捐赠母乳与配方奶喂养对早产儿并发症、生长发育及住院时长影响的Meta分析

Meta-analysis of the effects of donor human milk versus formula feeding on complications, growth, and length of hospital stay in preterm infants

摘要

目的 系统评价捐赠母乳与配方奶喂养对早产儿并发症、生长发育及住院时长的影响,为临床优化早产儿营养支持策略提供参考。方法 检索建库至2025年5月1日发表的捐赠母乳与配方奶喂养相关随机对照试验(RCT),提取数据后采用RevMan 5.4进行Meta分析。结果 最终纳入18篇文献。Meta分析结果显示,与配方奶相比,捐赠母乳可降低坏死性小肠结肠炎(NEC)发生率(RR=0.65,95%CI:0.51~0.84)、喂养不耐受发生率(RR=0.63,95%CI:0.42~0.94)和感染发生率(RR=0.84,95%CI:0.72~0.98),并缩短达全肠内营养时间(MD=-7.44,95%CI:-8.48~-6.39)及住院时长(MD=-3.97,95%CI:-5.10~-2.85),差异有统计学意义(P＜0.05)。在生长发育方面,捐赠母乳组头围增长速率(MD=-0.06,95%CI:-0.08~-0.03)、身长增长速率(MD=-0.07,95%CI:-0.10~-0.05)及体重增长速率(MD=-0.61,95%CI:-0.73~-0.49)均较配方奶组更慢,差异有统计学意义(P＜0.05)。两组在降低支气管肺发育不良及早产儿视网膜病变发生率方面差异无统计学意义(P＞0.05)。结论 与配方奶相比,捐赠母乳可降低早产儿NEC、感染及喂养不耐受风险,并有助于缩短达到全肠内营养时间及住院时长,但其生长促进效果不及配方奶。临床应用中应综合考虑母乳强化以支持生长,仍需更多高质量RCT进一步验证。

Abstract

Objective To systematically evaluate the effects of donor human milk (DHM) versus formula feeding on complications, growth, and length of hospital stay in preterm infants, so as to provide reference for prioritizing nutritional support strategies for preterm infants. Methods Randomized controlled trials (RCT) comparing DHM feeding with formula feeding were searched from database inception to May 1st, 2025.Data were extracted and pooled using RevMan 5.4. Results A total of 18 articles were included.Meta-analysis results showed that compared with formula feeding, DHM feeding significantly reduced the incidence of necrotizing enterocolitis (NEC)(RR=0.65, 95%CI: 0.51 - 0.84), feeding intolerance (RR=0.63, 95%CI: 0.42 - 0.94), and infection (RR=0.84, 95%CI: 0.72 - 0.98), and shortened the time to full enteral nutrition (MD=-7.44, 95%CI: -8.48 to -6.39) and length of hospital stay (MD=-3.97, 95%CI: -5.10 to -2.85) (P＜0.05).However, growth rates were significantly lower in the DHM group(P＜0.05), including head circumference (MD=-0.06, 95%CI: -0.08 to -0.03), length (MD=-0.07, 95%CI: -0.10 to -0.05), and weight gain (MD=-0.61, 95%CI: -0.73 to -0.49).No significant differences were found in the prevalence rates ofbronchopulmonary dysplasia or retinopathy of prematurity (P＞0.05). Conclusions DHM feeding is associated with lower risks of NEC, feeding intolerance, and infection, and shorter time to full enteral nutrition and hospital stay compared with formula feeding.However, growth outcomes are less favorable, suggesting that appropriate fortification may be required to support growth in preterm infants, and further high-quality RCT are warranted to confirm these findings.

关键词

捐赠母乳 / 配方奶 / 系统综述 / 早产儿 / Meta分析

Key words

donor human milk / formula milk / systematic review / preterm infants / Meta-analysis

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基金资助

昆明市卫生科技人才培养项目(2022-SW-35)