人乳与早产儿配方乳喂养对早产儿生长的Meta分析

目的对单纯人乳、强化人乳和早产儿配方乳喂养早产儿的生长进行评价。方法检索PubMed、ScienceDirect、EBSCOHost 、EMBASE 、OVID 、Cochrane图书 馆、维普中文科技期刊数据库和中国期刊全文数据库,并手工检索会议记录和专 题论文集等,收集关于单纯人乳、强化人乳与早产儿配方乳喂养早产儿的RCT研究 ,进行文献筛选和质量评价,采用RevMan 5.0.18软件进行Meta分析,计量资料采 用加权均数差（WMD）及其95％CI表示。无法进行合并分析的资料进行描述性分析 。结果共纳入7篇文献,文献质量评价5篇为B级,2篇为C级。Meta分析结果显示：① 对近期生长的影响：单纯人乳喂养组新生儿期体重增加速度（WMD＝-6.03,95％ CI：-9.58～-2.47,P=0.000 9）、身长增长速度（WMD＝-1.96,95％CI：-2.77 ～-1.16,P<0.000 01）及头围增长速度（WMD＝-2.04,95%CI：-3.71～-0.37, P=0.02）均显著慢于早产儿配方乳喂养组;强化人乳喂养组新生儿期体重、身长和 头围的增长速度与早产儿配方乳喂养组差异均无统计学意义。②对远期生长的影 响：单纯人乳喂养组与早产儿配方乳喂养组随访至9和18个月,以及7.5~8岁时的 体重、身长（高）和头围的差异均无统计学意义。结论现有证据提示,强化人乳喂养可促进早产儿生后近期内生长,单纯人乳和强 化人乳对早产儿远期生长的影响仍需进一步研究。

Meta-analysis of human milk versus preterm formula on growth in preterm infants

Objective To assess human milk (or fortified human milk) versus preterm formula on growth in preterm infants. Methods Systematic review and meta-analysis of randomized controlled trials (RCTs) or quasi-randomized controlled trials were taken to compare human milk with preterm formula in preterm infants. The standard search strategy included electronic search and manual search. Electronic search was carried out in databases including PubMed, ScienceDirect, EBSCOHost, EMBASE, OVID, Cochrane Library, VIP and CNKI. No language restriction was applied. As a supplement, references in previous reviews and studies identified as relevant were examined by manual search. Two independent reviewers assessed the quality of included studies and extracted data and processed meta-analysis. RevMan 5.0.18 was used for statistical analysis. Effects were expressed as weighted mean difference (WMD) and 95% confidence interval (CI) for continuous data,P <0.05 was considered as statistically significant. Results Only seven trials fulfilled the inclusion criteria. All included studies described randomization but no one mentioned whether blindness was used. The methodological quality evaluation revealed 5 included trials were graded B, 2 -6.03,95%CI: -9.58 to -2.47,P=0.000 9), length increase (WMD= - 1.96,95%CI: -2.77 to -1.16,P<0.000 01) and head circumference increase ( WMD = - 2.04,95% CI: - 3.71 to - 0.37, P = O. 02 ) were found in preterm infants fed with human milk compared with preterm formula, the overall effects favored preterm formula. But no significant difference in short-term human milk with preterm formula, no significant difference was found in weight, length and head circumference when the preterm infants were followed-up at 9 months, 18 months and 7.5 -8 years. No enough data were available to be combined for comparison of fortified human milk with preterm formula. Conclusions Feeding with fortified human milk could promote early postnatal short-term growth in preterm infants. Due to the limits of the included trials,further trials are still needed to evaluate the long-term growth in preterm infants fed with human milk and fortified human milk.