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

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

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

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

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