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Fat supplementation of human milk for promoting growth in preterm infants

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

Cochrane database of systematic reviews, 2020-08, Vol.2020 (10), p.CD000341-CD000341 [Periódico revisado por pares]

Chichester, UK: John Wiley & Sons, Ltd

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  • Título:
    Fat supplementation of human milk for promoting growth in preterm infants
  • Autor: Harding, Jane E ; Amissah, Emma A ; Brown, Julie ; Harding, Jane E
  • Assuntos: Child health ; Complementary & alternative medicine ; Dietary Fats ; Dietary Fats - administration & dosage ; Dietary Supplements ; Enteral Nutrition ; Feeding the low birthweight infant ; Fortification of human milk ; Humans ; Infant Nutritional Physiological Phenomena ; Infant, Newborn ; Infant, Premature ; Infant, Premature - growth & development ; Medicine General & Introductory Medical Sciences ; Milk, Human ; Neonatal care ; Nutrition and Metabolism in the High-Risk Neonate
  • É parte de: Cochrane database of systematic reviews, 2020-08, Vol.2020 (10), p.CD000341-CD000341
  • Notas: new_version
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  • Descrição: Background As preterm infants do not experience the nutrient accretion and rapid growth phase of the third trimester of pregnancy, they are vulnerable to postnatal nutritional deficits, including of fat. Consequently, they require higher fat intakes compared to their full term counterparts to achieve adequate growth and development. Human milk fat provides the major energy needs of the preterm infant and also contributes to several metabolic and physiological functions. Although human milk has many benefits for this population, its fat content is highly variable and may be inadequate for their optimum growth and development. This is a 2020 update of a Cochrane Review last published in 2000. Objectives To determine whether supplementation of human milk with fat compared with unsupplemented human milk fed to preterm infants improves growth, body composition, 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 23 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 randomised controlled trials were eligible if they used random or quasi‐random methods to allocate preterm infants fed human milk in hospital to supplementation or no supplementation with additional fat. Data collection and analysis No new randomised controlled trials matching the selection criteria were found but we extracted data from the previously included trial due to changes in review outcomes from when the protocol was first published. Two reviewers independently ed data, assessed trial quality, and the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. We planned to perform meta‐analyses using risk ratio (RR) for dichotomous data and mean difference (MD) 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. Main results One randomised trial involving 14 preterm infants was included. This risk of bias was unclear for all methodological domains. Very low‐quality evidence means that there is uncertainty about the effect of fat supplemention on in‐hospital rates of growth in weight (MD 0.6 g/kg/day, 95% CI −2.4 to 3.6; 1 RCT, n = 14 infants,), length (MD 0.1 cm/week, 95% CI −0.08 to 0.3; 1 RCT, n = 14 infants) and head circumference (MD 0.2 cm/week, 95% CI −0.07 to 0.4; 1 RCT n = 14 infants), and on the risk of feeding intolerance (RR 3.0, 95% CI 0.1 to 64.3; 1 RCT, n = 16 infants). No data were available regarding the effects of fat supplementation on the risk of necrotising enterocolitis or neurodevelopmental outcomes. Authors' conclusions The one included trial suggests no evidence of an effect of fat supplementation of human milk on short‐term growth and feeding intolerance in preterm infants. However, the very low‐quality evidence, small sample size, few events, and low precision diminishes our confidence that these results reflect the true effect of fat supplementation of human milk in preterm infants, and no long‐term outcomes were reported. Further high‐quality research should evaluate the effect on growth, neurodevelopmental and cardio‐metabolic outcomes in the context of the development of multicomponent fortifiers.
  • Editor: Chichester, UK: John Wiley & Sons, Ltd
  • Idioma: Inglês
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