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. 2019 May;104(3):F333-F340.
doi: 10.1136/archdischild-2018-315946. Epub 2018 Dec 6.

Milk feed osmolality and adverse events in newborn infants and animals: a systematic review

Zoë-Marie Ellis  1 , Hui Shan Grace Tan  1 , Nicolas D Embleton  2 , Per Torp Sangild  3   4 , Ruurd M van Elburg  1   5
Affiliations

Milk feed osmolality and adverse events in newborn infants and animals: a systematic review

Zoë-Marie Ellis et al. Arch Dis Child Fetal Neonatal Ed. 2019 May.

Abstract

Background: High feed osmolality (or osmolarity) is often suggested to be linked with adverse gastrointestinal events in preterm infants.

Aim: To systematically review the literature on milk feed osmolality and adverse gastrointestinal events in newborn and low birthweight infants and animals.

Methods: MEDLINE, Embase, CAB Abstracts, Current Contents, BIOSIS Previews and SciSearch were searched from inception to May 2018 to identify potentially relevant studies.

Inclusion criteria: randomised controlled or observational studies of newborn and low birthweight infants or animals investigating the effects of milk-based feeds with different osmolalities. Only full-text, English-language papers were included.

Results: Ten human and six animal studies met the inclusion criteria. Of human studies, seven reported no differences in adverse events with varying feed osmolalities; one reported delayed gastric emptying with feed osmolarity of 539 mOsm/L compared with lower levels; one reported higher necrotising enterocolitis (NEC) incidence with feed osmolarity of 650 mOsm/L compared with 359 mOsm/L; one found higher NEC incidence with the lowest feed osmolality (326 mOsm/kg compared with 385 mOsm/kg). Of animal studies, two reported delayed gastric emptying with feed osmolarity >624 mOsm/L, one reported decreased survival due to dehydration with dietary osmolarities ≥765 mOsmol/L and none reported increased NEC incidence with differing feed osmolalities. No clear mechanisms were found, and diet composition differences limited the interpretations regarding the independent impact of osmolality.

Conclusions: There is no consistent evidence that differences in feed osmolality in the range 300-500 mOsm/kg are associated with adverse gastrointestinal symptoms in neonates.

Keywords: infant feeding; neonatology; nutrition; osmolality; tolerance.

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Conflict of interest statement

Competing interests: Z-ME, HSGT and RMvE are employees of Danone Nutricia Research, Utrecht, The Netherlands. NDE has previously conducted research with support from manufacturers of infant formula including Nestec SA (Switzerland), Wyeth UK and Nutricia UK but did not receive any payment, support or benefit in kind for contribution to this manuscript and has no ongoing personal, consultancy or financial relationships with Nutricia or other relevant commercial interest. PTS has nothing to declare.

Figures

Figure 1
Figure 1
Flow diagram of the literature search process.
Figure 2
Figure 2
Assessment of the risk of bias in included human randomised controlled trials and the review authors’ judgements about each risk of bias item presented as percentages.
Figure 3
Figure 3
Assessment of the risk of bias in included animal studies and the review authors’ judgements about each risk of bias item presented as percentages.
See this image and copyright information in PMC

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