- •
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.
Necrotizing Enterocolitis and Human Milk Feeding: A Systematic Review
Section snippets
Key points
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
References (67)
- et al.
Breastmilk feeding and lipoprotein profile in adolescents born preterm: follow-up of a prospective randomised study
Lancet
(2004) - et al.
Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials
Lancet
(2001) - et al.
An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products
J Pediatr
(2010) - et al.
Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants
J Pediatr
(2013) - et al.
Necrotising enterocolitis
Lancet
(2006) - et al.
Intestinal mucosal defense system, Part 1. Consensus recommendations for immunonutrients
J Pediatr
(2013) - et al.
Premature delivery influences the immunological composition of colostrum and transitional and mature human milk
J Nutr
(2011) - et al.
Early secretory antibodies in breast milk promote long-term intestinal homeostasis by regulating the gut microbiota and host gene expression
J Pediatr
(2016) - et al.
Improving the use of human milk during and after the NICU stay
Clin Perinatol
(2010) - et al.
Impact of optimized breastfeeding on the costs of necrotizing enterocolitis in extremely low birthweight infants
J Pediatr
(2016)
Breastfeeding and the use of human milk
Pediatrics
Impact of early human milk on sepsis and health-care costs in very low birth weight infants
J Perinatol
Systematic review and meta-analysis of human milk intake and retinopathy of prematurity: a significant update
J Perinatol
Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age
Pediatrics
Impact of breast milk on intelligence quotient, brain size, and white matter development
Pediatr Res
Randomized trial of donor human milk versus preterm formula as substitutes for mothers' own milk in the feeding of extremely premature infants
Pediatrics
Necrotizing enterocolitis
N Engl J Med
Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009
Pediatrics
Neurofunctional assessment at term equivalent age can predict 3-year neurodevelopmental outcomes in very low birth weight infants
Acta Paediatr
Pasteurized human donor milk use among US level 3 neonatal intensive care units
J Hum Lact
Variability of criteria for pasteurized donor human milk use: a survey of U.S. Neonatal Intensive Care Unit Medical Directors
JPEN J Parenter Enteral Nutr
Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis
Arch Dis Child Fetal Neonatal Ed
Formula versus donor breast milk for feeding preterm or low birth weight infants
Cochrane Database Syst Rev
Effect of donor milk on severe infections and mortality in very low-birth-weight infants: the Early Nutrition Study randomized clinical trial
JAMA Pediatr
Impact of donor milk availability on breast milk use and necrotizing enterocolitis rates
Pediatrics
A retrospective analysis of the effect of human milk on prevention of necrotizing enterocolitis and postnatal growth
J Perinatol
Greater mortality and morbidity in extremely preterm infants fed a diet containing cow milk protein products
Breastfeed Med
An exclusively human milk diet reduces necrotizing enterocolitis
Breastfeed Med
Beyond necrotizing enterocolitis prevention: improving outcomes with an exclusive human milk-based diet
Breastfeed Med
Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet
J Perinatol
Role of human milk in extremely low birth weight infants' risk of necrotizing enterocolitis or death
J Perinatol
Intake of own mother's milk during the first days of life is associated with decreased morbidity and mortality in very low birth weight infants during the first 60 days of life
Neonatology
Cited by (86)
Associations Between Breastfeeding and Post-perinatal Infant Deaths in the U.S.
2023, American Journal of Preventive MedicineThe role of intestinal alkaline phosphatase in the development of necrotizing enterocolitis
2023, Early Human DevelopmentThe association between human milk and human milk fortifiers and necrotising enterocolitis in preterm infants: A review
2023, Journal of Neonatal NursingCitation Excerpt :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).
Healthcare-Associated Infections
2023, Avery's Diseases of the NewbornComparison of twelve human milk oligosaccharides in mature milk from different areas in China in the Chinese Human Milk Project (CHMP) study
2022, Food ChemistryCitation Excerpt :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).
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.