捐赠母乳与配方奶喂养对极低和超低出生体重儿影响的meta分析  

Meta-analysis of donor human milk versus formula milk for feeding very low birth weight and extremely low birth weight infants

作　　者：余章斌[1] 韩树萍[1] 陈小慧[1] 周娟[1] 刘蓓蓓[1] 沙莉[1] 董小明 

机构地区：[1]南京医科大学附属南京妇幼保健院儿科,210004

出　　处：《中华围产医学杂志》2014年第11期748-754,共7页Chinese Journal of Perinatal Medicine

基　　金：江苏省医学重点人才基金（RC2011021）;南京市卫生青年人才基金（QRX11107）

摘　　要：目的评价捐赠母乳与配方奶喂养对极低出生体重儿（very low birth weight infant，VLBWI）和超低出生体重儿（extremely low birth weight infant，ELBWI）的影响。方法检索Cochrane图书馆、PubMed、EMBASE、万方数据库、中国期刊全文数据库和中国维普数据库，检索文献起止时间均从建库起至2014年2月。纳入捐赠母乳与配方奶喂养对VLBWI和ELBWI影响的随机和半随机对照试验，对文献进行质量评价。采用RevMan5．2．9软件进行meta分析，计量资料选取均数差（mean difference，MD）及其95％CI表示，计数资料采用RR及其95％CI表示。结果共纳入5篇文献，文献质量评价2篇为B级，3篇为C级。Meta分析结果显示：与配方奶喂养比较，捐赠母乳喂养可以降低VLBWI和ELBWI新生儿坏死性小肠结肠炎的发生率（RR=0．36，95％CI：0．18-0．73，P〈0．01），但不能降低败血症（RR=0．92，95％CI：0．50～1．72，P=0．80）、早产儿视网膜病的发生率（RR=1．21，95％CI：0．84～1．74，P=0．31）和住院病死率（RR=0．66，95％CI：0．18～2．37，P=0．52）。捐赠母乳组新生儿期体重增长速度（MD=-6．58，95％CI：-11．19～-1．98，P〈0．01）和身长增长速度（MD=-0．30，95％CI：-0．41～-0．20，P〈0．01）均低于配方奶喂养组，新生儿期头围的增长速度与配方奶喂养组差异没有统计学意义（MD=-0．16，95％CI：-0．33～0．01，P=0．13）。结论VLBWI和ELBWI使用捐赠母乳喂养可降低NEC的发生率，但对新生儿期生长发育的影响仍需进一步研究。Objective To determine the effects of feeding donor human milk versus formula milk on very low birth weight infants （ VLBWI ） and extremely low birth weight infants （ ELBWI ） . Methods The Cochrane library, PubMed, EMBASE, Wanfang, CNKI and VIP database were searched for the randomized controlled trials （ RCT ） that compare donor human milk with formula milk in VLBWI and ELBWI from the establishment of database up to February 2014. The quality of the included studies was assessed. Meta analysis was performed using RevMan 5.2.9 software. The results were expressed by mean difference （ MD ） and 95%CI for continuous variables, RR and 95%CI for categorical variables. Results Only five trials were included： in quality evaluation, two trials were graded B, and the other three were graded C. Meta-analysis showed that, compared with the formula milk, feeding of donor human milk could reduce the risk of necrotizing enterocolitis （ RR=0.36, 95%CI： 0.18-0.73, P〈0.0I ） , but not the risks of sepsis （ RR=0.92, 95%CI： 0.50-1.72, P=0.80 ）, retinopathy of prematurity （ RR=1.21, 95%CI： 0.84-1.74, P=0.31 ） and in-hospital mortality （ RR=0.66, 95%CI： 0.18-2.37, P=0.52 ） . The significantly lower rates in weight gains in neonatal period （MD= - 6.58, 95%CI： - 11.19 to - 1.98, P〈0.01 ） and body length （MD= - 0.30, 95%CI： - 0.41 to - 0.20, P〈0.01 ）were found in donor human milk compared with formula milk. No significant difference in head circumference （ MD= - 0.16, 95%CI： - 0.33 to 0.01, P=0.13 ） was seen in comparison of donor human milk with formula milk. Conclusions Feeding with donor human milk can reduce the risk of necrotizing enterocolitis in VLBWI and ELBWI, but its effects on neonatal growth need to be further studied in large-scale RCT.

关 键 词：婴儿 出生时低体重 母乳喂养 婴儿配方 META分析 

分 类 号：R722.6[医药卫生—儿科]