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
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中华医学会肠外肠内营养学分会儿科学组,中华医学会儿科学分会新生儿学组,中华医学会小儿外科学分会新生儿外科学组,等.中国新生儿营养支持临床应用指南[J].中华小儿外科杂志,2013,34(10):782-787.
[2] 李巾宇,李正红.捐赠母乳的临床应用及人乳库发展[J].中华临床营养杂志,2024,32(3):180-185.
Li JY, Li ZH. The clinical application of donated human milk and theestablishment of human milk banks[J].Chin J Clin Nutr, 2024,32(3):180-185.(in Chinese)
[3] 中华医学会儿科学分会新生儿学组,中国医师协会儿童健康专业委员会全国母乳库学组,中国医师协会新生儿分会营养专业委员会,等.新生儿重症监护病房捐赠人乳应用与管理专家共识(2025)[J].中华儿科杂志,2025,63(3):230-237.The Subspecialty Group of Neonatology, the Society of Pediatrics, Chinese Medical Association; National Human Milk Bank Group of Child Health Professional Committee, Chinese Medical Doctor Association; Nutrition Professional Committee of the Society of Neonatology, Chinese Medical Doctor Association, et al.Expert consensus on the application and management of donor human milk at neonatal intensive care units (2025)[J].Chin J Pediatr, 2025,63(3):230-237.(in Chinese)
[4] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].5版.北京:人民卫生出版社,2019:64.
Shao XM, Ye HM, Qiu XS.Practice of neonatology[M].5th ed.Beijing: People′s Medical Publishing House, 2019:64.(in Chinese)
[5] Sterne JAC, Savovic J, Page MJ, et al.RoB 2: A revised tool for assessing risk of bias in randomised trials[J].BMJ,2019,366:l4898.
[6] 郑卿勇,许建国,刘明,等.网状Meta分析中的偏倚风险评估工具概览与思考[J].中国循证医学杂志,2025,25(5):584-594.
Zheng QY, Xu JG, Liu M, et al.Overview and perspectives on risk of bias assessment tools in network meta-analysis[J].Chinese Journal of Evidence-Based Medcine, 2025,25(5):584-594.(in Chinese)
[7] 韩露艳,李淼,谷亚楠,等.不同喂养配方在早产儿生后早期喂养中应用的临床研究[J].中华临床营养杂志,2024,32(3):160-166.
Han LY, Li M, Gu YN, et al.A clinical study on the application of different feeding formulas in early postnatal feeding of premature infants[J].Chin J Clin Nutr, 2024,32(3):160-166.(in Chinese)
[8] 季国静,杨飞,郭婉颖,等.捐母乳喂养对极低出生体质量早产儿肠道微生物及代谢产物的影响[J].中国基层医药,2023,30(12):1867-1870.
Ji GJ, Yang F, Guo WY, et al.Effect of donated breast milk feeding on intestinal microbiota and metabolites in preterm infants with very low birth weight[J].Chin J Prim Med Pharm, 2023,30(12):1867-1870.(in Chinese)
[9] 陈宁,才海燕,高彩云,等.捐赠母乳对极低出生体质量早产儿的应用效果[J].中国妇幼健康研究,2022,33(2):106-110.
Chen N, Cai HY, Gao CY, et al.Application effect of donated breast milk on preterm infants with very low birth weight[J].Chin J Woman Child Health Res, 2022,33(2):106-110.(in Chinese)
[10] 邹丹,李瑞苑,刘彩霞.母乳库捐乳喂养对低体重早产儿喂养效果与并发症的影响[J].护理实践与研究,2020,17(6):120-122.
Zou D, Li RY, Liu CX.Effects of applying breastfeeding in breast milk banking for feeding effects and complications of low birth weight premature infants[J].Nursing Practice and Research, 2020,17(6):120-122.(in Chinese)
[11] 闭宏娟,许靖,韦秋芬.捐献母乳喂养对极低出生体重儿院内感染发生的影响[J].中国当代儿科杂志,2018,20(2):102-105.
Bi HJ, Xu J, Wei QF.Role of donor human milk feeding in preventing nosocomial infection in very low birth weight infants[J].Chin J Contemp Pediatr, 2018,20(2):102-105.(in Chinese)
[12] 肖妮蓉,刘喜红,陈慧敏,等.母乳库捐乳喂养对低体质量早产儿常见并发症的影响[J].实用医学杂志,2018,34(10):1734-1736.
