Formula milk versus donor breast milk for feeding preterm or low birth weight infants

Publisher Website
Google Scholar
Abstract
When sufficient maternal breast milk is not available, the alternative sources of enteral nutrition for preterm or low birth weight infants are donor breast milk or artificial formula milk. Feeding preterm or low birth weight infants with formula milk might increase nutrient input and growth rates. However, since feeding with formula milk may be associated with a higher incidence of feeding intolerance and necrotising enterocolitis, this may adversely affect growth and development. To determine the effect of formula milk compared with donor human breast milk on growth and development in preterm or low birth weight infants. The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007), MEDLINE (1966 ‐ May 2007), EMBASE (1980 ‐ May 2007), CINAHL (1982 ‐ May 2007), conference proceedings, and previous reviews. Randomised controlled trials comparing feeding with formula milk versus donor breast milk in preterm or low birth weight infants. Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two reviewer authors, and synthesis of data using relative risk, risk difference and weighted mean difference. Eight trials fulfilled the inclusion criteria. Only one trial used nutrient‐fortified donor breast milk. Enteral feeding with formula milk compared with donor breast milk resulted in higher rates of growth in the short term. There was no evidence of an effect on long‐term growth rates or neurodevelopmental outcomes. Meta‐analysis of data from five trials demonstrated a statistically significantly higher incidence of necrotising enterocolitis in the formula fed group: typical relative risk 2.5 (95% confidence interval 1.2, 5.1); typical risk difference: 0.03 (95% confidence interval 0.01, 0.06; number needed to harm: 33 (95% confidence interval 17, 100). In preterm and low birth weight infants, feeding with formula milk compared with donor breast milk results in a higher rate of short‐term growth but also a higher risk of developing necrotising enterocolitis. There are only limited data on the comparison of feeding with formula milk versus nutrient‐fortified donor breast milk. This limits the applicability of the findings as nutrient fortification of breast milk is now a common practice in neonatal care. Future trials may compare growth, development and adverse outcomes in infants who receive formula milk versus nutrient‐fortified donor breast milk given as a supplement to maternal expressed breast milk or as a sole diet. 對早產兒或低出生體重嬰兒給予配方奶或捐贈母奶的比較 當母奶不足時，早產兒或低出生體重嬰兒其他經腸道營養的選擇包括捐贈母奶或人工配方奶。用配方奶來餵食早產兒或低出生體重嬰兒可以增加營養輸入和生長速度。然而，餵食配方奶可能會提高餵食不耐和壞死性腸炎的機會，如此反而會影響生長和發展。 比較配方奶和捐贈母奶對早產兒和低出生體重嬰兒生長和發展的差別。 使用Cochrane Neonatal Review Group的標準搜尋策略，包括電子搜尋Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007) 、MEDLINE (1966  May 2007) 、EMBASE (1980  May 2007) 、CINAHL (1982  May 2007) 、研討會記碌和之前的回顧文獻。 隨機控制研究比較早產兒或低出生體重嬰兒餵食配方奶和捐贈母奶的差別。 使用Cochrane Neonatal Review Group取得資料的標準方法，由兩位評論者分別評估研究品質，使用相對危險、危險差異和加重平均差異來分析資料。 8個試驗符合納入標準。只有一個試驗用營養加強的捐贈母奶。經腸道餵食配方奶比捐贈母奶在短期內有較高的生長速度。沒有證據顯示對長期生長速率或神經學發育有所影響。從5個試驗整合分折所得資料顯示，使用配方奶組有較高的壞死性腸炎發生率：典型相對危險性2.5 (95% 信賴區間1.2, 5.1) ，典型危險差異：0.03 (95% 信賴區間0.01, 0.06; 造成傷害所需數目：33 (95% 信賴區間 17,100) 。 在早產兒和低出生體重嬰兒，餵食配方奶相較於捐贈母奶在短期間會有較高的生長速度，也會有較高壞死性腸炎的危險。只有少數的資料比較餵食配方奶或加強營養捐贈母奶，因此現今照顧新生兒常使用加強營養至母奶的作法之相關發現尚受資料不足之限。未來研究可比較使用配方奶和營養加強化捐贈母奶 (補充母親擠出的母奶或當作主食) 的嬰兒兩者之生長、發育和不良預後差異。 本摘要由馬偕醫院張龍翻譯。 此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。 當早產兒或低出生體重嬰兒的母親本身母奶不足時，其他的選擇是配方奶或捐贈母奶。回顧8個隨機控制試驗顯示，餵食配方奶可以增加短期生長速度但也會增加壞死性腸炎的危險，沒有證據顯示長期的生長或發育會有所不同。尚需往後的試驗來評佑兩者差異，應該要針對早產兒配方奶和營養添加的捐贈母奶加以比較。