Contributors: University of Auckland Auckland; Ospedale del Ponte Varese, Italy; McMaster University Hamilton, Ontario; Italian Association of Human Milk Banks Milan, Italy (AIBLUD); Newcastle University Newcastle; Great Ormond Street Institute of Child Health (UCL); University College of London London (UCL); Universidade Federal do Maranhão = Federal University of Maranhão (UFMA); Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU); Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico; Università degli Studi di Milano = University of Milan (UNIMI); Bilkent City Hospital = Ankara Şehir Hastanesi Ankara, Turkey (BCH); Wayne State University Detroit; Meir Medical Center Kfar Saba, Israel (2MC); Liverpool Women's NHS Foundation Trust; Post Graduate Institute of Medical Education and Research Chandigarh, India (PGIMER); Alma Mater Studiorum Università di Bologna = University of Bologna (UNIBO); Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN); Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); Hôpital de la Croix-Rousse CHU - HCL; Hospices Civils de Lyon (HCL); Institute of Child Health London; Oslo University Hospital Oslo; Alder Hey Children's Hospital NHS Foundation Trust Liverpool; Odense University Hospital (OUH); University of Southern Denmark (SDU)
Abstract: International audience ; Neonatal nutritional supplements are widely used to improve growth and development but may increase risk of later metabolic disease, and effects may differ by sex. We assessed effects of supplements on later development and metabolism. We searched databases and clinical trials registers up to April 2019. Participant-level data from randomised trials were included if the intention was to increase macronutrient intake to improve growth or development of infants born preterm or small-for-gestational-age. Co-primary outcomes were cognitive impairment and metabolic risk. Supplementation did not alter cognitive impairment in toddlers (13 trials, n = 1410; adjusted relative risk (aRR) 0.88 [95% CI 0.68, 1.13]; p = 0.31) or older ages, nor alter metabolic risk beyond 3 years (5 trials, n = 438; aRR 0.94 [0.76, 1.17]; p = 0.59). However, supplementation reduced motor impairment in toddlers (13 trials, n = 1406; aRR 0.76 [0.60, 0.97]; p = 0.03), and improved motor scores overall (13 trials, n = 1406; adjusted mean difference 1.57 [0.14, 2.99]; p = 0.03) and in girls not boys (p = 0.03 for interaction). Supplementation lowered triglyceride concentrations but did not affect other metabolic outcomes (high-density and low-density lipoproteins, cholesterol, fasting glucose, blood pressure, body mass index). Macronutrient supplementation for infants born small may not alter later cognitive function or metabolic risk, but may improve early motor function, especially for girls.
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