Nutritional interventions to reduce rates of infection, necrotizing enterocolitis and mortality in very preterm infants.
Christoph BührerHendrik S FischerSven WellmannPublished in: Pediatric research (2019)
Observational studies demonstrating reduced rates of infections, necrotizing enterocolitis (NEC), and mortality in preterm infants fed their own mother's milk, as opposed to formula, have prompted endeavors to achieve similar effects with the right choice of food and food additives. In a systematic review of meta-analyses and randomized controlled trials (RCTs), we considered nutritional interventions aimed at reducing the rates of infections, NEC, or mortality in very preterm infants. The overall effects of particular interventions were presented as risk ratios with 95% confidence intervals. In RCTs, pasteurized human donor milk, as opposed to formula, reduced NEC but not infections or mortality. No differences emerged between infants receiving human or bovine milk-based fortifiers. Pooled data of small trials and a recent large RCT suggested that bovine lactoferrin reduced rates of fungal sepsis without impact on other infections, NEC, or mortality. Pooled data of RCTs assessing the use of prebiotic oligosaccharides found reduced infection but not mortality. Enteral L-glutamine (six RCTs) lowered infection rates, and enteral L-arginine (three RCTs) reduced NEC. A meta-analysis sensitivity approach found multiple-strain (but not single-strain) probiotics to be highly effective in reducing NEC and mortality. Thus, selected food components may help to improve outcomes in preterm infants.
Keyphrases
- preterm infants
- low birth weight
- cardiovascular events
- human milk
- risk factors
- physical activity
- systematic review
- intensive care unit
- cardiovascular disease
- coronary artery disease
- type diabetes
- electronic health record
- meta analyses
- induced pluripotent stem cells
- big data
- phase iii
- septic shock
- pluripotent stem cells