Donor Human Milk Protects against Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis.

Eduardo Villamor-Martínez,Eduardo Villamor,Fabio Mosca,Maria Pierro,Boris Kramer,Giacomo Cavallaro

doi:10.3390/nu10020238

Abstract

Bronchopulmonary dysplasia (BPD) is the most common complication after preterm birth. Pasteurized donor human milk (DHM) has increasingly become the standard of care for very preterm infants over the use of preterm formula (PF) if the mother’s own milk (MOM) is unavailable. Studies have reported beneficial effects of DHM on BPD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on the effects of DHM on BPD and other respiratory outcomes. Eighteen studies met the inclusion criteria. Meta-analysis of RCTs could not demonstrate that supplementation of MOM with DHM reduced BPD when compared to PF (three studies, risk ratio (RR) 0.89, 95% confidence interval (CI) 0.60–1.32). However, meta-analysis of observational studies showed that DHM supplementation reduced BPD (8 studies, RR 0.78, 95% CI 0.67–0.90). An exclusive human milk diet reduced the risk of BPD, compared to a diet with PF and/or bovine milk-based fortifier (three studies, RR 0.80, 95% CI 0.68–0.95). Feeding raw MOM, compared to feeding pasteurized MOM, protected against BPD (two studies, RR 0.77, 95% CI 0.62–0.96). In conclusion, our data suggest that DHM protects against BPD in very preterm infants.

Highlights

The nutritional and immunological benefits of providing human milk to very preterm (gestational age (GA) < 32 weeks) or very low birth weight (VLBW, i.e., birth weight < 1500 g) infants have been increasingly recognized [1,2,3,4,5]
Evidence exists regarding the protective effects of mother’s own milk (MOM) in reducing the risk of necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and retinopathy of prematurity (ROP) in VLBW infants, questions remain regarding whether donor human milk (DHM) provides the same benefits [5,9,10,11,12,13,14,15]
We found no evidence of publication bias in any of the analyses that we performed, either through visual inspection of funnel plots or Egger’s regression intercept

Summary

Introduction

The nutritional and immunological benefits of providing human milk to very preterm (gestational age (GA) < 32 weeks) or very low birth weight (VLBW, i.e., birth weight < 1500 g) infants have been increasingly recognized [1,2,3,4,5]. Official bodies such as the World Health Organisation [6], American. When MOM is not available, pasteurized donor human milk (DHM) is the preferred choice [7,8]. DHM is Nutrients 2018, 10, 238; doi:10.3390/nu10020238 www.mdpi.com/journal/nutrients

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