Campbell-Yeo Marsha, Gullickson Courtney, McCulloch Holly, Disher Tim, Hughes Brianna
School of Nursing, Dalhousie University, Halifax, NS B3H 4R2, Canada.
Mom-Linc Lab, IWK Health, Halifax, NS B3K 6R8, Canada.
Nutrients. 2025 May 12;17(10):1651. doi: 10.3390/nu17101651.
Optimal feeding regimens for preterm neonates, including the role of multi-nutrient fortification, are unknown, leading to large practice variation in comparing different feeding regimens that include fortification and their impact on outcomes for preterm infants. Using a network meta-analyses design, two reviewers independently extracted data. A Cochrane CENTRAL, Medline, Embase, and CINAHL search was conducted for all studies published up to 27 June 2023. Randomized clinical trials of feeding regimens for preterm infants that included multi-nutrient fortification were included. Outcomes were mortality, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis, periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), time to full enteral feeds, and the Bayley II MDI developmental score. : Fifty-nine studies were included. For mortality, NEC, and time to reach full enteral feeds, the top-ranked treatment class was the mother's own milk with donor milk and a human-milk-based fortifier. For ROP and BPD, the top-ranked treatment class was mother's own milk with a phosphorus fortifier. For sepsis, the top-ranked treatment class was mother's own milk with formula. For PVL, the top-ranked treatment classes were mother's own milk and mother's own milk with donor milk and a bovine fortifier in the two disconnected networks. For the Bayley II MDI score, the top-ranked treatment class was mother's own milk with formula and bovine fortification. Treatment rankings are consistent with the underlying hypothesis that increased mother's own milk intake appears to be associated with better clinical outcomes. This review provides the first global view of interventions and highlights insufficient high-quality evidence to support or refute one fortification feeding regimen over another.
早产儿的最佳喂养方案，包括多种营养素强化的作用，目前尚不清楚，这导致在比较不同的强化喂养方案及其对早产儿结局的影响时，临床实践存在很大差异。采用网状荟萃分析设计，两名 reviewers 独立提取数据。对截至2023年6月27日发表的所有研究进行了Cochrane CENTRAL、Medline、Embase和CINAHL检索。纳入了包括多种营养素强化的早产儿喂养方案的随机临床试验。结局指标包括死亡率、坏死性小肠结肠炎（NEC）、早产儿视网膜病变（ROP）、败血症、脑室周围白质软化症（PVL）、支气管肺发育不良（BPD）、完全经口喂养的时间以及贝利II MDI发育评分。共纳入59项研究。对于死亡率、NEC和完全经口喂养的时间，排名最高的治疗类别是母亲自己的母乳加捐赠母乳和基于人乳的强化剂。对于ROP和BPD，排名最高的治疗类别是母亲自己的母乳加磷强化剂。对于败血症，排名最高的治疗类别是母亲自己的母乳加配方奶。对于PVL，在两个不相连的网络中，排名最高的治疗类别是母亲自己的母乳以及母亲自己的母乳加捐赠母乳和牛强化剂。对于贝利II MDI评分，排名最高的治疗类别是母亲自己的母乳加配方奶和牛强化剂。治疗排名与潜在假设一致，即增加母亲自己的母乳摄入量似乎与更好的临床结局相关。本综述首次提供了全球范围内的干预措施观点，并强调缺乏足够的高质量证据来支持或反驳一种强化喂养方案优于另一种。
