Intervention Review

Protein supplementation of human milk for promoting growth in preterm infants

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

Editorial Group: Cochrane Neonatal Group

Published Online: 24 APR 2000

Assessed as up-to-date: 12 DEC 1999

DOI: 10.1002/14651858.CD000433


How to Cite

Kuschel CA, Harding JE. Protein supplementation of human milk for promoting growth in preterm infants. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD000433. DOI: 10.1002/14651858.CD000433.

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: 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 preterm infants is less well defined as it contains insufficient quantities of some nutrients to meet the estimated needs of the infant. Preterm infants require higher protein intakes than term infants to attain adequate growth rates, and have relatively higher protein turnover rates. Inadequate protein intakes may be partly responsible for low serum albumin and blood urea concentrations in preterm infants.

Objectives

The main objective was to determine if addition of protein 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 Review Group was used. This includes searches of the Oxford Database of Perinatal Trials, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, and journal handsearching mainly in the English language.

Selection criteria

All trials utilizing random or quasi-random allocation to supplementation of human milk with protein or no supplementation in preterm infants who remained in hospital were eligible.

Data collection and analysis

Data were extracting using the standard methods of the Cochrane 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

Protein supplementation of human milk results in increases in short term weight gain (WMD 3.6 g/kg/day, 95% CI 2.4 to 4.8 g/kg/day), linear growth (WMD 0.28 cm/week, 95% CI 0.18 to 0.38 cm/week) and head growth (WMD 0.15 cm/week, 95% CI 0.06 to 0.23 cm/week). There are insufficient data to evaluate long term neurodevelopmental and growth outcomes.

There are too few infants studied to be certain that adverse effects of protein supplementation are not increased. Blood urea levels are increased (WMD 1.0 mmol/l, 95% CI 0.8 to 1.2 mmol/l).

Authors' conclusions

Protein supplementation of human milk in relatively well preterm infants results in increases in short term weight gain, linear and head growth. Urea levels are increased, which may reflect adequate rather than excessive dietary protein intake. Further research should be directed towards the evaluation of specific levels of protein intake in preterm infants and the clinical effects of supplementation with protein, including long term growth and neurodevelopmental outcomes. This may best be done in the context of refinement of available multicomponent fortifier preparations.

 

Plain language summary

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

Protein supplementation of human milk for promoting growth in preterm infants

Not enough evidence to show the effect of protein supplementation of breast milk for promoting growth in preterm babies. Breast milk is the best source of nutrition for full-term babies but babies born preterm (before 37 weeks) have different nutritional needs. It is possible that premature breast milk may not meet all these needs. Preterm infants need more protein but also use up protein more quickly than full-term babies. The review of trials found that adding protein to breast milk increases short-term weight gain and body growth. However, too much protein given in formula can cause problems with infant development in the longer term. More research is needed to find the safest and most effective levels of protein supplementation.

 

摘要

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

背景

用於促進早產兒生長之母乳蛋白質補充

對足月兒來說,母乳可提供適當營養以促進生長,並可對免疫力以及母嬰情緒狀態提供潛在效益。然而,母乳對於早產兒之作用則較少受到詳細定義,因其在某些營養素之含量上並不足以滿足早產兒之預估需求。早產兒需要比足月兒更高之蛋白質攝取量以達成適當生長率,且其具有相對較高之蛋白質轉換率。不適當之蛋白質攝取量可能是造成早產兒之低血清白蛋白及低血中尿素濃度的部分肇因。

目標

本回顧之主要目的為判斷於母乳中添加蛋白質是否能在不具有重大不良作用之情形下改善早產兒的生長及神經發育結果。

搜尋策略

利用Cochrane Neonatal Review Group標準的搜尋策略,. 包含搜尋Oxford Database of Perinatal Trials、MEDLINE、先前的文獻回顧,包括交叉對照參考資料、摘要、研討會及座談會手冊、專家資訊,及人工搜尋以英文為主之期刊。

選擇標準

針對住院早產兒,在母奶中補充或無補充蛋白質之隨機或半隨機分派的所有試驗皆為適用。

資料收集與分析

使用Cochrane Neonatal Review Group之標準方法來摘錄數據,由各個作者獨立評估試驗品質及摘錄數據,並使用相對風險及加權平均差 (weighted mean difference;WMD) 來合成數據。

主要結論

在母乳中補充蛋白質可造成下列情形之提升:短期之體重增加 (WMD 3.6 公克/公斤/天, 95% CI 2.4 – 4.8 公克/公斤/天) 、線性生長 (身高) (WMD 0.28 公分/週, 95% CI 0.18 – 0.38 公分/週) 、以及頭部生長 (頭圍) (WMD 0.15 公分/週, 95% CI 0.06 – 0.23 公分/週) 。並無足夠之數據可用以評估長期之神經發育及生長結果。目前僅有過少之嬰兒研究,無法確認蛋白質之補充不會造成不良作用之增加。血中尿素之含量具有增加情形 (WMD 1.0 mmol/l, 95% CI 0.8 – 1.2 mmol/l) 。

作者結論

對於相對健康之早產兒來說,母乳之蛋白質補充可造成較高之短期體重增加、線性及頭圍生長。尿素含量亦有增加,此可反應出適當而非過量之飲食蛋白攝取量。進一步之研究應針對評估早產兒的特定蛋白質攝取量以及蛋白質補充之臨床效應而進行,包括長期之生長及神經發育結果。此種研究之最佳方式為藉由改善目前已有之複方強化配方製品 (母奶添加物) 而完成。

翻譯人

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

總結

並無足夠證據得以顯示母乳之蛋白質補充對於促進早產兒生長的效應。對於足月兒來說,母乳是最佳之營養來源,但是非足月出生之嬰兒 (在37週前) 卻具有不同之營養需求。以母乳餵食早產嬰兒可能無法達成所有此等需求。相較於足月兒,早產兒需要更多之蛋白質,但其消耗蛋白質之速度亦較快。本試驗回顧發現,在母乳中添加蛋白質可增進短期之體重增加及身體生長。然而,在配方中給與過多之蛋白質可能會對長期之嬰兒發育造成問題。茲需要更多之研究以找出最安全及最有效的蛋白質補充量。