Analysis Of Immunocompetent Cells Collected Breast Milk And The Growth And Development In Preterm Children,

【Abstract】Objective: To assess the effects of human milk (or fortified human milk) versus preterm formula milk on growth and development for feeding preterm infants. Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) or quasi-randomized controlled trials comparing human milk versus preterm formula milk for preterm infants. The standard search strategy included electronic search and manual search. Electronic search was carried out in databases including PUBMED, SCIENCEDIRECT, EBSCOHOST, EMBASE, OVID, Cochrane Library, VIP and CNKI. There was no language restriction was applied. As a supplement, references in previous reviews and studies identified as relevant had been examined by manual search. Two independent reviewers assessed the quality of included studies and extracted data and processed meta-analysis. RevMan5.0.18 was used in the statistical analyses. Effects were expressed as weighted mean difference (WMD) and 95% confidence interval (CI) for a continuous data while risk ratio (RR) and 95%CI for a categorical data, P<0.05 was considered statistically significant. Results: There were only seven trials fulfilled the pre-specified inclusion criteria of this systematic review. All included studies described randomization but no one mentioned whether blindness was used. The methodological quality of the seven included trials were graded B. Results of this meta-analysis:①The effects on short-term growth: Significantly lower rates in short-term weight gain (WMD: -6.03; 95%CI: -9.58～-2.47; P= 0.0009), length increase (WMD: -1.96; 95%CI: -2.77～ -1.16; P< 0.00001) and head circumference increase (WMD: -2.04; 95%CI: -3.71～-0.37; P= 0.02) were found in preterm infants fed with human milk compared with preterm formula milk, the overall effects favored preterm formula milk. But no significant difference in short-term growth was seen in comparisons of fortified human milk versus preterm formula milk.②T he effects on long-term growth: In comparisons of human milk versus preterm formula milk no significant difference was found in weight, length and head circumference when the preterm infants were followed-up to 9 months, 18 months and 7.5-8 years. No data was available to be combined in comparisons of fortified human milk versus preterm formula milk.③The effects on adverse complications: No significant difference was shown in the incidence of necrotizing enterocolitis (NEC) in comparisons of fortified human milk versus preterm formula milk (RR: 0.55; 95% CI: 0.23～1.32; P= 0.18). No data was available to be combined in our meta-analysis to evaluate the effects on feeding intolerance. Conclusions: The clinical evidences to date indicated that feeding with fortified human milk could promote the early postnatal short-term growth in preterm infants, and no increase in the incidence of adverse complications was found. Due to the limits of this meta-analysis, further trials are still needed to evaluate the long-term growth and development in preterm infants fed with human milk and fortified human milk. 【Abstract】Objective: To investigate the functional capability of the lymphocytes and their potential benefits in feeding preterm infants, the authors studied the lymphocytes subsets in preterm milk. Methods: Colostrum, transitional milk, and mature milk had been collected from the preterm puerperants and cell suspensions obtained from those milk samples had been analyzed by flow cytometry. SPSS 13.0 was used in the statistical analyses and the results of the lymphocytes subsets were expressed as Mean±SD, P< 0.05 was considered statistically significant. Results There were 32 milk samples had been analyzed in this study. Results of the lymphocytes subsets in preterm milk:①The majority of preterm milk lymphocytes were CD3+ T cells, the proportion of CD16+CD56+ NK cells and CD19+ B cells respectively occupied the second and third place. T cells in the colostrum and transitional milk groups were significantly more than mature milk group, but no significant difference was seen in the colostrum and transitional milk groups.②Compared with CD8+ subgroup and Th2 subgroup, CD4+ subgroup and Th1 subgroup were in the ascendant in T lymphocytes. Conclusions These findings indicate that the characteristics of the lymphocytes subpopulations in preterm milk appear to be one reason of the immunologically protective benefits in anti-infection and anti-anaphylaxis associated with breast-feeding. However, further investigations are still needed to interpret the dynamic variations of the immunocompetent cells in preterm milk and to confirm the immunologically protective benefits in detail.