Multicomponent fortified human milk for promoting growth in preterm infants
Editorial Group: Cochrane Neonatal Group
Published Online: 26 JAN 2004
Assessed as up-to-date: 28 AUG 2003
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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.
- Publication Status: Edited (no change to conclusions)
- Published Online: 26 JAN 2004
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).
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.
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.
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.
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.
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
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.
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)
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。
此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。