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Meta-Analysis
. 2018 Feb 20;10(2):238.
doi: 10.3390/nu10020238.

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

Eduardo Villamor-Martínez  1 , Maria Pierro  2 , Giacomo Cavallaro  3 , Fabio Mosca  4 , Boris W Kramer  5 , Eduardo Villamor  6
Affiliations
Meta-Analysis

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

Eduardo Villamor-Martínez et al. Nutrients. .

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.

Keywords: breast milk; bronchopulmonary dysplasia; donor human milk; pasteurization; preterm formula.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the literature search process.
Figure 2
Figure 2
Meta-analysis of randomized controlled trials assessing the effects of supplementation of MOM with DHM, compared with supplementation with PF, on risk of BPD36. Circles (O) represent the effect sizes per study, and their size represents the relative weight of the study in the meta-analysis. Diamonds (◆) represent the pooled effect size. DHM: donor human milk; PF: preterm formula; BPD36: bronchopulmonary dysplasia defined as oxygen dependency at 36 weeks post-menstrual age; MH: Mantel-Haenszel.
Figure 3
Figure 3
Meta-analysis of randomized controlled trials assessing the effects of supplementation of MOM with DHM, compared with supplementation with PF, on mean days on MV. Circles (O) represent the effect sizes per study, and their size represents the relative weight of the study in the meta-analysis. Diamonds (◆) represent the pooled effect size. DHM: donor human milk; PF: preterm formula; MV: mechanical ventilation.
Figure 4
Figure 4
Meta-analysis of observational studies assessing the effects of supplementation of MOM with DHM, compared with supplementation with PF, on risk of BPD36. Circles (O) represent the effect sizes per study, and their size represents the relative weight of the study in the meta-analysis. Diamonds (◆) represent the pooled effect size. DHM: donor human milk; PF: preterm formula; BPD36: bronchopulmonary dysplasia defined as oxygen depenency at 36 weeks post-menstrual age; MH: Mantel-Haenszel.
Figure 5
Figure 5
Meta-analysis of observational studies assessing the effects of supplementation of MOM with DHM, compared with supplementation with PF, on mean days on mechanical ventilation. Circles (O) represent the effect sizes per study, and their size represents the relative weight of the study in the meta-analysis. Diamonds (◆) represent the pooled effect size. DHM: donor human milk; PF: preterm formula.
Figure 6
Figure 6
Meta-analysis of observational studies assessing the effects of supplementation of MOM with DHM, compared with supplementation with PF, on mean days on oxygen. Circles (O) represent the effect sizes per study, and their size represents the relative weight of the study in the meta-analysis. Diamonds (◆) represent the pooled effect size. DHM: donor human milk; PF: preterm formula.
Figure 7
Figure 7
Meta-analysis of observational studies assessing the effects of receiving mainly MOM vs. receiving mainly DHM, on risk of BPD36. Circles (O) represent the effect sizes per study, and their size represents the relative weight of the study in the meta-analysis. Diamonds (◆) represent the pooled effect size. MOM: mother’s own milk; DHM: donor human milk; BPD36: bronchopulmonary dysplasia defined as oxygen dependency at 36 weeks post-menstrual age; MH: Mantel-Haenszel.
Figure 8
Figure 8
Meta-analysis of studies assessing the effects of receiving raw MOM vs. receiving pasteurized MOM, on risk of BPD36. Circles (O) represent the effect sizes per study, and their size represents the relative weight of the study in the meta-analysis. Diamonds (◆) represent the pooled effect size. MOM: mother’s own milk; BPD36: bronchopulmonary dysplasia defined as oxygen dependency at 36 weeks post-menstrual age; MH: Mantel-Haenszel.
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