Donor human milk versus formula for preventing necrotising enterocolitis in preterm infants: systematic review

Abstract

Objectives: To determine if enteral feeding with donor human milk compared with formula milk reduces the incidence of necrotising enterocolitis (NEC) in preterm or low birthweight infants.

Methods: Systematic review and meta-analysis of randomised controlled trials.

Results: Four small trials, all initiated more than 20 years ago, fulfilled the prespecified inclusion criteria. None of the trials individually found any statistically significant difference in the incidence of NEC. However, meta-analysis found that feeding with donor human milk was associated with a significantly reduced relative risk (RR) of NEC. Infants who received donor human milk were three times less likely to develop NEC (RR 0.34; 95% confidence interval (CI) 0.12 to 0.99), and four times less likely to have confirmed NEC (RR 0.25; 95% CI 0.06 to 0.98) than infants who received formula milk.

Conclusions: It may be appropriate to consider further larger trials to compare growth, development, and the incidence of adverse outcomes, including NEC, in preterm infants who receive donor human milk versus formula milk.

Figure 1

Relative risk of necrotising enterocolitis in infants randomised to donor human milk versus formula milk.

Figure 2

Relative risk of confirmed necrotising enterocolitis in infants randomised to donor human milk versus formula milk.