鑽石舞台

系統綜述問題

我們評價了相關證據，以確定在餵養早產兒的母乳中添加額外的脂肪（作為補充劑）與不添加額外脂肪相比，是否能改善生長、體脂、肥胖、心臟問題、高血糖和大腦發育，而沒有明顯的副作用。

（圖片來自zhuanlan.zhihu.com）

研究背景

早產兒在出生時缺乏足夠的脂肪儲備，因為他們是在妊娠晚期快速生長階段儲存營養物質之前出生的。因此，與足月的同齡兒相比，早產兒需要更高的脂肪攝入量才能充分滿足生長和發育需要。脂肪提供了母乳中大約一半的熱量，並支持生長和大腦發育。雖然母乳對早產兒有很多好處，但母乳中脂肪含量不穩定，數量不足，不能保證嬰兒的正常生長和發育。母乳餵養的早產兒脂肪供應不足可能會對其生長發育產生不利影響。因此，可以在母乳中添加額外的脂肪，通常是通過在少量（如20毫升）的母乳中添加商業製備的脂肪混合物。

研究特徵

我們納入了一項證據質量極低的試驗，涉及14名早產兒。檢索時間截至2019年8月。

主要結果

在母乳中添加額外的脂肪對早產兒的短期體重增長、體長增長和頭部生長沒有明顯的益處。沒有證據表明添加了額外的脂肪會增加餵養不耐受的風險。沒有數據表明添加額外脂肪對長期生長、體脂、肥胖、高血糖或腦發育有影響。評估副作用的數據也很有限。

結論

沒有足夠的高質量證據證明在母乳中添加額外脂肪對早產兒的益處和傷害，也沒有長期結局的報告。由於目前在母乳中添加額外脂肪是多營養強化的一部分，今後的試驗應評估脂肪成份對短期和長期生長、體脂、肥胖、高血糖或大腦發育的影響。還應評估所需額外脂肪的含量和成份、副作用和添加方法。

作者:Amissah EA, Brown J, Harding JE；譯者：秦茂洋；審校：劉琴，重慶醫科大學公共衛生與管理學院循證醫學中心 Cochrane中國協作網成員單位，The Cochrane China Network Affiliate School of Public Health and Management, Chongqing Medical University；編輯排版：索于思，北京中醫藥大學循證醫學中心

相關文章鏈接

【Cochrane簡語概要】早產兒或低出生體重兒的早期全腸內餵養

【Cochrane簡語概要】早產兒母乳餵養養成期間避免使用奶瓶

【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.