[13] 刘丽芳,陈宏洁,田青,等.不同的奶方喂养对早产儿生长发育的研究[J].中国儿童保健杂志,2017,25(2):128-130,157.
Liu LF, Chen HJ, Tian Q, et al.Study on the growth and development of premature infant with different milk formulas feeding[J].Chin J Child Health Care, 2017,25(2):128-130,157.(in Chinese)
[14] Colaizy TT, Poindexter BB, Mcdonald SA, et al.Neurodevelopmental outcomes of extremely preterm infants fed donor milk or preterm infant formula: A randomized clinical trial[J].JAMA,2024,331(7):582-591.
[15] Costa S, Maggio L, Alighieri G, et al.Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants: A randomized non-inferiority trial[J].Ital J Pediatr,2018,44(1):96.
[16] O′Connor DL, Gibbins S, Kiss A, et al.Effect of supplemental donor human milk compared with preterm formula on neurodevelopment of very low-birth-weight infants at 18 months: A randomized clinical trial[J].JAMA,2016,316(18):1897-1905.
[17] Corpeleijn WE, de Waard M, Christmann V, et al.Effect of donor milk on severe infections and mortality in very low-birth-weight infants: The early nutrition study randomized clinical trial[J].JAMA Pediatr,2016,170(7):654-661.
[18] Cristofalo EA, Schanler RJ, Blanco CL, et al.Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants[J].J Pediatr,2013,163(6):1592-1595.
[19] Sullivan S, Schanler RJ, Kim JH, et al.An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products[J].J Pediatr,2010,156(4):562-567.
[20] Schanler RJ, Lau C, Hurst NM, et al.Randomized trial of donor human milk versus preterm formula as substitutes for mothers′ own milk in the feeding of extremely premature infants[J].Pediatrics,2005,116(2):400-406.
[21] Lucas A, Gore SM, Cole TJ, et al.Multicentre trial on feeding low birthweight infants: Effects of diet on early growth[J].Arch Dis Child,1984,59(8):722-730.
[22] Gross SJ.Growth and biochemical response of preterm infants fed human milk or modified infant formula[J].N Engl J Med,1983,308(5):237-241.
[23] Tyson JE, Lasky RE, Mize CE, et al.Growth, metabolic response, and development in very-low-birth-weight infants fed banked human milk or enriched formula.I.Neonatal findings[J].J Pediatr,1983,103(1):95-104.
[24] Davies DP.Adequacy of expressed breast milk for early growth of preterm infants[J].Arch Dis Child,1977,52(4):296-301.
[25] 王琳,苑静,张玉,等.标准强化捐赠人乳与早产儿配方奶补充喂养极低/超低出生体重儿短期结局比较[J].中华围产医学杂志,2024,27(1):62-67.
Wang L, Yuan J, Zhang Y, et al.Comparison of the short-term outcomes in very/extremely low birth weight infants supplemented with fortified donor human milk or preterm formula[J].Chin J Perinat Med, 2024,27(1):62-67.(in Chinese)
[26] Boyd CA, Quigley MA, Brocklehurst P.Donor breast milk versus infant formula for preterm infants: Systematic review and meta-analysis[J].Arch Dis Child Fetal Neonatal Ed,2007,92(3):F169-F175.
[27] Quigley M, Embleton ND, Meader N, et al.Donor human milk for preventing necrotising enterocolitis in very preterm or very low-birthweight infants[J].Cochrane Database Syst Rev,2024,9(9):CD002971.
[28] Mcclintock T, Fiddes C, Harris S, et al.Donor human milk versus infant formula for low-risk infants: A systematic review[J].Pediatr Res,2025,97(1):81-91.
[29] Lin R, Shen W, Wu F, et al.Human milk fortification in very preterm infants in china: A multicenter survey[J].Front Pediatr,2022,10:795222.
[30] 姚欣蕊,王琳,苑静,等.应用捐赠母乳对极/超低出生体重早产儿医疗费用的影响[J].中华临床营养杂志,2025,33(2):112-117.
Yao XR, Wang L, Yuan J, et al.Effects of donor human milk on medical costs in very low birth weight and extremely low birth weight infants[J].Chin J Clin Nutr, 2025,33(2):112-117.(in Chinese)
[31] Villamor-Martinez E, Pierro M, Cavallaro G, et al.Donor human milk protects against bronchopulmonary dysplasia: A systematic review and meta-analysis[J].Nutrients,2018,10(2):238.
基金
昆明市卫生科技人才培养项目(2022-SW-35)
PDF(9627 KB)
