【Cochrane简语概要】早产儿母乳喂养养成期间避免使用奶瓶

综述问题

对于那些母亲想用母乳喂养的早产儿来说，使用奶瓶会干扰母乳喂养的成功吗？

（图片来自usmama.com）

背景

早产儿起初通过管饲喂奶，随着他们长大，便可以通过吮吸的方式进食。随着宝宝发育成熟，每天的吸吮次数会逐渐增加。在婴儿每次需要吸吮进食母乳时，早产儿的母亲可能并不总在医院。按照惯例，会用瓶装母乳或配方奶来替代。有人猜测，使用奶瓶可能会干扰母乳喂养的成功。

研究特征

我们找到了七项符合纳入条件的研究（涉及1152名早产儿）。这些研究的规模为小到中等，大多数在研究设计或实施方面存在问题。检索日期截至2020年6月18日。

关键结果

有五项研究（其中纳入了两项规模最大的研究）用杯子喂养，有一项研究使用管饲。有一项研究使用了一种特殊设计的奶嘴，其喂食动作与传统的奶瓶喂养相比，与母乳喂养更为相似。大多数研究是在高收入国家进行的，只有两项研究在中等收入国家进行，而没有研究在低收入国家进行。总体而言，如不使用奶瓶喂养（传统奶嘴的奶瓶），婴儿更可能在出院回家时以及在出院回家后的三个月和六个月内获得全母乳喂养或至少进行些母乳喂养。而使用特殊设计奶嘴的研究表明，其与使用母乳喂养的结局没有差异，因此单独使用杯子喂养或单独使用管饲，提高了母乳喂养率。然而，由于单独使用管饲的研究质量低，我们无法确定单独使用管饲对母乳喂养进行补充的方法是否会改善母乳喂养结局。我们没有在任何报告结局中，包括住院时间长短或体重增加，发现有关获益或伤害的证据。

结论

使用杯子代替奶瓶喂养可以提高早产儿出院后长达6个月的全母乳喂养和（任何）母乳喂养的程度与持续时间。应对单独使用管饲的方法进行进一步的高质量研究。

证据质量

这些结果质量为低到中等。

作者结论: 

当早产儿需要补充喂养时，避免使用奶瓶可能会提高出院时母乳喂养的程度，并可能在出院后6个月内提高（任何）母乳喂养和全母乳喂养的程度。大多数证明获益的证据是用杯子喂养的。只有一项研究使用了管饲。我们不确定单独使用管饲补充母乳，是否会改善母乳喂养结局，需要进一步的高质量证据以确定这一点。

作者:Allen E, Rumbold AR, Keir A, Collins CT, Gillis J, Suganuma H；译者：杨雯珺，北京中医药大学人文学院；审校：温海煜，北京中医药大学人文学院；编辑排版：索于思，北京中医药大学循证医学中心

相关文章链接

【Cochrane Plain Language Summary】

Avoidance of bottles during the establishment of breastfeeds in preterm infants

Review question

In preterm infants whose mothers want to breastfeed, does using bottles interfere with breastfeeding success?

Background

Preterm infants start milk feeds by tube, and as they mature they are able to manage sucking feeds. The number of sucking feeds each day is gradually increased as the baby matures. Women with preterm infants may not always be in hospital every time the baby needs a sucking feed. Conventionally, bottles with mother's milk or formula have been used. It has been suggested that using bottles may interfere with breastfeeding success.

Study characteristics

We found seven eligible studies (involving 1152 preterm babies). These studies were of small to moderate size, and most had some problems with study design or conduct. The search is up to date as of 18 June 2020.

Key results

Five studies (which included two of the largest studies) used cup feeds, and one used tube feeds. One study used a specially designed teat with feeding action suggested to be more like breastfeeding than conventional bottle feeding. Most studies were conducted in high-income countries, only two in middle-income countries and none in low-income countries. Overall if bottle feeds (with a conventional teat) were not given, babies were more likely to be fully breastfed or to have at least some breastfeeds on discharge home and at three and six months postdischarge home. The study with the specially designed teat showed no difference in breastfeeding outcomes, so it was the cup alone or the tube alone that improved breastfeeding rates. However, because of the poor quality of the tube alone study, we are uncertain whether a tube alone approach to supplementing breastfeeds improves breastfeeding outcomes. We found no evidence of benefit or harm for any of the reported outcomes, including length of hospital stay or weight gain.

Conclusions

Using a cup instead of a bottle increases the extent and duration of full and any breastfeeding in preterm infants up to six months postdischarge. Further high-quality studies of the tube alone approach should be undertaken.

Certainty of evidence

We have low to moderate confidence in these results.

Authors' conclusions: 

Avoiding the use of bottles when preterm infants need supplementary feeds probably increases the extent of any breastfeeding at discharge, and may improve any and full breastfeeding (exclusive) up to six months postdischarge. Most of the evidence demonstrating benefit was for cup feeding. Only one study used a tube feeding strategy. We are uncertain whether a tube alone approach to supplementing breastfeeds improves breastfeeding outcomes; further studies of high certainty are needed to determine this.

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