Necrotizing Enterocolitis and Human Milk Feeding: A Systematic Review

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Key points

  • There is a lack of clear evidence that donor milk decreases the incidence of necrotizing enterocolitis (NEC) in preterm infants.

  • An exclusive human milk diet may provide protection against NEC.

  • A higher dose of human milk, particularly more than 50% of feedings, reduces the risk of NEC in preterm infants.

Search Strategy

A search was conducted in the electronic databases PubMed, Embase, CINAHL, and the Cochrane Database of Systematic Reviews using the search terms “Human Milk and Necrotizing Enterocolitis,” “Donor Milk and Necrotizing Enterocolitis,” “Breast Milk and Necrotizing Enterocolitis.” Journal articles published between January 1, 2000, and June 30, 2016, were identified. The bibliographies of all articles included for data extraction were hand searched for additional eligible articles. Because of

Results

The search revealed 24 studies that met inclusion criteria (Fig. 1).

Discussion

This systematic review summarizes the evidence regarding the association of DHM, an EHM diet, and different HM doses with the incidence of NEC in premature infants. There is (1) a lack of clear evidence that DHM decreases the incidence of NEC, (2) preliminary evidence that an EHM diet may provide protection against NEC, and (3) consistent evidence that a higher dose of MOM reduces the risk of NEC.

One consideration that needs to be taken into account for all NEC-related studies is the criteria

Summary

This systematic review summarizes the evidence regarding whether DHM and/or an EHM diet decrease the incidence of NEC, and the dose of HM necessary to reduce the risk of NEC in premature infants. There is a lack of clear evidence that DHM decreases the incidence of NEC, preliminary evidence that an EHM diet may provide protection against NEC, and consistent evidence that a higher dose of MOM reduces the risk of NEC. Additional research regarding the protection afforded by DHM and EHM, as well

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      The association between the use of human milk and the decreased risk for necrotising enterocolitis may be related to the amount of milk consumed. Poulimeneas et al. (2021) confirm the former but do not identify the percentage of human milk consumed associated with a decrease in necrotising enterocolitis, whilst Cacho et al. (2017) (Table 1), report that a dose of at least 50% human milk is associated with a decrease in necrotising enterocolitis. Altobelli et al. (2020) report that an exclusive diet of human milk is superior to a mixed diet of 50% or more human milk in decreasing necrotising enterocolitis (Table 1).

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      Interestingly, amounts of DSLNT were lower than as reported in other studies from other counties (Leo et al., 2010; Gabrielli et al., 2011; Thurl et al., 2017; Tonon et al., 2019) and similar with that reported in Chinese cohort by (Huang et al., 2019; Wang et al., 2020). It was suggested that a lower DSLNT content was a risk factor for necrotising enterocolitis (NEC) and perhaps for spontaneous intestinal perforation (SIP) in infants, especially in preterm infants (Autran et al., 2018; Cacho et al., 2017; Hassinger et al., 2020; Meinzen-Derr et al., 2009). The HMOs, in particular DSLNT, appeared to play a protective role in NEC development among infants (Autran et al., 2018; Hassinger et al., 2020).

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    Disclosure: N.T. Cacho, L.A. Parker, and J. Neu all receive a grant funded by Medela. L.A. Parker and J. Neu are funded by the National Institutes of Health R15NR013566-01A1. J. Neu is on the Scientific Advisory Board for Medela and receives a research grant from Medela. He also serves on the Scientific Advisory Board for Infant Bacterial Therapeutics and is principal investigator for a multicenter safety phase trial.

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