C A Kuschel1, J E Harding. 1. Newborn Services, National Women's Hospital, Private Bag 92 189, Auckland, New Zealand. CarlK@adhb.govt.nz
Abstract
BACKGROUND: Preterm infants are born with low skeletal stores of calcium and phosphorus. Preterm human milk provides insufficient calcium and phosphorus to meet their estimated needs. OBJECTIVES: To determine if addition of calcium and phosphorus supplements to human milk leads to improved growth and bone metabolism without significant adverse effects in preterm infants. SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group (NRG) was used. This includes searches of the Oxford Database of Perinatal Trials, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language. SELECTION CRITERIA: All trials utilizing random or quasi-random allocation to supplementation of human milk with calcium and/or phosphorus or no supplementation in preterm infants within a hospital were eligible. DATA COLLECTION AND ANALYSIS: Data were extracted using the standard methods of the Cochrane NRG, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and weighted mean difference. MAIN RESULTS: No studies which met selection criteria were identified. Excluded studies that were identified included minerals as one component of a multicomponent fortifier or reported only non-clinical outcomes (for example, urinary excretion of calcium). Two studies were excluded because of methodological concerns. REVIEWER'S CONCLUSIONS: There are no randomized controlled data evaluating clinical outcomes of calcium and phosphorus supplementation of human milk for preterm infants on which to base practice recommendations. Further trials should assess the clinical benefits and potential adverse effects of supplementation of human milk with minerals. This may best be done in the context of manipulation of the composition of human milk fortifiers containing multiple nutrients (carbohydrate, protein, and minerals).
BACKGROUND: Preterm infants are born with low skeletal stores of calcium and phosphorus. Preterm human milk provides insufficient calcium and phosphorus to meet their estimated needs. OBJECTIVES: To determine if addition of calcium and phosphorus supplements to human milk leads to improved growth and bone metabolism without significant adverse effects in preterm infants. SEARCH STRATEGY: The standard search strategy of the Cochrane Neonatal Review Group (NRG) was used. This includes searches of the Oxford Database of Perinatal Trials, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language. SELECTION CRITERIA: All trials utilizing random or quasi-random allocation to supplementation of human milk with calcium and/or phosphorus or no supplementation in preterm infants within a hospital were eligible. DATA COLLECTION AND ANALYSIS: Data were extracted using the standard methods of the Cochrane NRG, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and weighted mean difference. MAIN RESULTS: No studies which met selection criteria were identified. Excluded studies that were identified included minerals as one component of a multicomponent fortifier or reported only non-clinical outcomes (for example, urinary excretion of calcium). Two studies were excluded because of methodological concerns. REVIEWER'S CONCLUSIONS: There are no randomized controlled data evaluating clinical outcomes of calcium and phosphorus supplementation of human milk for preterm infants on which to base practice recommendations. Further trials should assess the clinical benefits and potential adverse effects of supplementation of human milk with minerals. This may best be done in the context of manipulation of the composition of human milk fortifiers containing multiple nutrients (carbohydrate, protein, and minerals).