Liu Yakun, Jin Shaobin, Zhang Guoqing, Chen Tingwei, Huang Shungen
General Surgery Department, Children's Hospital of Soochow University, Soochow, China.
Department of Pediatric Surgery, Shandong University Qilu Hospital, Jinan, China.
Matern Child Nutr. 2025 Jan;21(1):e13756. doi: 10.1111/mcn.13756. Epub 2024 Oct 24.
The association of enteral micronutrient supplementation and the neurodevelopmental outcomes of preterm or low birth weight (LBW) infants is controversial. This research was prospectively registered (CRD42023454034). We searched MEDLINE, Embase, PsycInfo, ClinicalTrials. gov, and the Cochrane Library for randomised clinical trials (RCTs) or quasi-RCTs comparing any enteral micronutrients supplementation with placebo or no supplementation in preterm or LBW infants. The primary outcome was neurodevelopmental impairment (NDI), with secondary outcomes involving various neurodevelopmental tests and disabilities. There was no evidence of an association between enteral micronutrients supplementation and the risk of NDI (RR, 1.03; 95% CI, 0.93-1.14; moderate certainty evidence). There was no evidence that the supplemented groups enhanced cognitive (MD, 0.65; 95% CI, -0.37 to 1.67; low certainty evidence), language (SMD, -0.01; 95% CI, -0.11 to 0.09; moderate certainty evidence), or motor scores (SMD, 0.04; 95% CI, -0.06 to 0.15; very low certainty evidence) or IQ (SMD, -0.20; 95% CI, -0.53 to 0.13; very low certainty evidence). Subgroup analysis showed that multiple micronutrients supplementation improved expressive language score (MD, 1.42; 95% CI, 0.39-2.45), and zinc supplementation enhanced fine motor score (SMD, 1.70; 95% CI, 0.98-2.43). The overall heterogeneity was low. This study demonstrates that enteral micronutrient supplementation is associated with little or no benefits in neurodevelopmental outcomes for preterm or LBW infants. Well-designed RCTs are needed to further ascertain these associations.
肠内微量营养素补充与早产或低出生体重（LBW）婴儿的神经发育结局之间的关联存在争议。本研究已进行前瞻性注册（CRD42023454034）。我们检索了MEDLINE、Embase、PsycInfo、ClinicalTrials.gov和Cochrane图书馆，以查找比较早产或低出生体重婴儿中任何肠内微量营养素补充与安慰剂或不补充的随机临床试验（RCT）或准RCT。主要结局是神经发育障碍（NDI），次要结局涉及各种神经发育测试和残疾情况。没有证据表明肠内微量营养素补充与NDI风险之间存在关联（风险比，1.03；95%置信区间，0.93 - 1.14；中等确定性证据）。没有证据表明补充组在认知（平均差，0.65；95%置信区间，-0.37至1.67；低确定性证据）、语言（标准化均值差，-0.01；95%置信区间，-0.11至0.09；中等确定性证据）或运动评分（标准化均值差，0.04；95%置信区间，-0.06至0.15；极低确定性证据）或智商（标准化均值差，-0.20；95%置信区间，-0.53至0.13；极低确定性证据）方面有所提高。亚组分析表明，多种微量营养素补充可改善表达性语言评分（平均差，1.42；95%置信区间，0.39 - 2.45），锌补充可提高精细运动评分（标准化均值差，1.70；95%置信区间，0.98 - 2.43）。总体异质性较低。本研究表明，肠内微量营养素补充对早产或低出生体重婴儿的神经发育结局几乎没有益处。需要设计良好的RCT来进一步确定这些关联。
