【摘要】：目的目前關(guān)于早產(chǎn)兒和低出生體質(zhì)量兒(LBW)預(yù)防性腸內(nèi)補鐵的最佳時機尚不十分清楚,本研究旨在比較LBW早期和晚期補鐵的療效。方法計算機檢索Pub Med、Cochrane Library、中國知網(wǎng)、萬方數(shù)據(jù)知識服務(wù)平臺等數(shù)據(jù)庫,檢索時間為建庫至2015-12-31。收集關(guān)于LBW早期補鐵療效(出生后2周開始補鐵)和晚期補鐵療效(出生后4周開始補鐵)的前瞻性隨機對照試驗。對納入文獻進行質(zhì)量評價和數(shù)據(jù)提取,采用Rev Man 5.3軟件對血清鐵蛋白、血紅蛋白(Hb)、輸血率、新生兒壞死性小腸結(jié)腸炎(NEC)發(fā)生率進行分析。結(jié)果共納入4篇文獻,418例患兒,其中早期補鐵組209例,晚期補鐵組209例。所納入文獻的質(zhì)量較高。Meta分析結(jié)果顯示,早期補鐵組血清鐵蛋白水平下降的幅度低于晚期補鐵組,差異有統(tǒng)計學(xué)意義〔均數(shù)差(MD)=14.08,95%CI(9.08,19.08),P0.001〕。早期補鐵組血紅蛋白水平下降的幅度低于晚期補鐵組,差異有統(tǒng)計學(xué)意義〔MD=0.87,95%CI(0.71,1.02),P0.001〕。早期補鐵組輸血率低于晚期補鐵組,差異有統(tǒng)計學(xué)意義〔OR=0.44,95%CI(0.27,0.71),P0.001〕。早期補鐵組和晚期補鐵組NEC發(fā)生率比較,差異無統(tǒng)計學(xué)意義〔OR=0.73,95%CI(0.33,1.60),P=0.43〕。經(jīng)leave one-out法進行敏感性分析,將每篇文獻依次剔除,研究結(jié)果沒有產(chǎn)生較大影響,具有良好可靠性。結(jié)論早期補鐵可減少血清鐵蛋白和血紅蛋白水平下降的幅度。然而,LBW補鐵應(yīng)謹慎對待,以免導(dǎo)致鐵過量和可能對神經(jīng)發(fā)育的長期負面影響。
[Abstract]:Objective to compare the effect of early and late iron supplementation on (LBW) in premature infants and low birth weight infants. Methods Pub Med,Cochrane Library, China knowledge Web, Wanfang data knowledge Service platform and other databases were searched by computer. The retrieval time was from 2015 to 12-31. Prospective randomized controlled trials were collected on the effects of early iron supplementation in LBW (iron supplementation at 2 weeks after birth) and late iron supplementation (iron supplementation at 4 weeks after birth). The quality evaluation and data extraction were carried out. Serum ferritin, hemoglobin (Hb), transfusion rate and incidence of neonatal necrotizing enterocolitis (NEC) were analyzed by Rev Man 5.3 software. Results A total of 418 children were included in 4 literatures, 209 in early iron supplementation group and 209 in late iron supplementation group. The results of Meta analysis showed that the decrease of serum ferritin level in early iron supplementation group was lower than that in late iron supplementation group, and the difference was statistically significant (mean difference (MD) = 14.0895 CI (9.0819.08), P 0.001). The decrease of hemoglobin level in the early iron supplementation group was lower than that in the late iron supplementation group (P < 0. 001). The difference was statistically significant (MD=0.87,95%CI (0. 71 鹵1. 02), P 0. 001). The blood transfusion rate in early iron supplementation group was lower than that in late iron supplementation group (OR=0.44,95%CI (0.270.71), P 0.001). There was no significant difference in the incidence of NEC between the early iron supplementation group and the late iron supplementation group (OR=0.73,95%CI (0.33 鹵1.60), P = 0.43). After sensitivity analysis by leave one-out method, each paper is eliminated in turn. The results of the study have no great influence and are of good reliability. Conclusion early iron supplementation can reduce the decrease of serum ferritin and hemoglobin levels. However, iron supplementation by LBW should be treated with caution in order not to lead to excessive iron and possible long term negative effects on neural development.
【作者單位】： 浙江省寧波市婦女兒童醫(yī)院新生兒科;山東省聊城市東阿縣人民醫(yī)院;
【分類號】：R722.6

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