铁补充剂对健康纯母乳喂养婴儿的影响：一项系统评价和荟萃分析。
Effect of iron supplementation in healthy exclusively breastfed infants: a systematic review and meta-analysis.
作者信息
Tian Ke, Liu Wenli, Huang Yi, Zhou Rong, Wang Yan
机构信息
Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
出版信息
Front Pediatr. 2025 May 20;13:1587457. doi: 10.3389/fped.2025.1587457. eCollection 2025.
BACKGROUND AND OBJECTIVES
Exclusively breastfed infants are at risk of iron deficiency due to the low iron content in breast milk. This study aims to evaluate the benefits and risks of daily oral iron supplementation on growth, cognitive outcomes, and hematologic parameters in these infants.
METHODS
Data sources include Cochrane Central Register of Controlled Trials, PubMed, and Embase from inception to December, 2024. Randomized controlled trials were included. The Cochrane risk of bias tool was used to assess the methodological quality of included trials. The continuous outcomes were analyzed by calculating the mean difference (MD) and the binary categorical variables were analyzed using relative risk (RR) with 95% confidence intervals (CI).
RESULTS
This study included 8 trials (685 participants) comparing iron supplementation to no iron. At 6 months of age, compared to infants who were exclusively breastfed without iron supplementation, those who received oral iron supplementation showed an increase in hemoglobin (Hb) levels (MD 0.42, 95% CI 0.19-0.66, < 0.001, = 76%) and a reduction in the incidence of iron deficiency (ID) (RR 0.38, 95% CI 0.15-1.00, = 0.050, = 29%) and iron-deficiency anemia (IDA) (RR 0.58, 95% CI 0.40-0.84, = 0.004, = 0). However, by 12 months of age, the supplementation had no effect on Hb levels, ID, the incidence of IDA or mental development index (MDI). Iron supplementation appeared to reduce weight gain (MD = -0.04, 95%CI -0.07 to -0.01, = 0.004, = 0) and head circumference gain (MD = -0.14, 95% CI -0.18 to -0.09, < 0.001, = 25%).
CONCLUSIONS
Limited available evidence suggests that iron supplementation is beneficial for hematologic parameters and the incidence of IDA in healthy exclusively breastfed infants. However, it may delay weight gain and head circumference growth.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, PROSPERO [CRD42024610082].
背景与目的
由于母乳中铁含量较低，纯母乳喂养的婴儿有缺铁风险。本研究旨在评估每日口服铁补充剂对这些婴儿生长、认知结局和血液学参数的益处与风险。
方法
数据来源包括Cochrane对照试验中心注册库、PubMed和Embase，检索时间从数据库建立至2024年12月。纳入随机对照试验。使用Cochrane偏倚风险工具评估纳入试验的方法学质量。连续变量结局通过计算平均差（MD）进行分析，二元分类变量使用相对风险（RR）并结合95%置信区间（CI）进行分析。
结果
本研究纳入了8项试验（685名参与者），比较了铁补充剂与不补充铁剂的情况。在6个月大时，与未补充铁剂的纯母乳喂养婴儿相比，接受口服铁补充剂的婴儿血红蛋白（Hb）水平升高（MD 0.42，95% CI 0.19 - 0.66，P < 0.001，I² = 76%），缺铁（ID）发生率降低（RR 0.38，95% CI 0.15 - 1.00，P = 0.050，I² = 29%），缺铁性贫血（IDA）发生率降低（RR 0.58，95% CI 0.40 - 0.84，P = 0.004，I² = 0）。然而，到12个月大时，补充铁剂对Hb水平、ID、IDA发生率或智力发育指数（MDI）没有影响。铁补充剂似乎会降低体重增加（MD = -0.04，95%CI -0.07至-0.01，P = 0.004，I² = 0）和头围增长（MD = -0.14，95% CI -0.18至-0.09，P < 0.001，I² = 25%）。
结论
有限的现有证据表明，铁补充剂对健康的纯母乳喂养婴儿的血液学参数和IDA发生率有益。然而，它可能会延迟体重增加和头围增长。
系统评价注册
https://www.crd.york.ac.uk/prospero/，PROSPERO [CRD42024610082]。
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