Intervention Review

Multinutrient fortification of human breast milk for preterm infants following hospital discharge

  1. Felicia M McCormick2,
  2. Ginny Henderson3,
  3. Tom Fahey4,
  4. William McGuire1,*

Editorial Group: Cochrane Neonatal Group

Published Online: 7 JUL 2010

Assessed as up-to-date: 13 MAY 2010

DOI: 10.1002/14651858.CD004866.pub3

Database Title

Additional Information

How to Cite

McCormick FM, Henderson G, Fahey T, McGuire W. Multinutrient fortification of human breast milk for preterm infants following hospital discharge. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD004866. DOI: 10.1002/14651858.CD004866.pub3.

Author Information

  1. 1

    Hull York Medical School, Centre for Reviews and Dissemination, York, Y010 5DD, UK

  2. 2

    University of York, Mother and Infant Research Unit, Department of Health Sciences, York, UK

  3. 3

    Griffith University, School of Nursing and Midwifery, South Brisbane, Queensland, Australia

  4. 4

    Royal College of Surgeons in Ireland Medical School, Department of Family Medicine and General Practice, Dublin, Ireland

*William McGuire, Centre for Reviews and Dissemination, Hull York Medical School, University of York, York, Y010 5DD, UK. William.McGuire@hyms.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 7 JUL 2010

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Abstract

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

Background

Preterm infants are usually growth restricted at hospital discharge. Feeding preterm infants after hospital discharge with multinutrient fortified breast milk rather than unfortified breast milk may facilitate more rapid catch-up growth and improve neurodevelopmental outcomes.

Objectives

To determine the effect of feeding with multinutrient fortified human breast milk versus unfortified breast milk on growth and development in preterm or low birth weight infants following hospital discharge.

Search methods

The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2010), MEDLINE (1966 to April 2010), EMBASE (1980 to April 2010), CINAHL (1982 to April 2010), conference proceedings, and previous reviews.

Selection criteria

Randomised or quasi-randomised controlled trials that compared feeding preterm infants following hospital discharge with multinutrient fortified breast milk compared with unfortified human breast milk.

Data collection and analysis

The standard methods of the Cochrane Neonatal Review Group were used, with separate evaluation of trial quality and data extraction by two review authors.

Main results

One small trial (N = 39) was identified. Multinutrient fortification of breast milk for 12 weeks after hospital discharge resulted in higher rates of growth during infancy. At 12 months corrected age, weight (mean difference 1187g, 95% confidence interval (CI) 259, 2115 g), length (3.8 cm, 95%CI 1.2, 6.4 cm) and head circumference (1.0 cm, 95%CI 0.1, 1.9 cm) were statistically significantly greater in the intervention group. No evidence of an effect on neurodevelopmental assessments at 18 months corrected age was found.

Authors' conclusions

The limited available data suggest that feeding preterm infants following hospital discharge with multinutrient fortified breast milk compared with unfortified breast milk increases growth rates during infancy. The importance of these effects on long-term growth and development is unclear and deserves further assessment in randomised controlled trials. Since fortifying breast milk for infants fed directly from the breast is logistically difficult and has the potential to interfere with breast feeding, it is important to determine if mothers would support further trials of this intervention.

 

Plain language summary

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  2. Abstract
  3. Plain language summary
  4. Resumen
  5. 摘要

Multicomponent fortification of human breast milk for preterm infants following hospital discharge

Preterm infants are often much smaller than term infants by the time that they are discharged home from hospital. This review attempted to identify trials that evaluated whether feeding these infants with breast milk fortified with added nutrients rather than unfortified breast milk would increase growth rates and benefit development. Only one small trial (in which 39 infants participated) of this intervention was found. This trial did provide some evidence that multinutrient fortification increases growth rates during infancy. Further trials are needed to confirm this finding and to determine long term effects on growth and development .

 

Resumen

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  2. Abstract
  3. Plain language summary
  4. Resumen
  5. 摘要

Antecedentes

Leche materna enriquecida con multinutrientes para lactantes prematuros después del alta hospitalaria

Generalmente, los lactantes prematuros presentan una limitación en el crecimiento al alta hospitalaria. La alimentación de los lactantes prematuros con leche materna enriquecida con nutrientes múltiples (en lugar de leche materna no enriquecida) después del alta hospitalaria puede facilitar la recuperación más rápida del crecimiento y mejorar los resultados del desarrollo nervioso.

