Intervention Review

Multicomponent fortified human milk for promoting growth in preterm infants

  1. Carl A Kuschel1,*,
  2. Jane E Harding2

Editorial Group: Cochrane Neonatal Group

Published Online: 26 JAN 2004

Assessed as up-to-date: 28 AUG 2003

DOI: 10.1002/14651858.CD000343.pub2


How to Cite

Kuschel CA, Harding JE. Multicomponent fortified human milk for promoting growth in preterm infants. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD000343. DOI: 10.1002/14651858.CD000343.pub2.

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

*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: 26 JAN 2004

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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. Observational studies have suggested that infants fed formula have a higher rate of growth than infants who are breast fed. However, there are potential short term and long term benefits from human milk. Commercially-produced multicomponent fortifiers provide additional nutrients to supplement human milk (in the form of protein, calcium, phosphate, and carbohydrate, as well as vitamins and trace minerals).

Objectives

The main objective was to determine if addition of multicomponent nutritional supplements to human milk leads to improved growth, bone metabolism and neurodevelopmental outcomes without significant adverse effects in premature infants.

Search methods

Searches were made of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 3003), MEDLINE (searched August 29, 2003), previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language.

Selection criteria

All trials utilising random or quasi-random allocation to supplementation of human milk with multiple nutrients or no supplementation in premature infants within a nursery setting were eligible.

Data collection and analysis

Data were extracted using the standard methods of the Cochrane Collaboration and its Neonatal 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

Supplementation of human milk with multicomponent fortifiers is associated with short term increases in weight gain, linear and head growth. There is no effect on serum alkaline phosphatase levels; it is not clear if there is an effect on bone mineral content. Nitrogen retention and blood urea levels appear to be increased.

There are insufficient data to evaluate long term neurodevelopmental and growth outcomes, although there appears to be no effect on growth beyond one year of life.

Use of multicomponent fortifiers does not appear to be associated with adverse effects, although the total number of infants studied and the large amount of missing data reduces confidence in this conclusion. Blood urea levels are increased and blood pH levels minimally decreased, but the clinical significance of this is uncertain.

Authors' conclusions

Multicomponent fortification of human milk is associated with short-term improvements in weight gain, linear and head growth. Despite the absence of evidence of long-term benefit and insufficient evidence to be reassured that there are no deleterious effects, it is unlikely that further studies evaluating fortification of human milk versus no supplementation will be performed. Further research should be directed toward comparisons between different proprietary preparations and evaluating both short-term and long-term outcomes in search of the "optimal" composition of fortifiers.

 

Plain language summary

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

Multicomponent fortified breast milk for promoting growth in preterm infants

Babies born at full term (40 weeks) get all their nutritional needs from breast milk. Babies born early (preterm) have different needs and grow very rapidly. Those fed breast milk may need extra supplements. The review of trials found evidence that adding nutritional supplements to breast milk leads to short term improved growth and possibly also bone formation. The review found no evidence of long-term benefits or adverse effects.

 

摘要

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

背景

多重成分的加強營養母奶 對於促進早產兒的生長

對於足月兒,母奶提供足夠的營養來促進生長。母奶對於增強免疫力以及維繫親子之間的情感也有很好的成效。可是母奶在早產兒的角色卻不是那麼明確,因為它所含的營養成分不足以維持嬰兒所需。觀察性的研究指出,嬰兒餵食配方牛奶比餵食母奶的有較好的生長。然而,母奶在短期上或長期上都有潛在的益處。商業上製造的多種成分加強乳 (multicomponent fortifiers) 可以彌補母奶不足的額外營養(以蛋白質,鈣,磷,碳水化合物,維生素,礦物質形式呈現)

目標

本篇的目的要證實:是否外加的多種成分營養補充,可以改善早產兒的生長、骨骼代謝和神經發展,而且沒有重大的副作用。

搜尋策略

搜尋來源:Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003), MEDLINE (搜尋2003年8月29日) ,之前的回顧包括互相比對的參考資料 (cross references) ,摘要,座談會,專家見解,英語雜誌的手動搜尋。

選擇標準

所有試驗利用隨機或類似隨機的配置:對於符合條件照顧的早產兒,分成有添加多重營養母奶成分的,以及沒有添加的。

資料收集與分析

選用的資料使用Cochrane Collaboration和Neonatal Review Group的標準方法,分別評估試驗的品質和每個作者提供的資料。這些資料利用相對危險性和加權均數差來合併組成。

主要結論

添加多重成分的營養加強母奶可以在短期上增加體重、身高和頭圍生長。對於血液中鹼性磷酸鹽酵素(alkaline phosphatase)的數值沒有影響;對於骨骼內礦物質的成分影響卻不是那麼清楚。氮(Nitrogen)滯留和血中尿素(urea)的數值是增加的。評估長期神經發展和生長的資料卻不足夠,然而對大於1歲的小孩沒有明顯生長的影響。使用多重成分的營養加強母奶和副作用沒有關聯,然而由於參與研究嬰兒總數的問題以及大量的資料漏失使得這項結論的可信度降低。血中尿素值是上升,而血中酸鹼值(pH)些微下降,但臨床上的意義卻是不確定的。

作者結論

多重成份的營養加強母奶在短期上可以改善體重的增加、身高和頭圍的生長。儘管缺乏長期上的益處和不足夠的證據來證實是無害的,未來研究針對營養加強母奶和沒有添加的實驗不太可能會再去執行。未來的研究應該將重點放在比較不同專利奶粉的調製,以及尋找最理想成分的加強乳來評估長期和短期的結果。

翻譯人

本摘要由馬偕醫院林佳瑩翻譯。

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

總結

多重成份的營養加強母奶對早產兒有促進生長益處。足月40周出生的嬰兒可以從母乳得到所有的營養。早產的嬰兒在營養上有不同的需求而且生長會很快。那些只有餵食母乳的需要額外的營養補充。回顧這些試驗,發現額外從母乳增加的營養可以讓嬰兒在短期生長上有改善,並且在骨骼生長上可能有幫助。這篇回顧沒有發現長期上的益處和副作用。