Effect of adjustable fortification on feeding during preterm hospitalization: a meta-analysis_West China Medical Journal

Authors：

TAN Jilei ,  WEI Qin , HUANG Xiaobo , FENG Zhaoyan , SONG Jingwen

Nursing Department, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P. R. China;

Corresponding?author：

WEI Qin, Email: 1605994712@qq.com

Keywords：

Adjustable fortification; premature infant; feeding effect; meta-analysis

DOI：

10.7507/1002-0179.202004482

Video：

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Objective To systematically review the effect of adjustable fortification on feeding during preterm hospitalization. Methods We searched Cochrane Library, Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang, Chongqing VIP for clinical controlled trials about adjustable fortification in premature infants. The retrieval time limit was from the establishment of each database to September 2022. We selected studies according to inclusion and exclusion criteria, extracted data and assessed their quality, then used RevMan5.3 for analysis. Results A total of 5 randomized controlled studies, 1 historical controlled study and 3 case-control studies were included, including 750 premature infants. Meta-analysis results showed that compared with the standard fortification group, the differences of body weight growth rate [mean difference (MD)=1.61 g/(kg·d), 95% confidence interval (CI) (0.73, 2.49) g/(kg·d), P=0.0003], body length growth rate [MD=0.15 cm/week, 95%CI (0.01, 0.29) cm/week, P=0.04], head circumference growth rate [MD=0.19 cm/week, 95%CI (0.06, 0.31) cm/week, P=0.003], incidence rate of necrotizing enterocolitis [relative risk (RR)=0.23, 95%CI (0.07, 0.75), P=0.01] were statistically significant in the adjustable fortification group. There was no significant difference in the incidence of feeding intolerance between the two groups [RR=0.58, 95%CI (0.31, 1.11), P=0.10]. Conclusion Adjusted fortification has a positive role in promoting the physical development of premature infants without increasing the incidence of feeding intolerance and necrotizing enterocolitis. When the growth of premature infants is poor after using standard fortification, adjustable fortification can be considered. However, due to the lack of included literature, more large sample, high-quality randomized controlled studies are needed in the future to further verify the feeding effect of adjustable fortification on premature infants.

Citation： TAN Jilei, WEI Qin, HUANG Xiaobo, FENG Zhaoyan, SONG Jingwen. Effect of adjustable fortification on feeding during preterm hospitalization: a meta-analysis. West China Medical Journal, 2022, 37(11): 1678-1685. doi: 10.7507/1002-0179.202004482 Copy