Objetivos

Determinar el efecto de la alimentación con leche materna humana enriquecida con multinutrientes versus leche materna no enriquecida sobre el crecimiento y desarrollo de lactantes prematuros o de bajo peso al nacer después del alta hospitalaria.

Estrategia de búsqueda

Se utilizó la estrategia de búsqueda estándar del Grupo Cochrane de Neonatología (Cochrane Neonatal Review Group). Ésta incluyó búsquedas en el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (CENTRAL, The Cochrane Library, número 4, 2010), MEDLINE (1966 hasta abril 2010), EMBASE (1980 hasta abril 2010), CINAHL (1982 hasta abril 2010), en resúmenes de congresos y en revisiones previas.

Criterios de selección

Ensayos controlados aleatorios o cuasialeatorios que compararan el efecto de la alimentación de lactantes prematuros después del alta hospitalaria con leche materna enriquecida con nutrientes, comparada con la leche materna no enriquecida.

Obtención y análisis de los datos

Se utilizaron los métodos estándar del Grupo Cochrane de Neonatología y dos revisores realizaron por separado la evaluación de la calidad del ensayo y la extracción de los datos.

Resultados principales

Se identificó un pequeño ensayo (N = 39). El enriquecimiento con multinutrientes de la leche materna durante 12 semanas después del alta hospitalaria dio lugar a mayores tasas de crecimiento durante los primeros meses de vida. A los 12 meses de edad corregida, el peso (diferencia media 1187 g, intervalo de confianza [IC] del 95%: 259, 2115 g), la talla (3,8 cm; IC del 95%: 1,2 a 6,4 cm) y el perímetro cefálico (1,0 cm; IC del 95%: 0,1 a 1,9 cm) fueron estadísticamente más significativos en el grupo de intervención. No se encontró evidencia de un efecto sobre las evaluaciones del desarrollo nervioso a los 18 meses de edad corregida.

Conclusiones de los autores

Los datos limitados existentes sugieren que alimentar a los lactantes prematuros después del alta hospitalaria con leche materna enriquecida con multicomponentes, comparada con la leche materna no enriquecida, aumenta las tasas de crecimiento en los primeros meses de vida. La importancia de estos efectos sobre el crecimiento y desarrollo a largo plazo es incierta y merece evaluación adicional en ensayos controlados aleatorios. Dado que el enriquecimiento de la leche materna para los lactantes que se alimentan directamente de la mama es logísticamente difícil, y podría interferir con la lactancia materna, sería importante determinar si las madres apoyarían un ensayo de esta intervención.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

 

摘要

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

背景

早產兒出院後餵食含多重成分母奶添加劑的母奶

早產兒在出院時往往生長仍有限,出院後餵食含母奶添加劑的早產兒 (相對於無添加劑的母奶) 可能可以促進更快的追趕性生長以及改善神經發展上的預後。

目標

目的在確定對於早產或是低體重新生兒在出院後餵食有或無添加多重成分母奶添加劑的母奶在生長及神經發育上的影響。

搜尋策略

使用Cochrane Neonatal Review Group標準搜尋策略，包括 Cochrane Central Register of Controlled Trials (CENTRAL，The Cochrane Library， Issue 2,2007), CINAHL (1982May 2007) ，研討會記錄及在先前的回顧性文章。

選擇標準

隨機或半隨機的實驗來比較在出院後的早產兒餵食有母奶添加劑或不含母奶添加劑的母奶的差異。

資料收集與分析

使用Cochrane Neonatal Review Group標準方法，由兩位作者分別評估實驗的品質以及資料的選取。

主要結論

沒有合適的實驗被找到。

作者結論

沒有隨機試驗的資料來確定出院後的早產兒餵食有多重成分母奶添加劑或不含母奶添加劑的母奶對於生長及神經發展的差異。關於增加營養來影響生長及發展是值得被進一步探討的。在邏輯上對於直接親餵母乳的嬰兒要添加母奶添加劑是困難的 (也會影響母奶哺育) ，所以母親對於這樣試驗的影響能否接受就很重要了。試驗應該著重在沒有辦法按嬰兒需求直接由乳房哺餵母乳、生長或營養狀況不好或是需要額外代謝要求的嬰兒。

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

早產兒在出院時體重常常較足月兒小很多，這篇回顧性的文章是要找尋評估對於早產兒餵食添加營養的母奶添加劑的母奶相對於無母奶添加劑的母奶是否可以增加生長速率及促進發展.沒有相關的試驗被找到，對於這樣的試驗母親是否能接受不得而知。

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