Zhang Ruolin, Ying Erya, Wu Xiujuan, Qin Han, Guo Yanping, Guo Xin, Yu Zhangbin, Chen Jun
Department of Neonatology, Nanshan Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China.
Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
Front Public Health. 2024 Nov 21;12:1401250. doi: 10.3389/fpubh.2024.1401250. eCollection 2024.
Prematurity significantly impacts neonatal health worldwide, necessitating effective interventions to improve outcomes for these vulnerable infants. While breastfeeding has emerged as a cornerstone of preterm care, its precise impact on neurodevelopment remains a subject of ongoing inquiry and debate. This systematic review aims to investigate the existing evidence in this area.
On December 17, 2023, online databases including PubMed, The Cochrane Library, Embase, Web of Science, CNKI, VIP, CBM, and Wan Fang Data were searched. Comparisons were classified into several categories: never breastfeeding (Never-BF) versus exclusive breastfeeding, Never-BF versus any breastfeeding (Any-BF), predominant preterm formula (Pre-PTF) versus predominant breastfeeding (Pre-BF), and Pre-PTF versus predominant donor breast milk (Pre-DBM) groups. Randomized controlled trials and observational studies were analyzed separately through meta-analyses. Each study's risk of bias was assessed, and the GRADE system was utilized to evaluate the certainty of the findings.
Sixteen studies met the inclusion criteria, comprising one RCT and 15 cohort studies. The key findings indicated that infants in the Any-BF groups demonstrated superior long-term cognitive scores compared to those in the Never-BF groups, particularly evident in infants assessed before 18 months in the Pre-BF groups versus Pre-PTF groups. A reduced risk of neurodevelopmental impairment was also observed in preterm infants in the Any-BF groups. Evidence regarding the effect of breastfeeding on motor development was inconclusive, except for potential motor improvement in extremely low birth weight infants in the Any-BF groups. Neither exclusive breastfeeding nor pre-DBM exhibited clear superiority over Pre-PTF in terms of neurodevelopmental outcomes for preterm infants. Caution is warranted due to potential publication bias impacting the assessment of breastfeeding's impact on motor skills.
Our systematic review supports current recommendations for breastfeeding in preterm infants, emphasizing its positive effects on cognitive abilities and reduced risk of neurodevelopmental disorders. Further studies are needed to clarify if DHM provides neurodevelopmental benefits comparable to maternal milk, as current evidence does not sufficiently address this question. Additionally, future investigations should prioritize refining our understanding of the influence of breastfeeding on motor development in this vulnerable population.
PROSPERO, identifier CRD42023492274, Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023492274.
早产对全球新生儿健康有重大影响，因此需要采取有效干预措施来改善这些脆弱婴儿的预后。虽然母乳喂养已成为早产护理的基石，但其对神经发育的确切影响仍是一个不断探讨和争论的话题。本系统评价旨在调查该领域的现有证据。
2023年12月17日，检索了包括PubMed、Cochrane图书馆、Embase、Web of Science、中国知网、维普、中国生物医学文献数据库和万方数据在内的在线数据库。比较分为几类：从未母乳喂养（Never-BF）与纯母乳喂养、Never-BF与任何母乳喂养（Any-BF）、主要使用早产配方奶（Pre-PTF）与主要母乳喂养（Pre-BF）、Pre-PTF与主要使用捐赠母乳（Pre-DBM）组。随机对照试验和观察性研究分别通过荟萃分析进行分析。评估了每项研究的偏倚风险，并使用GRADE系统评估研究结果的确定性。
16项研究符合纳入标准，包括1项随机对照试验和15项队列研究。主要研究结果表明，与Never-BF组相比，Any-BF组的婴儿在长期认知评分方面表现更优，在Pre-BF组与Pre-PTF组中，18个月前评估的婴儿中这一差异尤为明显。Any-BF组的早产儿神经发育障碍风险也有所降低。关于母乳喂养对运动发育影响的证据尚无定论，但Any-BF组的极低出生体重儿可能有运动能力改善。在早产儿的神经发育结局方面，纯母乳喂养和Pre-DBM均未表现出明显优于Pre-PTF。由于潜在的发表偏倚影响对母乳喂养对运动技能影响的评估，因此需要谨慎。
我们的系统评价支持当前关于早产儿母乳喂养的建议，强调其对认知能力的积极影响以及降低神经发育障碍风险。由于目前的证据不足以解决这个问题，因此需要进一步研究以阐明捐赠母乳是否能提供与母乳相当的神经发育益处。此外，未来的研究应优先增进我们对母乳喂养对这一脆弱人群运动发育影响的理解。
PROSPERO，标识符CRD42023492274，可在：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023492274获取。
