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Human Milk-Derived Fortifiers Compared with Bovine Milk-Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis.
Adv Nutr. 2020 Apr 11 [Online ahead of print]AN

Abstract

This systematic review assessed outcomes after using human milk-derived fortifier (HMF) compared with bovine milk-derived fortifier (BMF) in preterm infants. Six randomized controlled trials (RCTs) were included. Meta-analysis using a random-effects model showed the following results: 1) lower risk of necrotizing enterocolitis (NEC; ≥Stage II) (RR: 0.38; 95% CI: 0.15, 0.95; P = 0.04, I2 = 9%; n = 334, 4 RCTs) and surgical NEC (RR: 0.13; 95% CI: 0.02, 0.67; P = 0.02, I2 = 0%; n = 209, 3 RCTs) in the HMF group; 2) no significant difference in mortality (RR: 0.40; 95% CI: 0.14, 1.15; P = 0.09, I2 = 0%; n = 334, 4 RCTs); 3) lower weight gain in the HMF group [mean difference (MD) = -1.08 g · kg-1 · d-1; 95% CI: -1.96, -0.21 g · kg-1 · d-1; P = 0.02, I2 = 0%; n = 241, 4 RCTs]; 4) no differences for length (MD = -0.11 cm/wk; 95% CI: -0.26, 0.04 cm/wk; P = 0.14, I2 = 68%) and head circumference (MD = -0.02 cm/wk; 95% CI: -0.08, 0.05 cm/wk; P = 0.59, I2 = 23%); and 5) no significant difference in late-onset sepsis (RR: 0.96; 95% CI: 0.56, 1.67; P = 0.90, I2 = 63%; n = 334, 4 RCTs). The beneficial effects of HMF for NEC were no longer significant in sensitivity analyses after excluding studies with high risk of bias. Quality of evidence as per Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis was low to very low, and hence the confidence in these results is low. In summary, fortification of milk in preterm infants with HMF compared with BMF decreased the risk of NEC but was associated with lower weight gain. Given the low quality of evidence, adequately powered and well-designed RCTs without the influence of industry are required in this field.

Authors+Show Affiliations

Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India.Department of Neonatology, Surya Mother and Child Care Hospital, Mumbai, India.Department of Neonatal Paediatrics, Perth Children's Hospital, Perth, Western Australia, Australia. School of Medicine, University of Western Australia, Perth, Western Australia, Australia.School of Medicine, University of Western Australia, Perth, Western Australia, Australia. Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32277813

Citation

Ananthan, Anitha, et al. "Human Milk-Derived Fortifiers Compared With Bovine Milk-Derived Fortifiers in Preterm Infants: a Systematic Review and Meta-Analysis." Advances in Nutrition (Bethesda, Md.), 2020.
Ananthan A, Balasubramanian H, Rao S, et al. Human Milk-Derived Fortifiers Compared with Bovine Milk-Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis. Adv Nutr. 2020.
Ananthan, A., Balasubramanian, H., Rao, S., & Patole, S. (2020). Human Milk-Derived Fortifiers Compared with Bovine Milk-Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis. Advances in Nutrition (Bethesda, Md.). https://doi.org/10.1093/advances/nmaa039
Ananthan A, et al. Human Milk-Derived Fortifiers Compared With Bovine Milk-Derived Fortifiers in Preterm Infants: a Systematic Review and Meta-Analysis. Adv Nutr. 2020 Apr 11; PubMed PMID: 32277813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Human Milk-Derived Fortifiers Compared with Bovine Milk-Derived Fortifiers in Preterm Infants: A Systematic Review and Meta-Analysis. AU - Ananthan,Anitha, AU - Balasubramanian,Haribalakrishna, AU - Rao,Shripada, AU - Patole,Sanjay, Y1 - 2020/04/11/ PY - 2019/11/12/received PY - 2020/01/24/revised PY - 2020/03/11/accepted PY - 2020/4/12/entrez PY - 2020/4/12/pubmed PY - 2020/4/12/medline KW - bovine KW - breast milk KW - human milk fortifier KW - necrotizing enterocolitis KW - preterm JF - Advances in nutrition (Bethesda, Md.) JO - Adv Nutr N2 - This systematic review assessed outcomes after using human milk-derived fortifier (HMF) compared with bovine milk-derived fortifier (BMF) in preterm infants. Six randomized controlled trials (RCTs) were included. Meta-analysis using a random-effects model showed the following results: 1) lower risk of necrotizing enterocolitis (NEC; ≥Stage II) (RR: 0.38; 95% CI: 0.15, 0.95; P = 0.04, I2 = 9%; n = 334, 4 RCTs) and surgical NEC (RR: 0.13; 95% CI: 0.02, 0.67; P = 0.02, I2 = 0%; n = 209, 3 RCTs) in the HMF group; 2) no significant difference in mortality (RR: 0.40; 95% CI: 0.14, 1.15; P = 0.09, I2 = 0%; n = 334, 4 RCTs); 3) lower weight gain in the HMF group [mean difference (MD) = -1.08 g · kg-1 · d-1; 95% CI: -1.96, -0.21 g · kg-1 · d-1; P = 0.02, I2 = 0%; n = 241, 4 RCTs]; 4) no differences for length (MD = -0.11 cm/wk; 95% CI: -0.26, 0.04 cm/wk; P = 0.14, I2 = 68%) and head circumference (MD = -0.02 cm/wk; 95% CI: -0.08, 0.05 cm/wk; P = 0.59, I2 = 23%); and 5) no significant difference in late-onset sepsis (RR: 0.96; 95% CI: 0.56, 1.67; P = 0.90, I2 = 63%; n = 334, 4 RCTs). The beneficial effects of HMF for NEC were no longer significant in sensitivity analyses after excluding studies with high risk of bias. Quality of evidence as per Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis was low to very low, and hence the confidence in these results is low. In summary, fortification of milk in preterm infants with HMF compared with BMF decreased the risk of NEC but was associated with lower weight gain. Given the low quality of evidence, adequately powered and well-designed RCTs without the influence of industry are required in this field. SN - 2156-5376 UR - https://www.unboundmedicine.com/medline/citation/32277813/Human_Milk-Derived_Fortifiers_Compared_with_Bovine_Milk-Derived_Fortifiers_in_Preterm_Infants:_A_Systematic_Review_and_Meta-Analysis L2 - https://academic.oup.com/advances/article-lookup/doi/10.1093/advances/nmaa039 DB - PRIME DP - Unbound Medicine ER -
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