【Cochrane简语概要】母乳补充脂肪以促进早产儿生长

系统综述问题

我们评价了相关证据，以确定在喂养早产儿的母乳中添加额外的脂肪（作为补充剂）与不添加额外脂肪相比，是否能改善生长、体脂、肥胖、心脏问题、高血糖和大脑发育，而没有明显的副作用。

（图片来自zhuanlan.zhihu.com）

研究背景

早产儿在出生时缺乏足够的脂肪储备，因为他们是在妊娠晚期快速生长阶段储存营养物质之前出生的。因此，与足月的同龄儿相比，早产儿需要更高的脂肪摄入量才能充分满足生长和发育需要。脂肪提供了母乳中大约一半的热量，并支持生长和大脑发育。虽然母乳对早产儿有很多好处，但母乳中脂肪含量不稳定，数量不足，不能保证婴儿的正常生长和发育。母乳喂养的早产儿脂肪供应不足可能会对其生长发育产生不利影响。因此，可以在母乳中添加额外的脂肪，通常是通过在少量（如20毫升）的母乳中添加商业制备的脂肪混合物。

研究特征

我们纳入了一项证据质量极低的试验，涉及14名早产儿。检索时间截至2019年8月。

主要结果

在母乳中添加额外的脂肪对早产儿的短期体重增长、体长增长和头部生长没有明显的益处。没有证据表明添加了额外的脂肪会增加喂养不耐受的风险。没有数据表明添加额外脂肪对长期生长、体脂、肥胖、高血糖或脑发育有影响。评估副作用的数据也很有限。

结论

没有足够的高质量证据证明在母乳中添加额外脂肪对早产儿的益处和伤害，也没有长期结局的报告。由于目前在母乳中添加额外脂肪是多营养强化的一部分，今后的试验应评估脂肪成份对短期和长期生长、体脂、肥胖、高血糖或大脑发育的影响。还应评估所需额外脂肪的含量和成份、副作用和添加方法。

作者结论: 

纳入的这一项试验显示，没有证据表明添加脂肪的母乳对早产儿的短期生长和喂养不耐受有影响。然而，证据质量极低、样本量小、事件数少和精确度低，都减弱了我们的信心，这些结果反映了添加了脂肪的母乳对早产儿的真实效果，并且没有报告长期结局。进一步的高质量研究应评估在多成份强化剂发展背景下对生长、神经发育和心脏代谢结局指标的影响。

作者:Amissah EA, Brown J, Harding JE；译者：秦茂洋；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】

Fat supplementation of human milk for promoting growth in preterm infants

Review question

We reviewed the evidence to determine whether addition of extra fat (supplements) to human milk fed to infants born early (preterm) compared with no additional fat improves growth, body fat, obesity, heart problems, high blood sugar, and brain development, without significant side effects.

Background

Preterm babies at birth lack adequate fat stores because they are born before laying down nutrient stores in the rapid growth phase of the third trimester of pregnancy. Consequently, they require higher fat intakes compared to their full term counterparts to achieve adequate growth and development. Fat provides approximately half of the calories in human milk and supports growth and brain development. Although human milk has many benefits for the preterm baby, it may contain variable and insufficient quantities of fat for adequate growth and development. Inadequate supply of fat in preterm infants fed human milk may adversely affect their growth and development. Therefore, additional fat may be added to human milk, usually by adding commercially prepared fat mixtures to a small amount (e.g. 20 mL) of expressed breast milk.

Study characteristics

We included one trial with very low-quality evidence and involving 14 preterm infants. The search is up to date as of August 2019.

Key results

Addition of extra fat to human milk for preterm infants showed no clear benefits with regards to short-term rates of weight gain, length gain, and head growth. There was no evidence that the extra fat increased the risk of feeding intolerance. No data were available regarding the effects of addition of extra fat on long-term growth, body fat, obesity, high blood sugar, or brain development. There were also limited data to assess side effects.

Conclusions

There was insufficient high-quality evidence on the benefits and harms of the addition of extra fat to human milk in preterm infants, and no long-term outcomes have been reported. Since addition of extra fat to human milk is currently done as part of multi-nutrient fortification, future trials should evaluate the effect of the fat component on short- and long-term growth, body fat, obesity, high blood sugar, or brain development. The right amount and composition of extra fat needed, side effects, and delivery practices should also be evaluated.

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.

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