(1)简介:目前关于管理六个月以下有生长障碍或其他营养相关风险的婴儿的证据很少且质量低。这篇综述旨在为填补这一证据空白的研究重点提供信息,专注于母乳喂养的做法。(2)方法:我们搜索了PubMed,CINAHLPlus,和Cochrane图书馆进行喂养干预研究,旨在恢复或提高母乳喂养的量或质量和母乳喂养时,母乳喂养的做法是次优或过早停止。我们纳入了来自低收入和中等收入国家和高收入国家的研究。(3)结果:47项研究符合纳入标准。大多数来自高收入国家(n=35,74.5%),包括出生时有生长障碍风险的婴儿(早产儿/小于胎龄儿)和早期生长步履蹒跚的新生儿。干预措施包括配方强化或补充(n=31,66%),肠内喂养(n=8,17%),杯式喂养(n=2,4.2%),和其他(n=6,12.8%)。结果包括人体测量变化(n=40,85.1%),报告的喂养方式(n=16,34%),发病率(n=11,23.4%),死亡率(n=5,10.6%)。在评估配方强化或补充的31项研究中,30个报告的人体测量变化(n=17没有影响,n=9正,n=4混合),7例发病率(n=3无影响,n=2正,n=2负),五次喂食(n=2正,n=2没有效果,n=1负),和4例死亡率(n=3无影响,n=1负)。在评估肠内喂养干预的八项研究中,七个报告的人体测量变化(n=4阳性,n=3无效果),五种喂养方法(n=2正,n=2没有效果,n=1负),四种发病率(n=4无影响),1例报告死亡率(n=1无影响)。总的来说,对喂养实践有积极影响的干预措施包括:杯式喂养与早产儿的瓶式喂养相比;鼻胃管喂养与低出生体重早产儿的瓶式喂养相比;以及早期渐进式喂养与极低出生体重早产儿的延迟喂养相比.牛/牛奶喂养和大量喂养干预措施产生了不利的影响,而电动吸奶器和Galactagogue有混合效果。关于人体测量结果,总的来说,大量营养素强化配方,奶油补充剂,强化人乳配方对早产儿有积极作用(体重增加)。将人类母乳/供体奶与配方奶进行比较的干预具有混合效果。总的来说,与配方奶粉干预相比,只有母乳对早产儿的发病率有积极影响,而所有干预措施均未对死亡率产生积极影响.牛/牛奶补充对发病率和死亡率都有不利影响。(4)结论:未来的研究应优先考虑低收入和中等收入国家,包括在新生儿后期出现生长障碍的婴儿,并记录对发病率和死亡率结局的影响。
(1) Introduction: Current evidence on managing infants under six months with growth failure or other nutrition-related risk is sparse and low quality. This
review aims to inform research priorities to fill this evidence gap, focusing on breastfeeding practices. (2) Methods: We searched PubMed, CINAHL Plus, and Cochrane Library for studies on feeding interventions that aim to restore or improve the volume or quality of breastmilk and breastfeeding when breastfeeding practices are sub-optimal or prematurely stopped. We included studies from both low- and middle-income countries and high-income countries. (3) Results: Forty-seven studies met the inclusion criteria. Most were from high-income countries (n = 35, 74.5%) and included infants who were at risk of growth failure at birth (preterm infants/small for gestational age) and newborns with early growth faltering. Interventions included formula fortification or supplementation (n = 31, 66%), enteral feeds (n = 8, 17%), cup feeding (n = 2, 4.2%), and other (n = 6, 12.8%). Outcomes included anthropometric change (n = 40, 85.1%), reported feeding practices (n = 16, 34%), morbidity (n = 11, 23.4%), and mortality (n = 5, 10.6%). Of 31 studies that assessed formula fortification or supplementation, 30 reported anthropometric changes (n = 17 no effect, n = 9 positive, n = 4 mixed), seven morbidity (n = 3 no effect, n = 2 positive, n = 2 negative), five feeding (n = 2 positive, n = 2 no effect, n = 1 negative), and four mortality (n = 3 no effect, n = 1 negative). Of eight studies that assessed enteral feed interventions, seven reported anthropometric changes (n = 4 positive, n = 3 no effect), five feeding practices (n = 2 positive, n = 2 no effect, n = 1 negative), four morbidity (n = 4 no effect), and one reported mortality (n = 1 no effect). Overall, interventions with positive effects on feeding practices were cup feeding compared to bottle-feeding among preterm; nasogastric tube feed compared to bottle-feeding among low birth weight preterm; and early progressive feeding compared to delayed feeding among extremely low birth weight preterm. Bovine/cow milk feeding and high volume feeding interventions had an unfavourable effect, while electric breast pump and Galactagogue had a mixed effect. Regarding anthropometric outcomes, overall, macronutrient fortified formula, cream supplementation, and fortified human milk formula had a positive effect (weight gain) on preterm infants. Interventions comparing human breastmilk/donor milk with formula had mixed effects. Overall, only human milk compared to formula intervention had a positive effect on morbidity among preterm infants, while none of the interventions had any positive effect on mortality. Bovine/cow milk supplementation had unfavourable effects on both morbidity and mortality. (4) Conclusion: Future research should prioritise low- and middle-income countries, include infants presenting with growth failure in the post-neonatal period and record effects on morbidity and mortality outcomes.