1.	Liao WL, Lin MC, Wang TM, et al. Risk factors for postdischarge growth retardation among very-low-birth-weight infants: a nationwide registry study in Taiwan. Pediatr Neonatol, 2019, 60(6): 641-647.
2.	蔡威, 湯慶婭, 王瑩, 等. 中國新生兒營養支持臨床應用指南. 臨床兒科雜志, 2013(12): 1177-1182.
3.	何必子, 孫秀靜, 全美盈, 等. 早產母乳營養成分的分析. 中國當代兒科雜志, 2014, 16(7): 679-683.
4.	Kumar RK, Singhal A, Vaidya U, et al. Optimizing nutrition in preterm low birth weight infants-consensus summary. Front Nutr, 2017, 4: 20.
5.	早產兒母乳強化劑使用專家共識工作組, 中華新生兒科雜志編輯委員會. 早產兒母乳強化劑使用專家共識. 中華新生兒科雜志(中英文), 2019, 34(5): 321-328.
6.	Moro GE, Minoli I, Ostrom M, et al. Fortification of human milk: evaluation of a novel fortification scheme and of a new fortifier. J Pediatr Gastroenterol Nutr, 1995, 20(2): 162-172.
7.	邵肖梅, 葉鴻瑁, 丘小汕. 實用新生兒學. 5 版. 北京: 人民衛生出版社, 2019.
8.	Michaelis R, Tang V, Wagner JL, et al. Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life. Epilepsia, 2018, 59(2): 315-332.
9.	Arslanoglu S, Moro GE, Ziegler EE. Adjustable fortification of human milk fed to preterm infants: does it make a difference?. J Perinatol, 2006, 26(10): 614-621.
10.	王書煥, 劉戈力, 劉楊, 等. 個性化添加母乳強化劑對母乳喂養早產兒生長發育的影響. 中國兒童保健雜志, 2019, 27(2): 194-197.
11.	全美盈. 精準指導早產兒個體化母乳喂養的臨床研究;超低出生體重兒營養支持策略及出院后隨訪的臨床研究. 北京: 北京協和醫學院, 2017.
12.	鄧震平, 陳倩, 林寧, 等. 個性化添加母乳強化劑對低體質量早產兒生長發育影響的觀察. 中國臨床新醫學, 2019, 12(10): 1135-1138.
13.	Alan S, Atasay B, Cakir U, et al. An intention to achieve better postnatal in-hospital-growth for preterm infants: adjustable protein fortification of human milk. Early Hum Dev, 2013, 89(12): 1017-1023.
14.	Dorum BA, Ozkan H, Cakir SC, et al. What should be the protein target for adjustable Human Milk fortification in premature infants?. Pak J Med Sci, 2019, 35(1): 277-281.
15.	侯紅梅, 金未來, 張盼, 等. 個性化添加母乳強化劑對早產兒生長發育的影響. 深圳中西醫結合雜志, 2021, 31(18): 13-15.
16.	吳玉秀, 張永峰, 張嘉琦, 等. 調整性母乳強化對支氣管肺發育不良早產兒生長發育的近期影響. 濰坊醫學院學報, 2022, 44(1): 68-71.
17.	Cormack BE, Embleton ND, van Goudoever JB, et al. Comparing apples with apples: it is time for standardized reporting of neonatal nutrition and growth studies. Pediatr Res, 2016, 79(6): 810-820.
18.	Arslanoglu S, Boquien CY, King C, et al. Fortification of human milk for preterm infants: update and recommendations of the European Milk Bank Association (EMBA) Working Group on human milk fortification. Front Pediatr, 2019, 7: 76.
19.	桑田, 王穎, 胡秀麗, 等. 極低出生體重兒體格發育與神經發育關系的研究. 中國新生兒科雜志, 2016, 31(3): 161-167.
20.	趙小朋, 周偉, 宋燕燕, 等. 極低出生體重兒神經系統發育與早期營養的關系. 中國新生兒科雜志, 2016, 31(2): 101-104.
21.	丁文雯, 向奕瑾, 馬佳莉, 等. 極低出生體重早產兒校正月齡 12 個月內體格生長情況及影響因素分析. 中華護理雜志, 2019, 54(1): 52-57.
22.	莊思齊. 中國新生兒營養支持臨床應用指南(2013 年更新版)解讀. 臨床兒科雜志, 2014(9): 801-803.
23.	郝麗紅, 王艷, 楊秋凌, 等. 強化母乳喂養對促進早產兒生長發育的臨床觀察. 中國兒童保健雜志, 2015, 23(10): 1063-1066.
24.	蔣靜, 李開云, 周云, 等. 強化母乳喂養在 NICU 住院早產低出生體質量兒中的應用研究. 重慶醫學, 2014(35): 4731-4733,4736.
25.	Maas C, Mathes M, Bleeker C, et al. Effect of increased enteral protein intake on growth in human milk-fed preterm infants: a randomized clinical trial. JAMA Pediatr, 2017, 171(1): 16-22.
26.	Agostoni C, Buonocore G, Carnielli VP, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr, 2010, 50(1): 85-91.
27.	Mathes M, Maas C, Bleeker C, et al. Effect of increased enteral protein intake on plasma and urinary urea concentrations in preterm infants born at <32 weeks gestation and?<1500 g birth weight enrolled in a randomized controlled trial - a secondary analysis. BMC Pediatr, 2018, 18(1): 154.

