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Carbohydrate supplementation of human milk to promote growth in preterm infants

Harding, Jane E ; Amissah, Emma A ; Brown, Julie ; Harding, Jane E

Cochrane database of systematic reviews, 2020-09, Vol.2020 (10), p.CD000280-CD000280 [Periódico revisado por pares]

Chichester, UK: John Wiley & Sons, Ltd

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  • Título:
    Carbohydrate supplementation of human milk to promote growth in preterm infants
  • Autor: Harding, Jane E ; Amissah, Emma A ; Brown, Julie ; Harding, Jane E
  • Assuntos: Body Weight ; Child health ; Dietary Carbohydrates ; Dietary Carbohydrates - administration & dosage ; Dietary Supplements ; Enteral Nutrition ; Enterocolitis, Necrotizing ; Enterocolitis, Necrotizing - epidemiology ; Feeding the low birthweight infant ; Feeding the preterm infant ; Food Intolerance ; Food Intolerance - epidemiology ; Fortification of human milk ; Humans ; Infant Nutritional Physiological Phenomena ; Infant, Newborn ; Infant, Premature ; Infant, Premature - growth & development ; Length of Stay ; Medicine General & Introductory Medical Sciences ; Milk, Human ; Milk, Human - chemistry ; Neonatal care ; Nutrition and Metabolism in the High-Risk Neonate ; Oligosaccharides ; Oligosaccharides - administration & dosage ; Prebiotics
  • É parte de: Cochrane database of systematic reviews, 2020-09, Vol.2020 (10), p.CD000280-CD000280
  • Notas: new_version
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  • Descrição: Background Preterm infants are born with low glycogen stores and require higher glucose intake to match fetal accretion rates. In spite of the myriad benefits of breast milk for preterm infants, it may not adequately meet the needs of these rapidly growing infants. Supplementing human milk with carbohydrates may help. However, there is a paucity of data on assessment of benefits or harms of carbohydrate supplementation of human milk to promote growth in preterm infants. This is a 2020 update of a Cochrane Review first published in 1999. Objectives To determine whether human milk supplemented with carbohydrate compared with unsupplemented human milk fed to preterm infants improves growth, body composition, and cardio‐metabolic and neurodevelopmental outcomes without significant adverse effects. Search methods We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL 2019, Issue 8) in the Cochrane Library and MEDLINE via PubMed on 22 August 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi‐randomised trials. Selection criteria Published and unpublished controlled trials were eligible if they used random or quasi‐random methods to allocate preterm infants in hospital fed human milk to supplementation or no supplementation with additional carbohydrate. Data collection and analysis Two review authors independently ed data and assessed trial quality and the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. We planned to perform meta‐analyses using risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data, with their respective 95% confidence intervals (CIs). We planned to use a fixed‐effect model and to explore potential causes of heterogeneity via sensitivity analyses. We contacted study authors for additional information. Main results One unblinded, quasi‐randomised controlled trial (RCT) assessing effects of carbohydrate supplementation of human milk in the form of a prebiotic in 75 preterm infants was eligible for inclusion in this review. We identified two publications of the same trial, which reported different methods regarding blinding and randomisation. Study authors confirmed that these publications pertain to the same trial, but they have not yet clarified which method is correct. Our analyses showed very low certainty evidence of an effect of carbohydrate supplementation on weight by 30 days of age age (MD 160.4 grams, 95% CI 12.4 to 308.4 grams), and no effect on risk of feeding intolerance (RR 0.64, 95% CI 0.36 to 1.15) or necrotising enterocolitis (NEC) (RR 0.2, 95% CI 0.02 to 1.3). Duration of hospital stay was shorter in the prebiotic group than in the control group (median difference 9 days). No data were available for assessing effects of carbohydrate supplementation on long‐term growth and neurodevelopment. Authors' conclusions We are uncertain whether carbohydrate supplementation of human milk affects any outcomes in preterm infants. The only trial included in this review presented very low‐quality evidence, and study authors provided uncertain information about study methods and analysis. The evidence may be limited in its applicability because researchers included a small sample of preterm infants from a single centre. Future trials could assess the safety and efficacy of different types and concentrations of carbohydrate supplementation for preterm infants fed human milk. However, we do not envisage that further trials of digestible carbohydrates will be conducted, as this is currently done as a component of multi‐nutrient human milk fortification.
  • Editor: Chichester, UK: John Wiley & Sons, Ltd
  • Idioma: Inglês
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