the consistency of recommendations, and the gaps in recommendations.
We searched databases and websites for nutrition guidelines for preterm infants before first hospital discharge, which were endorsed, prepared, or authorized by a regional, national, or international body, written in English, and published between 2012 and 2023. Two reviewers independently screened articles and extracted the recommendations. Four reviewers appraised the included guidelines using Appraisal of Guidelines, Research, and Evaluation II.
A total of 7051 were identified, with 27 guidelines included, 26% of which were high in quality. Most guidelines lacked stakeholder involvement and rigor of development. We found considerable variation in recommendations, many of which lacked details on certainty of evidence and strength of recommendation. Recommendations for type of feed and breastmilk fortification were consistent among high-quality guidelines, but recommendations varied for intakes of almost all nutrients and monitoring of nutrition adequacy. Different guidelines gave different certainty of evidence for the same recommendations. Most gaps in recommendations were due to very low certainty of evidence.
Future development of nutrition guidelines for preterm infants should follow the standard guideline development method and ensure the rigorous process, including stakeholders' involvement, to improve the reporting of strength of recommendation, certainty of evidence, and gaps in recommendation. Evidence is needed to support recommendations about macro and micronutrient intakes, breastmilk fortification, and markers on adequacy of intake of different nutrients.
目前针对早产儿的最佳营养方案尚未达成共识，导致实践中存在较大差异。本研究旨在评估早产儿营养指南的质量、推荐意见的一致性以及推荐意见中的差距。
我们检索了 2012 年至 2023 年间发布的、由地区、国家或国际组织认可、制定或授权的、以英文撰写的早产儿出院前营养指南数据库和网站，纳入对象为针对早产儿的营养指南。由两名评审员独立筛选文献和提取推荐意见，由 4 名评审员使用 AGREE II 评估工具对纳入的指南进行质量评估。
共检索到 7051 篇文献，最终纳入 27 篇指南，其中仅有 26%的指南质量较高。大多数指南缺乏利益相关者的参与和严格的制定流程。我们发现推荐意见存在较大差异，其中许多推荐意见缺乏证据确定性和推荐强度的详细信息。高质量指南中关于喂养类型和母乳强化的推荐意见一致，但几乎所有营养素的摄入量和营养充足性监测的推荐意见存在差异。不同的指南对相同的推荐意见给予了不同的证据确定性。大多数推荐意见中的差距主要是由于证据确定性非常低。
未来早产儿营养指南的制定应遵循标准指南制定方法，并确保严格的制定流程，包括利益相关者的参与，以提高推荐意见的强度、证据确定性和推荐意见差距的报告质量。需要更多证据来支持关于宏量和微量营养素摄入、母乳强化以及不同营养素摄入充足性标志物的推荐意见。
