【Cochrane简语概要】个性化与标准膳食强化配方对早产儿生长发育的影响

综述问题

母乳喂养中个性化而不是标准的，非个性化的添加营养素和卡路里可以安全地改善早产儿的生长和其他结局吗？

背景

早产儿有出生后生长不良的危险。母乳可以降低他们患病的风险，但不能满足其营养需求。因此，母乳喂养的早产儿必须添加额外的营养素。强化母乳的常用方法对所有母乳和所有早产儿都是相同的。但是，有两种方法可以对每个早产儿进行个性化强化。有针对性的强化是根据母乳分析的结果向母乳中添加营养物质。可调节的强化配方根据早产儿实验室检查结果添加营养素。个性化的强化配方可能改善早产儿的生长或其他结局。然而，与标准方法相比，尚不清楚针对性的或可调性的强化是否安全或可改善早产儿的结局。

（图片来源于solacepediatrichealthcare.com）

研究特征

通过更新至2019年9月的文献搜索，我们发现有7项研究测试了针对早产儿母乳喂养的针对性强化或可调性强化与标准强化相比的效果，共发表了8篇文章（总共521名参与者参加了这些研究）。在我们的文献检索完成后发表的一项研究正在等待分类。

主要结果

与标准强化相比，针对性的或可调性的强化能改善早产儿的短期生长。确定定制母乳喂养的最佳方法是必要的，同时也要阐明母乳喂养的安全性和对其他临床结果的影响。

证据质量

极低到中等质量不等。中等质量意味着个性化的强化对早产儿生长的真实效果可能接近本综述的结果，但可能存在实质性差异。低质量意味着真实效果可能与本综述的结果有本质的不同。极低质量意味着个性化配方对早产儿生长的真实效果很可能与本综述的结果有本质不同。在本综述中证据质量被降级主要是因为纳入研究的参与者人数较少，并且纳入研究的设计和结局指标存在显着差异。

结论: 

我们发现中等到低质量的证据表明，与标准的非个性化强化相比，对极低出生体重的婴儿进行个性化（针对性或可调节）强化肠内喂养可增加干预期间的体重、身长和头围的生长速度。证据表明重要的住院和出院临床结果的证据很少，且质量很低，使不能得出关于安全性或短期生长以外的临床效益的推论。

原文作者：Fabrizio V, et al.

译者：秦茂洋，审校：刘琴，Cochrane中国协作网成员单位，重庆医科大学公共卫生与管理学院循证医学中心；编辑排版：张晓雯，Cochrane中国协作网成员单位，北京中医药大学循证医学中心

相关文章链接

【Cochrane Plain Language Summary】Individualized versus standard diet fortification for growth and development in very low birth weight infants receiving human milk

Review question: does individualized rather than standard, non-individualized addition of nutrients and calories to breast milk feeds safely improve growth and other outcomes in preterm infants?

Background: preterm infants are at risk for poor growth following birth. Breast milk reduces their risk of illness but does not meet their nutritional needs. Therefore, breast milk fed to preterm infants must be fortified with extra nutrients. Usual methods of fortifying breast milk treat all breast milk and all preterm infants the same. However, two methods are available for individualizing fortification for each preterm infant. Targeted fortification adds nutrients to breast milk based on the results of breast milk analysis. Adjustable fortification adds nutrients based on the results of preterm infant laboratory results. Individualized fortification may improve preterm infant growth or other outcomes. However, it is not known whether targeted or adjustable fortification is safe or improves outcomes for preterm infants compared with the standard method.

Study characteristics: through literature searches updated to September 2019, we found seven studies that tested the effects of targeted or adjustable fortification of breast milk feeds compared to standard fortification in preterm infants, yielding eight publications (521 total participants were enrolled in these studies). One study that was published after our literature search was completed is awaiting classification.

Key results: targeted or adjustable fortification improves short-term growth compared to standard fortification in preterm infants. Determining the best way to customize breast milk feeds is necessary, as is clarifying its safety and effects on other clinical outcomes.

Certainty of evidence: very low to moderate. Moderate certainty means that the true effect of individualized fortification on growth in preterm infants is likely to be close to the result of this review but there is a possibility that it is substantially different. Low certainty means that the true effect may be substantially different from the results of this review. Very low certainty means that the true effect of individualized fortification on growth in preterm infants is likely to be substantially different from the results of this review. Certainty of evidence was downgraded most often in this review due to small numbers of participants in included studies and significant differences in study design and outcome measures among included studies.

Authors' conclusions: 

We found moderate- to low-certainty evidence suggesting that individualized (either targeted or adjustable) fortification of enteral feeds in very low birth weight infants increases growth velocity of weight, length, and head circumference during the intervention compared with standard non-individualized fortification. Evidence showing important in-hospital and post-discharge clinical outcomes was sparse and of very low certainty, precluding inferences regarding safety or clinical benefits beyond short-term growth.

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