Early Feeding for the Prevention of Neonatal Hypoglycaemia: A Systematic Review and Meta-Analysis.
Early Feeding for the Prevention of Neonatal Hypoglycaemia: A Systematic Review and Meta-Analysis.
复制标题
早期喂养预防新生儿低血糖：系统评价和荟萃分析。
DOI：
10.1159/000535503
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发表时间：
2024
期刊：
影响因子：
2.5
通讯作者：
Lin,Luling
中科院分区：
文献类型：
--
作者：
Roberts,LilyF;Harding,JaneE;Crowther,CarolineA;Watson,Estelle;Wang,Zeke;Lin,Luling
背景 除其他因素外，喂养不良容易导致新生儿发生低血糖。人们广泛建议早期喂养以预防高血糖风险人群发生低血糖，但其有效性尚不确定。本综述旨在总结和分析早期喂养预防新生儿低血糖有效性的证据。方法从研究开始至2023年5月24日检索了四个数据库和三个临床试验注册中心。考虑纳入已发表和未发表的随机对照试验（RCT）、准RCT、整群随机试验、干预措施的非随机研究以及有对照组的观察性研究，不受语言或发表日期的限制。我们纳入了针对早期（出生后 60 分钟内或研究定义）与延迟喂养的新生儿的研究。使用 Cochrane 偏差风险 1 工具或有效公共卫生实践项目质量评估工具评估研究质量。使用建议评估、制定和评价分级方法对证据的确定性进行了评估。 RevMan 5.4。 1 或 R 用于综合随机效应荟萃分析的结果。该综述在 PROSPERO 上进行了前瞻性注册（CRD42022378904）。结果 19 项研究共纳入 175,392 名参与者，其中 2 项为随机对照研究、14 项队列研究、2 项横断面研究和一项病例对照研究。大多数研究（13/19）是在低收入或中低收入国家进行的。早期喂养可能与减少新生儿低血糖有关（四项队列研究，744名婴儿，比值比[OR] 0.19（95% CI：0.10-0.35），p<0.00001，I 2 = 44%），并且初次住院时间略有缩短（一项队列研究，1,673名婴儿，平均差：–0.20天[95% CI：− 0.31 到− 0.09]，p= 0.0003），但证据非常不确定。一项随机对照试验发现早期喂养对新生儿死亡风险影响很小或没有影响，但三项队列研究发现早期喂养可能与降低风险相关（136,468 名婴儿，OR 0.51 [95% CI: 0.37–0.72]；低质量证据；p< 0.0001；I 2= 54%）。结论我们发现早期喂养可能会降低新生儿低血糖的发生率，但证据非常充分不确定。鉴于其许多其他好处，应继续建议早期喂养。本次审查主要由新西兰基金会和美国国立卫生研究院尤尼斯·肯尼迪·施赖弗国家儿童健康和人类发展研究所 (NICHD) 资助。
BackgroundPoor feeding, among other factors, predisposes neonates to hypoglycaemia. Early feeding is widely recommended to prevent hypoglycaemia in those at risk, but the effectiveness of this is uncertain. This review aimed to summarise and analyse the evidence on the effectiveness of early feeding for prevention of neonatal hypoglycaemia.MethodsFour databases and three clinical trial registries were searched from inception to May 24, 2023. Published and unpublished randomised controlled trials (RCTs), quasi-RCTs, cluster randomised trials, non-randomised studies of interventions, and observational studies with comparison groups were considered for inclusion with no language or publication date restrictions. We included studies of neonates who were fed early (within 60 min of birth or study defined) versus delayed. Study quality was assessed using the Cochrane Risk of Bias 1 tool or Effective Public Health Practice Project Quality Assessment tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RevMan 5.4. 1 or R was used to synthesise results in random-effects meta-analyses. This review was registered prospectively with PROSPERO (CRD42022378904).ResultsA total of 175,392 participants were included across 19 studies, of which two were RCTs, 14 cohort studies, two cross-sectional studies, and one a case-control study. Most studies (13/19) were conducted in low-or lower-middle-income countries. Early feeding may be associated with reduced neonatal hypoglycaemia (four cohort studies, 744 infants, odds ratio [OR] 0.19 (95% CI: 0.10–0.35), p< 0.00001, I 2= 44%) and slightly reduced duration of initial hospital stay (one cohort study, 1,673 infants, mean difference:–0.20 days [95% CI:− 0.31 to− 0.09], p= 0.0003), but the evidence is very uncertain. One RCT found early feeding had little or no effect on the risk of neonatal mortality, but three cohort studies found early feeding may be associated with reduced risk (136,468 infants, OR 0.51 [95% CI: 0.37–0.72]; low certainty evidence; p< 0.0001; I 2= 54%).ConclusionWe found that early feeding may reduce the incidence of neonatal hypoglycaemia, but the evidence is very uncertain. Given its many other benefits, early feeding should continue to be recommended. This review was primarily funded by the Aotearoa Foundation and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health.