【Cochrane简语概要】早产儿或低出生体重儿的早期全肠内喂养
综述问题
当早产儿或低出生体重婴儿（出生早或体重小）在出生后不久就以母乳喂养所有营养物质，是否会长得更快，问题更少（与通过静脉滴注（通过静脉缓慢注入到血液中）喂食液体或营养物质的同时逐渐引入母乳喂养相比）？
（图片来自babycenter）
背景
“早期全肠内喂养”是指早产儿或低出生体重儿在出生后不久就以母乳喂养的方式获得全部营养，并且不通过静脉滴注获得任何补充液体或营养。评估这种方法是否安全有益，尤其适用于喂养极早产或极低出生体重婴儿（出生在32周之前，或出生体重低于1500克）。
研究特征
我们纳入了六项试验，均在2010年代在印度的新生儿护理中心进行。尽管大多数试验规模较小（总共涉及526名婴儿），但这些试验的质量普遍良好。受试者是出生体重1000克至1500克的早产儿。
文献检索截止至2020年7月。
主要结果
没有足够的数据表明，从一出生就接受完全母乳喂养的婴儿是否比那些在出生后的头一两周内逐渐接受母乳喂养的婴儿体重增加和生长更快。这些试验并未报告关于早期全奶喂养可能对婴儿以后的发育和生长有影响的信息。纳入的试验没有发现早期全奶喂养的其他潜在益处或伤害，包括对喂养或肠道问题的任何影响。
结论
没有足够的证据来确定早期全奶喂养是否有益于早产儿或低出生体重儿。还需开展新的试验来解决这种不确定性。
证据质量
我们将这些证据评估为低质量或极低质量，因为纳入的试验规模小，存在一些方法学上的缺陷，而且它们的发现彼此不一致。这意味着进一步的研究很可能对效果的估计以及我们对研究结果的信心产生重要影响。
作者结论:
由于试验提供的数据不足，无法确定与延迟或逐步引入肠内喂养相比，早期完全肠内喂养对早产儿或低出生体重儿生长的影响。我们不确定早期全肠内喂养是否会影响坏死性小肠结肠炎的发生风险，因为试验存在偏倚风险（由于缺乏盲法）、不一致性和不精确性。
作者:Walsh V, Brown JV, Copperthwaite BR, Oddie SJ, McGuire W；译者：吴文懿；审校：刘琴，重庆医科大学公共卫生与管理学院循证医学中心 Cochrane中国协作网成员单位 The Cochrane China Network Affiliate，School of Public Health and Management, Chongqing Medical University；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】
Early full enteral feeds for preterm or low birth weight infants
Review question
do preterm or low birth weight infants (babies born early or small) grow faster and have fewer problems when they receive all their nutrients as milk feeds from shortly after birth (compared with gradually introducing milk feeds while giving fluid or nutrients via an intravenous drip (a slow infused into the bloodstream via a vein))?
Background
'early full enteral feeding' means that preterm or low birth weight infants receive all their nutrition as milk feeds from shortly after birth, and do not receive any supplemental fluids or nutrition via intravenous drips. Assessing whether this approach is safe and beneficial is particularly relevant to feeding very preterm or very low birth weight infants (born before 32 weeks, or birth weigh less than 1500 g).
Study characteristics: we included six trials, all undertaken in neonatal care units in India during the 2010s. The trials were generally good quality although most were small (involving 526 infants in total). Participants were preterm infants of birth weight 1000 g to 1500 g.
The search is up to date as of July 2020.
Key results
there were insufficient data to show whether infants who received full milk feeds from birth put on weight and grew more quickly than those for whom feeds were introduced gradually during the first week or two after birth. The trials reported no information about the effects early full milk feeds might have on development and growth later in the baby's life. The included trials found no evidence of other potential benefits or harms of early full feeds, including any effects on feeding or bowel problems.
Conclusion
there is not enough evidence to determine whether early full milk feeds benefit preterm or low birth weight infants. New trials would be needed to resolve this uncertainty.
Quality of evidence
we assessed this evidence as being of low or very low quality because the included trials were small with some methodological weaknesses and their findings were inconsistent with each other. This means that further research is very likely to have an important impact on the estimates of effect and our confidence in the findings.
Authors' conclusions:
There is little research focusing specifically on healthcare workers' perceptions and experiences of communication with older adults about vaccination. The studies we identified suggest that healthcare workers differed among themselves in their perceptions about the aim of this communication and about the role of older adults in vaccine decisions. Based on these findings and the other findings in our review, we have developed a set of questions or prompts that may help health system planners or programme managers when planning or implementing strategies for vaccination communication between healthcare workers and older adults.
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