Intervention Review

Fat supplementation of human milk for promoting growth in preterm infants

  1. Carl A Kuschel1,*,
  2. Jane E Harding2,
  3. Vazhkudai S Kumaran3

Editorial Group: Cochrane Neonatal Group

Published Online: 24 APR 2000

Assessed as up-to-date: 9 APR 2002

DOI: 10.1002/14651858.CD000341


How to Cite

Kuschel CA, Harding JE, Kumaran VS. Fat supplementation of human milk for promoting growth in preterm infants. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD000341. DOI: 10.1002/14651858.CD000341.

Author Information

  1. 1

    The Royal Women's Hospital, Neonatal Services, Carlton, Victoria, Australia

  2. 2

    University of Auckland, Department of Paediatrics, Auckland, New Zealand

  3. 3

    Auckland City Hospital, Newborn Services, Auckland, New Zealand

*Carl A Kuschel, Neonatal Services, The Royal Women's Hospital, 132 Grattan Street, Carlton, Victoria, 3053, Australia. carl.kuschel@rwh.org.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 24 APR 2000

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

For term infants, human milk provides adequate nutrition to facilitate growth, as well as potential beneficial effects on immunity and the maternal-infant emotional state. However, the role of human milk in premature infants is less well defined as it contains insufficient quantities of some nutrients to meet the estimated needs of the infant. There are potential short term and long term benefits from human milk, although observational studies have suggested that infants fed formula have a higher rate of growth than infants who are breast fed.

Objectives

The main objective is to determine if addition of supplemental fat to human milk leads to improved growth and neurodevelopmental outcomes without significant adverse effects in preterm infants.

Search methods

The standard search strategy of the Cochrane Neonatal Collaborative Review Group was used. This includes searches of the Oxford Database of Perinatal Trials, MEDLINE (1966-Apr 2002), Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002), previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language.

Selection criteria

All trials utilizing random or quasi-random allocation to supplementation of human milk with fat or no supplementation in preterm infants within a hospital were eligible.

Data collection and analysis

Data were extracted using the standard methods of the Cochrane Neonatal Collaborative Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and weighted mean difference.

Main results

Results are available for only one small study evaluating the effects of fat supplementation. There are insufficient data to evaluate short term or long term growth outcomes and neurodevelopmental outcomes. There are insufficient data to comment on potential adverse effects.

Authors' conclusions

There is insufficient evidence to make recommendations for practice. Further research should evaluate the practice of supplementation of human milk with fat. This may best be done in the context of the development of multicomponent fortifiers. Both short term growth outcomes and long term growth and neurodevelopmental outcomes should be evaluated. Adverse effects should be evaluated.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Fat supplementation of human milk for promoting growth in preterm infants

Human breast milk provides good nutrition for term infants for growth and has benefits for immunity and maternal-infant bonding. It may, however, contain insufficient quantities of some nutrients and calories to meet the needs for adequate growth of an infant born prematurely unless fed in large volumes. Fats provide approximately half of the calories in human milk and the milk contains components (bile-salt stimulated lipase) that help digest the fat. The fat component in some commercial human milk fortifiers is often in very low quantities because of concerns that preterm infants will deposit fat tissue to a greater extent than when in the uterus. They also have relatively poor digestion and absorption of fat with their immature digestive systems. Supplementing with medium-chain triglycerides (MCT), which are more easily digested than long-chain fats, may provide a ready source of energy for preterm infants for growth and neuronal development. The review authors searched the medical literature and found only one small randomised controlled trial (14 infants) investigating the effectiveness of human milk fat supplements with vitamins and minerals (calcium and phosphate). Growth was similar with and without fat supplement over the short study period. One infant in the fat supplement group developed feeding intolerance and there were no reports of damaging inflammation of the gut (necrotizing
enterocolitis).

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

脂肪添加於母乳餵食促進早產兒生長

對於足月嬰兒來說,母乳可提供促進生長的足夠營養,並對免疫與母嬰情緒狀態有潛在幫助。然而,母乳對早產兒的角色尚未確定,因為其中有些營養素的含量不能滿足嬰兒的需要。儘管觀察性研究提示,用配方食品餵養的嬰兒較之母乳喂養嬰兒的生長速度快,但母乳有潛在的短期和長期好處。

目標

主要目的是確定脂肪添加於母乳餵養是否改善早產兒的生長和神經發育,且不會有不良影響。

搜尋策略

使用 Cochrane Neonatal Collaborative Review Group 的標準檢索策略。包括檢索Oxford Database of Perinatal Trials, MEDLINE(1966年−2002年4月),Cochrane Controlled Trials Register(Cochrane Library 2002年第2期),以往回顧包含參考文獻,摘要,會議與研討會論文集,專家訊息,並主要對英語雜誌進行手工檢索。

選擇標準

所有使用隨機或小型隨機分配法對醫院中母乳餵養早產兒進行添加或不添加脂肪的試驗。

資料收集與分析

應用 Cochrane Neonatal Collaborative Review Group的標準方法進行數據提取,每個作者分別對試驗質量進行評估和數據提取,使用相對風險和加權均數差進行資料整合。

主要結論

只有一項小型研究評估添加脂肪的效果。沒有足夠的短期或長期生長和神經發育結果評估的數據。也沒有足夠的數據對潛在不良影響進行評論。

作者結論

沒有足夠的證據能對臨床執行提供建議。應有進一步研究針對脂肪添加於母乳餵養的應用進行評估。最好在開發多成分強化食品的考量下進行這方面研究。對短期生長和長期生長及神經發育結果應同時進行評估。還應評估其不良影響。

翻譯人

本摘要由臺中榮民總醫院葉惠英翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

母乳添加脂肪促進早產兒生長:母乳哺育提供足產兒良好的生長所需營養,並提供免疫及親子互動的好處。然而除非大量給與,否則它某些營養或熱量未能符合早產兒需求。儘管觀察性研究提示,用配方食品餵養的嬰兒較之母乳喂養嬰兒的生長速度快,但母乳有潛在的短期和長期好處。脂肪提供大約一半母乳一半的熱量與幫忙脂肪消化的成分(膽鹽刺激脂脢)。因早產兒比在子宮裡積存更多的脂肪組織,所以某些市售母乳脂肪成分量經常非常不足的。對未成熟的消化系統它們也相對不好消化與吸收。比長鏈脂肪,中鍊三酸甘油脂(MCT)更容易消化取,可能對早產兒生長與神經發育提供更適當的能量來源。本回顧作者檢索醫學文獻只找到一項小型隨機控制對照試驗(14位嬰兒)研究母乳添加脂肪,維他命及礦物質(鈣與磷).在短期研究期間加不加脂肪對生長沒有影響。在脂肪添加組有一位嬰兒有餵食耐受不良但沒有傷害性胃腸發炎的報告。 (壞死性腸炎)