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, 汤庆娅, 王莹, 等. 中国新生儿营养支持临床应用指南. 临床儿科杂志, 2013(12): 1177-1182.
3.	何必子, 孙秀静, 全美盈, 等. 早产母乳营养成分的分析. 中国当代儿科杂志, 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.	早产儿母乳强化剂使用专家共识工作组, 中华新生儿科杂志编辑委员会. 早产儿母乳强化剂使用专家共识. 中华新生儿科杂志(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, 叶鸿瑁, 丘小汕. 实用新生儿学. 5 版. 北京: 人民卫生出版社, 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.	王书焕, 刘戈力, 刘杨, 等. 个性化添加母乳强化剂对母乳喂养早产儿生长发育的影响. 中国儿童保健杂志, 2019, 27(2): 194-197.
11.	全美盈. 精准指导早产儿个体化母乳喂养的临床研究;超低出生体重儿营养支持策略及出院后随访的临床研究. 北京: 北京协和医学院, 2017.
12.	邓震平, 陈倩, 林宁, 等. 个性化添加母乳强化剂对低体质量早产儿生长发育影响的观察. 中国临床新医学, 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.	侯红梅, 金未来, 张盼, 等. 个性化添加母乳强化剂对早产儿生长发育的影响. 深圳中西医结合杂志, 2021, 31(18): 13-15.
16.	吴玉秀, 张永峰, 张嘉琦, 等. 调整性母乳强化对支气管肺发育不良早产儿生长发育的近期影响. 潍坊医学院学报, 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, 王颖, 胡秀丽, 等. 极低出生体重儿体格发育与神经发育关系的研究. 中国新生儿科杂志, 2016, 31(3): 161-167.
20.	赵小朋, 周伟, 宋燕燕, 等. 极低出生体重儿神经系统发育与早期营养的关系. 中国新生儿科杂志, 2016, 31(2): 101-104.
21.	丁文雯, 向奕瑾, 马佳莉, 等. 极低出生体重早产儿校正月龄 12 个月内体格生长情况及影响因素分析. 中华护理杂志, 2019, 54(1): 52-57.
22.	庄思齐. 中国新生儿营养支持临床应用指南(2013 年更新版)解读. 临床儿科杂志, 2014(9): 801-803.
23.	郝丽红, 王艳, 杨秋凌, 等. 强化母乳喂养对促进早产儿生长发育的临床观察. 中国儿童保健杂志, 2015, 23(10): 1063-1066.
24.	蒋静, 李开云, 周云, 等. 强化母乳喂养在 NICU 住院早产低出生体质量儿中的应用研究. 重庆医学, 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, 汤庆娅, 王莹, 等. 中国新生儿营养支持临床应用指南. 临床儿科杂志, 2013(12): 1177-1182.
3. 何必子, 孙秀静, 全美盈, 等. 早产母乳营养成分的分析. 中国当代儿科杂志, 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. 早产儿母乳强化剂使用专家共识工作组, 中华新生儿科杂志编辑委员会. 早产儿母乳强化剂使用专家共识. 中华新生儿科杂志(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, 叶鸿瑁, 丘小汕. 实用新生儿学. 5 版. 北京: 人民卫生出版社, 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. 王书焕, 刘戈力, 刘杨, 等. 个性化添加母乳强化剂对母乳喂养早产儿生长发育的影响. 中国儿童保健杂志, 2019, 27(2): 194-197.
11. 全美盈. 精准指导早产儿个体化母乳喂养的临床研究;超低出生体重儿营养支持策略及出院后随访的临床研究. 北京: 北京协和医学院, 2017.
12. 邓震平, 陈倩, 林宁, 等. 个性化添加母乳强化剂对低体质量早产儿生长发育影响的观察. 中国临床新医学, 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. 侯红梅, 金未来, 张盼, 等. 个性化添加母乳强化剂对早产儿生长发育的影响. 深圳中西医结合杂志, 2021, 31(18): 13-15.
16. 吴玉秀, 张永峰, 张嘉琦, 等. 调整性母乳强化对支气管肺发育不良早产儿生长发育的近期影响. 潍坊医学院学报, 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, 王颖, 胡秀丽, 等. 极低出生体重儿体格发育与神经发育关系的研究. 中国新生儿科杂志, 2016, 31(3): 161-167.
20. 赵小朋, 周伟, 宋燕燕, 等. 极低出生体重儿神经系统发育与早期营养的关系. 中国新生儿科杂志, 2016, 31(2): 101-104.
21. 丁文雯, 向奕瑾, 马佳莉, 等. 极低出生体重早产儿校正月龄 12 个月内体格生长情况及影响因素分析. 中华护理杂志, 2019, 54(1): 52-57.
22. 庄思齐. 中国新生儿营养支持临床应用指南(2013 年更新版)解读. 临床儿科杂志, 2014(9): 801-803.
23. 郝丽红, 王艳, 杨秋凌, 等. 强化母乳喂养对促进早产儿生长发育的临床观察. 中国儿童保健杂志, 2015, 23(10): 1063-1066.
24. 蒋静, 李开云, 周云, 等. 强化母乳喂养在 NICU 住院早产低出生体质量儿中的应用研究. 重庆医学, 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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