Effects of different breast milk fortifier methods on growth and development of preterm infants: a meta-analysis / 中国新生儿科杂志

ABSTRACT

Objective:To evaluate the impact of different methods of human milk fortifier (HMF) on the growth and development of preterm infants.Methods:Computer searches were conducted in PubMed, Embase, Clinicaltrials, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, VIP Database, and China National Full-text Database for biomedical literature from database inception to December 1, 2022. The inclusion criteria encompassed randomized controlled studies (RCTs) involving infants with a gestational age of less than 37 weeks who were subjected to HMF. The quality of included studies was assessed using the Cochrane bias analysis tool. Meta-analyses were performed using RevMan 5.3 software to compare individual fortification with standard fortification, targeted fortification with adjusted fortification of breast milk, and their effects on preterm infant weight gain, length, head circumference growth rates, as well as the incidence of bronchopulmonary dysplasia, osteopenia, feeding intolerance, and necrotizing enterocolitis.Results:A total of 11 RCTs were included, with 10 having low to moderate bias risk and 1 having a high bias risk. The results of meta-analysis showed that compared to standard fortification, individual fortification led to an increase in the weight gain rate of preterm infants ( SMD=0.87,95% CI 0.36-1.38 ,P<0.001), with no statistically significant differences observed in the effects on length and head circumference growth rates ( SMD=0.64,95% CI -0.07-1.34, P=0.08; SMD=0.58, 95% CI -0.06-1.22, P=0.08). The incidence of feeding intolerance and necrotizing enterocolitis in the individual intensive group was lower than that in the standard intensive group ( RR=0.45, 95% CI 0.22-0.89, P=0.02; RR=0.32, 95% CI 0.13-0.78, P=0.01), but no statistically significant difference in the incidence of bronchopulmonary dysplasia ( RR=0.93, 95% CI 0.76-1.20, P=0.67). Only two studies compared targeted fortification with adjusted fortification for growth and development outcomes in preterm infants, but the results were not consistent. Only one RCT showed no statistically significant difference in the incidence of osteopenia between the targeted fortification and adjusted fortification groups. Conclusions:Compared with standard fortification, individual intensive breastfeeding appears to promote the early growth and development of preterm infants. However, the effect of targeted and adjustable fortification on the growth and development of preterm infants is not significantly different.