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Multi‐nutrient fortification of human milk for preterm infants

Brown, Jennifer VE ; Embleton, Nicholas D ; Harding, Jane E ; McGuire, William ; McGuire, William

Cochrane database of systematic reviews, 2016-05, Vol.2016 (5), p.CD000343-CD000343 [Periódico revisado por pares]

Chichester, UK: John Wiley & Sons, Ltd

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  • Título:
    Multi‐nutrient fortification of human milk for preterm infants
  • Autor: Brown, Jennifer VE ; Embleton, Nicholas D ; Harding, Jane E ; McGuire, William ; McGuire, William
  • Assuntos: Child health ; Enteral Nutrition ; Feeding the low birthweight infant ; Food, Fortified ; Fortification of human milk ; Humans ; Infant Nutritional Physiological Phenomena ; Infant, Newborn ; Infant, Premature ; Infant, Premature - growth & development ; Medicine General & Introductory Medical Sciences ; Milk, Human ; Milk, Human - chemistry ; Neonatal care ; Nutrition and Metabolism in the High‐Risk Neonate ; Randomized Controlled Trials as Topic
  • É parte de: Cochrane database of systematic reviews, 2016-05, Vol.2016 (5), p.CD000343-CD000343
  • Notas: new_version
    ObjectType-Article-2
    SourceType-Scholarly Journals-1
    ObjectType-Feature-1
    ObjectType-Review-4
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    ObjectType-Undefined-3
  • Descrição: Background Exclusively breast milk‐fed preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with multi‐nutrient fortified human breast milk rather than unfortified breast milk may increase nutrient accretion and growth rates and may improve neurodevelopmental outcomes. Objectives To determine whether multi‐nutrient fortified human breast milk improves important outcomes (including growth and development) over unfortified breast milk for preterm infants without increasing the risk of adverse effects (such as feed intolerance and necrotising enterocolitis). Search methods We used the standard search strategy of the Cochrane Neonatal Review Group. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (until February 2016), as well as conference proceedings and previous reviews. Selection criteria Randomised and quasi‐randomised controlled trials that compared feeding preterm infants with multi‐nutrient (protein and energy plus minerals, vitamins or other nutrients) fortified human breast milk versus unfortified (no added protein or energy) breast milk. Data collection and analysis We extracted data using the standard methods of the Cochrane Neonatal Review Group. We separately evaluated trial quality, data extracted by two review authors and data synthesised using risk ratios (RRs), risk differences and mean differences (MDs). We assessed the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Main results We identified 14 trials in which a total of 1071 infants participated. The trials were generally small and weak methodologically. Meta‐analyses provided low‐quality evidence that multi‐nutrient fortification of breast milk increases in‐hospital rates of growth (MD 1.81 g/kg/d, 95% confidence interval (CI) 1.23 to 2.40); length (MD 0.12 cm/wk, 95% CI 0.07 to 0.17); and head circumference (MD 0.08 cm/wk, 95% CI 0.04 to 0.12). Only very limited data are available for growth and developmental outcomes assessed beyond infancy, and these show no effects of fortification. The data did not indicate other potential benefits or harms and provided low‐quality evidence that fortification does not increase the risk of necrotising enterocolitis in preterm infants (typical RR 1.57, 95% CI 0.76 to 3.23; 11 studies, 882 infants). Authors' conclusions Limited available data do not provide strong evidence that feeding preterm infants with multi‐nutrient fortified breast milk compared with unfortified breast milk affects important outcomes, except that it leads to slightly increased in‐hospital growth rates.
  • Editor: Chichester, UK: John Wiley & Sons, Ltd
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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