Azhar Maha, Yasin Rahima, Hanif Sawera, Bughio Sharib Afzal, Das Jai K, Bhutta Zulfiqar A
Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan.
Neonatology. 2025;122(Suppl 1):209-223. doi: 10.1159/000542154. Epub 2024 Nov 26.
INTRODUCTION: Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes. METHODS: We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts. RESULTS: We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant. CONCLUSION: Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence. INTRODUCTION: Preterm and low birth weight (LBW) infants are at an increased risk of morbidity and mortality compared with their term counterparts, with more than 20 million LBW infants born each year, the majority in lower middle-income countries (LMICs). Given the increased vulnerability and higher nutritional needs of these infants, optimizing feeding strategies may play a crucial role in improving their health outcomes. METHODS: We updated evidence of Every Newborn Series published in The Lancet 2014 by identifying relevant systematic reviews, extracting low-income country (LIC) and LMIC data, and conducting revised meta-analysis for these contexts. RESULTS: We found 15 reviews; the evidence showed that early initiation of enteral feeding reduced neonatal mortality overall, but not in LIC/LMIC settings. Breastfeeding promotion interventions increased the prevalence of early initiation of breastfeeding and exclusive breastfeeding at 3 and 6 months of age in LMIC settings. There was an increased risk of neonatal mortality with formula milk in LIC/LMIC settings. Despite contributing to greater weight gain, there was a higher risk of necrotizing enterocolitis with formula milk overall. Breast milk fortification and nutrient-enriched formula improved growth outcomes. Iron and vitamin A supplementation reduced anemia and mortality rates (LMIC), respectively. The evidence also suggested that benefits of various different micronutrient supplementation interventions such as zinc, calcium/phosphorous, and vitamin D, outweigh the risks since our review demonstrates little to no adverse effects deriving from their supplementation, particularly for a breastfed preterm and/or LBW infant. CONCLUSION: Early adequate nutritional support of preterm or LBW infant is paramount to averse adverse health outcomes, contribute to normal growth, resistance to infection, and optimal development. Breast milk feeding and micronutrient supplementation are crucial to reduce diarrhea incidence and mortality respectively while feed fortification or nutrient-enriched formula, when breast milk is not available, to enhance better growth especially in LMICs where there is higher population of growth restriction and stunting. This review also highlights need for randomized trials in LMICs at large scale to further strengthen the evidence.
引言:与足月儿相比,早产和低出生体重(LBW)婴儿发病和死亡风险更高。每年有超过2000万低出生体重婴儿出生,其中大多数在中低收入国家(LMICs)。鉴于这些婴儿的脆弱性增加和营养需求更高,优化喂养策略可能对改善其健康结局起着关键作用。 方法:我们通过识别相关的系统评价、提取低收入国家(LIC)和中低收入国家的数据,并对这些背景进行修订的荟萃分析,更新了2014年发表在《柳叶刀》上的《每一个新生儿系列》的证据。 结果:我们找到了15篇综述;证据表明,早期开始肠内喂养总体上降低了新生儿死亡率,但在低收入国家/中低收入国家环境中并非如此。促进母乳喂养的干预措施提高了中低收入国家环境中3个月和6个月时早期开始母乳喂养和纯母乳喂养的普及率。在低收入国家/中低收入国家环境中,使用配方奶会增加新生儿死亡风险。尽管配方奶有助于增加体重,但总体上发生坏死性小肠结肠炎的风险更高。母乳强化剂和营养强化配方奶改善了生长结局。补充铁和维生素A分别降低了贫血率和死亡率(中低收入国家)。证据还表明,各种不同的微量营养素补充干预措施(如锌、钙/磷和维生素D)的益处大于风险,因为我们的综述表明,这些补充剂几乎没有不良影响,特别是对于母乳喂养的早产和/或低出生体重婴儿。 结论:对早产或低出生体重婴儿进行早期充分的营养支持对于避免不良健康结局、促进正常生长、抗感染和实现最佳发育至关重要。母乳喂养和微量营养素补充分别对于降低腹泻发病率和死亡率至关重要,而在无法获得母乳时,使用饲料强化剂或营养强化配方奶可促进更好的生长,特别是在生长受限和发育迟缓人口较多的中低收入国家。本综述还强调需要在中低收入国家进行大规模随机试验,以进一步加强证据。 引言:与足月儿相比,早产和低出生体重(LBW)婴儿发病和死亡风险更高。每年有超过2000万低出生体重婴儿出生,其中大多数在中低收入国家(LMICs)。鉴于这些婴儿的脆弱性增加和营养需求更高,优化喂养策略可能对改善其健康结局起着关键作用。 方法:我们通过识别相关的系统评价、提取低收入国家(LIC)和中低收入国家的数据,并对这些背景进行修订的荟萃分析,更新了2014年发表在《柳叶刀》上的《每一个新生儿系列》的证据。 结果:我们找到了15篇综述;证据表明,早期开始肠内喂养总体上降低了新生儿死亡率,但在低收入国家/中低收入国家环境中并非如此。促进母乳喂养的干预措施提高了中低收入国家环境中3个月和6个月时早期开始母乳喂养和纯母乳喂养的普及率。在低收入国家/中低收入国家环境中,使用配方奶会增加新生儿死亡风险。尽管配方奶有助于增加体重,但总体上发生坏死性小肠结肠炎的风险更高。母乳强化剂和营养强化配方奶改善了生长结局。补充铁和维生素A分别降低了贫血率和死亡率(中低收入国家)。证据还表明,各种不同的微量营养素补充干预措施(如锌、钙/磷和维生素D)的益处大于风险,因为我们的综述表明,这些补充剂几乎没有不良影响,特别是对于母乳喂养的早产和/或低出生体重婴儿。 结论:对早产或低出生体重婴儿进行早期充分的营养支持对于避免不良健康结局、促进正常生长、抗感染和实现最佳发育至关重要。母乳喂养和微量营养素补充分别对于降低腹泻发病率和死亡率至关重要,而在无法获得母乳时,使用饲料强化剂或营养强化配方奶可促进更好的生长,特别是在生长受限和发育迟缓人口较多的中低收入国家。本综述还强调需要在中低收入国家进行大规模随机试验,以进一步加强证据。
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