Abstract
Objectives: To examine the protective effects that feeding with expressed maternal milk and donor breast milk compared with formula milk reduces the risk of development of necrotizing enterocolitis in preterm infants. Data sources: The studies for our systematic review were searched from our library’s electronic databases including PUBMED/MEDLINE, SCIENCEDIRECT (1997-2008), EBSCOHOST (1965-2008), EMBASE (1974-2008), OVID (1993-2008) and Cochrane Library. Methods: Systematic review and meta-analysis of randomized controlled trials or quasi-randomized controlled trials. Results: In our systematic review and meta-analysis only five trials fulfilled the prespecified inclusion criteria. Except for one study, all the rest included studies which were initiated nearly three decades ago. None of the individual trials found any statistically significant difference in the incidence of necrotizing enterocolitis. However, meta-analysis found that preterm infants feeding with donor breast milk was associated with a significantly reduced relative risk of necrotizing enterocolitis. Suspected necrotizing enterocolitis was three times less likely (relative risk 0.31; 95% confidence interval 0.12-0.81; p=0.02<0.05) and confirmed necrotizing enterocolitis was four times less likely (relative risk 0.24; 95% confidence interval 0.07-0.76; p=0.02<0.05) in premature infants feeding with donor breast milk compared with formula milk given as a sole diet. No data to date was available to be combined in our meta-analysis to compare expressed maternal milk with formula milk given as a sole diet. Conclusion: Feeding with donor breast milk is associated with a lower risk of necrotizing enterocolitis in preterm infants, but the protective benefits of donor breast milk are described as of borderline effects and the quality of the evidence is limited. Further trials should be focused on the effects of fortified expressed maternal milk and donor breast milk for preventing necrotizing enterocolitis in premature infants.
Highlights
As advances in neonatology and the modern neonatal intensive care unit (NICU) have improved, much more premature infants could survive after birth
In the subgroup meta-analysis of the sole diet comparison (Figure 3) we found a statistically significant difference (RR 0.31; 95% confidence interval (CI) 0.12-0.81; p=0.02
Term formula milk is different with preterm formula milk which was used in other included studies. To eliminate this potential confounding factor, the data abstracted from the studies in which preterm infants were fed with preterm formula milk, were combined in sensitivity analysis, and we found a statistically significant difference (RD -0.05; 95% CI -0.10-0.00; p=0.03
Summary
As advances in neonatology and the modern neonatal intensive care unit (NICU) have improved, much more premature infants could survive after birth. Necrotizing enterocolitis (NEC) remains a major cause of neonatal morbidity and death. The mortality rate (15%– 25%) for affected infants has not changed appreciably in the past 30 years [1]. Necrotizing enterocolitis is primarily a disease of premature infants; >90% of those affected were born prior to 36 weeks gestation [2]. Prematurity is the only risk factor for necrotizing enterocolitis consistently identified in case-control studies. The mechanism of the development of necrotizing enterocolitis is unclear; a leading hypothesis is that the immature intestinal epithelial cells mount an exaggerated inflammatory response to intestinal injury in preterm infants [3]
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