1. Liao WL, Lin MC, Wang TM, et al. Risk factors for postdischarge growth retardation among very-low-birth-weight infants: a nationwide registry study in Taiwan. Pediatr Neonatol, 2019, 60(6): 641-647.
2. 蔡威, 湯慶婭, 王瑩, 等. 中國新生兒營養支持臨床應用指南. 臨床兒科雜志, 2013(12): 1177-1182.
3. 何必子, 孫秀靜, 全美盈, 等. 早產母乳營養成分的分析. 中國當代兒科雜志, 2014, 16(7): 679-683.
4. Kumar RK, Singhal A, Vaidya U, et al. Optimizing nutrition in preterm low birth weight infants-consensus summary. Front Nutr, 2017, 4: 20.
5. 早產兒母乳強化劑使用專家共識工作組, 中華新生兒科雜志編輯委員會. 早產兒母乳強化劑使用專家共識. 中華新生兒科雜志(中英文), 2019, 34(5): 321-328.
6. Moro GE, Minoli I, Ostrom M, et al. Fortification of human milk: evaluation of a novel fortification scheme and of a new fortifier. J Pediatr Gastroenterol Nutr, 1995, 20(2): 162-172.
7. 邵肖梅, 葉鴻瑁, 丘小汕. 實用新生兒學. 5 版. 北京: 人民衛生出版社, 2019.
8. Michaelis R, Tang V, Wagner JL, et al. Cochrane systematic review and meta-analysis of the impact of psychological treatments for people with epilepsy on health-related quality of life. Epilepsia, 2018, 59(2): 315-332.
9. Arslanoglu S, Moro GE, Ziegler EE. Adjustable fortification of human milk fed to preterm infants: does it make a difference?. J Perinatol, 2006, 26(10): 614-621.
10. 王書煥, 劉戈力, 劉楊, 等. 個性化添加母乳強化劑對母乳喂養早產兒生長發育的影響. 中國兒童保健雜志, 2019, 27(2): 194-197.
11. 全美盈. 精準指導早產兒個體化母乳喂養的臨床研究;超低出生體重兒營養支持策略及出院后隨訪的臨床研究. 北京: 北京協和醫學院, 2017.
12. 鄧震平, 陳倩, 林寧, 等. 個性化添加母乳強化劑對低體質量早產兒生長發育影響的觀察. 中國臨床新醫學, 2019, 12(10): 1135-1138.
13. Alan S, Atasay B, Cakir U, et al. An intention to achieve better postnatal in-hospital-growth for preterm infants: adjustable protein fortification of human milk. Early Hum Dev, 2013, 89(12): 1017-1023.
14. Dorum BA, Ozkan H, Cakir SC, et al. What should be the protein target for adjustable Human Milk fortification in premature infants?. Pak J Med Sci, 2019, 35(1): 277-281.
15. 侯紅梅, 金未來, 張盼, 等. 個性化添加母乳強化劑對早產兒生長發育的影響. 深圳中西醫結合雜志, 2021, 31(18): 13-15.
16. 吳玉秀, 張永峰, 張嘉琦, 等. 調整性母乳強化對支氣管肺發育不良早產兒生長發育的近期影響. 濰坊醫學院學報, 2022, 44(1): 68-71.
17. Cormack BE, Embleton ND, van Goudoever JB, et al. Comparing apples with apples: it is time for standardized reporting of neonatal nutrition and growth studies. Pediatr Res, 2016, 79(6): 810-820.
18. Arslanoglu S, Boquien CY, King C, et al. Fortification of human milk for preterm infants: update and recommendations of the European Milk Bank Association (EMBA) Working Group on human milk fortification. Front Pediatr, 2019, 7: 76.
19. 桑田, 王穎, 胡秀麗, 等. 極低出生體重兒體格發育與神經發育關系的研究. 中國新生兒科雜志, 2016, 31(3): 161-167.
20. 趙小朋, 周偉, 宋燕燕, 等. 極低出生體重兒神經系統發育與早期營養的關系. 中國新生兒科雜志, 2016, 31(2): 101-104.
21. 丁文雯, 向奕瑾, 馬佳莉, 等. 極低出生體重早產兒校正月齡 12 個月內體格生長情況及影響因素分析. 中華護理雜志, 2019, 54(1): 52-57.
22. 莊思齊. 中國新生兒營養支持臨床應用指南(2013 年更新版)解讀. 臨床兒科雜志, 2014(9): 801-803.
23. 郝麗紅, 王艷, 楊秋凌, 等. 強化母乳喂養對促進早產兒生長發育的臨床觀察. 中國兒童保健雜志, 2015, 23(10): 1063-1066.
24. 蔣靜, 李開云, 周云, 等. 強化母乳喂養在 NICU 住院早產低出生體質量兒中的應用研究. 重慶醫學, 2014(35): 4731-4733,4736.
25. Maas C, Mathes M, Bleeker C, et al. Effect of increased enteral protein intake on growth in human milk-fed preterm infants: a randomized clinical trial. JAMA Pediatr, 2017, 171(1): 16-22.
26. Agostoni C, Buonocore G, Carnielli VP, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr, 2010, 50(1): 85-91.
27. Mathes M, Maas C, Bleeker C, et al. Effect of increased enteral protein intake on plasma and urinary urea concentrations in preterm infants born at <32 weeks gestation and?<1500 g birth weight enrolled in a randomized controlled trial - a secondary analysis. BMC Pediatr, 2018, 18(1): 154.

West China Medical Journal

Effect of adjustable fortification on feeding during preterm hospitalization: a meta-analysis

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