早产儿喂养标准奶粉和配方奶粉的比较
水解奶粉被认为可减少食物不耐受和坏死性肠炎的发生率，因此尽管价格较高，使用量仍在增加。本研究通过整合多项临床数据，发现水解奶粉在降低食物不耐受、坏死性肠炎的发病率方面没有优势，反而可能抑制体重增加。作者在总结研究成果的同时，也归纳了本研究数据量较小、缺少长期跟踪和特殊病例追踪的局限性，对研究配方奶粉对婴儿健康的影响具有参考价值，值得专业人士关注。
论文摘要
This JAMA Clinical Evidence Synopsis summarizes a Cochrane review1regarding hydrolyzed formula compared with stan- dard formula for preterm infants. When human milk is not avail- able for preterm infants, hydrolyzed formula is increasingly used as an alternative to standard cow’s milk formula. Hydrolyzed for- mula is perceived as better tolerated and less likely to lead to seri- ous complications such as necrotizing enterocolitis. However, hydrolyzed formulas are more expensive than standard formulas, and concern exists that their use in practice is not supported by high-quality evidence.2
Feeding hydrolyzed formulas to preterm infants was not associated with a lower risk of feeding intolerance defined as (1) a high mean prefeeding gastric residual volume necessi- tating enteral feeding discontinuation or (2) abdominal dis- tention or other concerning gastrointestinal signs (3/82 for hydrolyzed formula [3.7%] vs 1/79 for nonhydrolyzed formula [1.3%]; risk ratio [RR], 2.71 [95% CI, 0.29 to 25.00]; P = .38). There was no association of formula type with necrotizing enterocolitis (6/199 for hydrolyzed formula [3.0%] vs 5/186 for nonhydrolyzed formula [2.7%]; RR, 1.10 [95% CI, 0.36 to 3.34]; P = .87) (Figure).
Hydrolyzed formula was associated with slower weight gain (mean between-group difference, −3.0 g/kg/d [95% CI, −4.7 to −1.4 g/kg/d]). There were no associations of formula type with bone mineralization (serum alkaline phosphatase level at 36 to 40 weeks’ postmenstrual age: 371 U/L for hydrolyzed formula vs 387.6 U/L for nonhydrolyzed formula; mean between-group difference, 16.6 U/L [95% CI, −34.1 to 67.4 U/L]). No trials reported mortality rates, growth and neuro- developmental outcomes, or risk of allergy or atopy beyond the initial hospital admission.
实验综述
① 汇总11项随机临床数据、纳入665名早产儿的研究发现，与标准配方奶粉相比，水解配方奶粉未能减少早产儿对食物的不耐受和坏死性肠炎的发生率；
② 水解配方奶粉喂养与早产儿体重增长缓慢有关，与骨质钙化情况无关；
③ 本研究的样本量难以评估与食物不耐受、坏死性肠炎相关的轻微症状的临床意义；
④ 奶粉类型的长期影响尚不明确，也不能确定是否影响具有特定疾病或术后状况早产儿的健康状况；
⑤ 目前缺乏推荐水解配方奶粉喂养早产儿的国际共识。