Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 May 31;10(6):707.
doi: 10.3390/nu10060707.

A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants

Jacqueline Miller  1   2 , Emma Tonkin  3 , Raechel A Damarell  4 , Andrew J McPhee  5   6 , Machiko Suganuma  7 , Hiroki Suganuma  8 , Philippa F Middleton  9   10 , Maria Makrides  11   12 , Carmel T Collins  13   14
Affiliations
Meta-Analysis

A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants

Jacqueline Miller et al. Nutrients. .

Abstract

This systematic review and meta-analysis synthesised the post-1990 literature examining the effect of human milk on morbidity, specifically necrotising enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and neurodevelopment in infants born ≤28 weeks' gestation and/or publications with reported infant mean birth weight of ≤1500 g. Online databases including Medline, PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched, and comparisons were grouped as follows: exclusive human milk (EHM) versus exclusive preterm formula (EPTF), any human milk (HM) versus EPTF, higher versus lower dose HM, and unpasteurised versus pasteurised HM. Experimental and observational studies were pooled separately in meta-analyses. Risk of bias was assessed for each individual study and the GRADE system used to judge the certainty of the findings. Forty-nine studies (with 56 reports) were included, of which 44 could be included in meta-analyses. HM provided a clear protective effect against NEC, with an approximate 4% reduction in incidence. HM also provided a possible reduction in LOS, severe ROP and severe NEC. Particularly for NEC, any volume of HM is better than EPTF, and the higher the dose the greater the protection. Evidence regarding pasteurisation is inconclusive, but it appears to have no effect on some outcomes. Improving the intake of mother's own milk (MOM) and/or donor HM results in small improvements in morbidity in this population.

Keywords: bronchopulmonary dysplasia; donor human milk; formula feeding; human milk; necrotising enterocolitis; neurodevelopment; preterm infant; retinopathy of prematurity; sepsis.

PubMed Disclaimer

Conflict of interest statement

The views expressed in this article are solely the responsibility of the authors and do not reflect the views of the National Health and Medical Research Council (NHMRC), Australia. C.T.C. and M.M. are authors on an included paper (Jacobi-Polishook 2016). Collins’ salary was supported by a Research Fellowship from the M.S. McLeod Research Fund of the Women’s and Children’s Hospital Research Foundation and NHMRC TRIP Fellowship 1132596. Outside the submitted work, M.M. serves on scientific advisory boards for Fonterra and Nestle. Honoraria are paid to her institution for continuing education of early career researchers. M.M. also holds a Principal Research Fellowship from the NHMRC (APP1061704). All other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Forest plot of relative risk for the association between human milk and necrotising enterocolitis.
Figure 2
Figure 2
Forest plot of relative risk for the association between human milk and late onset sepsis.
Figure 3
Figure 3
Forest plot of relative risk for the association between human milk and bronchopulmonary dysplasia.
Figure 4
Figure 4
Forest plot of relative risk for the association between human milk and retinopathy of prematurity.
Figure 5
Figure 5
Forest plot of mean difference for association between human milk and neurodevelopmental scores. Footnotes: (1) BSID II MDI at 12 months, Mean adjusted for maternal Peabody Picture Vocabulary Test score and number days of oxygen; (2) BSID II MDI at 20 months; (3) BISD II MDI at 18 months; (4) BSID II MDI at 18 months; (5) BSID II MDI at 12 months CA; (6) BSID II MDI at 6 months CA; (7) BSID II MDI at 12 months; (8) BSID II MDI at 12 months CA; (9) BSID II MDI at 12 months; (10) BSID III MDI at 18 months CA, Adjusted Mean; (11) BSID III MDI at 18 months; (12) BSID II MDI at 20 months; (13) BSID II MDI at 18 months; (14) BSID III MDI at 2 years CA; (15) KABC five-year mental processing; (16) BSID II PDI at 20 months; (17) BSID II PDI at 18 months; (18) BSID II PDI at 18 months; (19) BSID III PDI at 18 months CA, Adjusted Mean; (20) BSID III PDI at 12 months CA; (21) BSID II PDI at 6 months CA; (22) BSID III PDI at one year CA; (23) BSID II PDI at 12 months CA; (24) BSID II PDI at 12 month; (25) BSID III PDI at 18 months; (26) BSID II at 20 months; (27) BSID II PDI at 18 months; (28) BSID III PDI at two years CA. Abbreviations: BSID, Bayley’s Scale of Infant Development; CA, corrected age; KABC, Kaufman Assessment Battery for Children; MDI, Mental Developmental Index; PDI, physical developmental scale.
See this image and copyright information in PMC

References

    1. Agostoni C., Buonocore G., Carnielli V.P., De Curtis M., Darmaun D., Decsi T., Domellöf M., Embleton N.D., Fusch C., Genzel-Boroviczeny O., et al. Enteral nutrient supply for preterm infants: Commentary from the european society of paediatric gastroenterology, hepatology and nutrition committee on nutrition. J. Pediatr. Gastroenterol. Nutr. 2010;50:85–91. doi: 10.1097/MPG.0b013e3181adaee0. - DOI - PubMed
    1. Committee on Nutrition. Section on Brreastfeeding. Committee on Fetus and Newborn Donor human milk for the high-risk infant: Preparation, safety, and usage options in the United States. Pediatrics. 2017;139:e20163044. - PubMed
    1. Arslanoglu S., Corpeleijn W., Moro G., Braegger C., Campoy C., Colomb V., Decsi T., Domellof M., Fewtrell M., Hojsak I., et al. Donor human milk for preterm infants: Current evidence and research directions. J. Pediatr. Gastroenterol. Nutr. 2013;57:535–542. doi: 10.1097/MPG.0b013e3182a3af0a. - DOI - PubMed
    1. Grovslien A.H., Gronn M. Donor milk banking and breastfeeding in Norway. J. Hum. Lact. 2009;25:206–210. doi: 10.1177/0890334409333425. - DOI - PubMed
    1. Lucas A., Cole T.J. Breast milk and neonatal necrotising enterocolitis. Lancet. 1990;336:1519–1523. doi: 10.1016/0140-6736(90)93304-8. - DOI - PubMed

MeSH terms