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. 2019 Jun 6:7:224.
doi: 10.3389/fped.2019.00224. eCollection 2019.

Mother's Own Milk and Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

Eduardo Villamor-Martínez  1 , Maria Pierro  2 , Giacomo Cavallaro  3 , Fabio Mosca  3 , Eduardo Villamor  1
Affiliations

Mother's Own Milk and Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

Eduardo Villamor-Martínez et al. Front Pediatr. .

Abstract

Background: Bronchopulmonary dysplasia (BPD) is the most common complication of very preterm birth and can lead to lifelong health consequences. Optimal nutrition is a cornerstone in the prevention and treatment of BPD. In very preterm infants, mother's own milk (MOM) feeding is associated with lower risks of necrotizing enterocolitis, retinopathy of prematurity, and sepsis. Although several studies have shown that MOM may protect against BPD, a systematic analysis of the evidence has not been performed to date. Methods: A comprehensive literature search was conducted using PubMed/MEDLINE and EMBASE, from their inception to 1 December 2017. Longitudinal studies comparing the incidence of BPD in preterm infants fed with exclusive MOM, MOM supplemented with preterm formula (PF), and/or exclusively fed with PF were selected. A random-effects model was used to calculate the Mantel Haenszel risk ratio (RR) and 95% confidence interval (CI). Results: Fifteen studies met the inclusion criteria (4,984 infants, 1,416 BPD cases). Use of exclusive MOM feedings was associated with a significant reduction in the risk of BPD (RR 0.74, 95% CI 0.57-0.96, 5 studies). In contrast, meta-analysis could not demonstrate a significant effect on BPD risk when infants fed with more than 50% MOM were compared with infants fed with <50% MOM (RR 0.98, 95% CI 0.77-1.23, 10 studies) or when infants fed with MOM supplemented with PF were compared with infants fed with exclusive PF (RR 1.00, 95% CI 0.78-1.27, 6 studies). Meta-regression showed that differences in gestational age were a significant confounder of the effect of MOM. Conclusion: To our knowledge, this is the first systematic review and meta-analysis that specifically evaluates the role of MOM on BPD. Our data indicate that MOM may reduce the incidence of BPD when used as an exclusive diet, but this result needs to be interpreted with caution. We did not find the same difference in analyses with other dosages of MOM. Further studies adequately powered to detect changes in BPD rates and that adjust for confounders are needed to confirm the beneficial effects of MOM on BPD.

Keywords: bronchopulmonary dysplasia; human milk; meta-analysis; meta-regression; mother's own milk; preterm formula; systematic review.

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Figures

Figure 1
Figure 1
PRISMA diagram of the search.
Figure 2
Figure 2
Meta-analysis of exclusive MOM vs. any PF and risk of BPD. MOM, mother's own milk; PF, preterm formula; BPD, bronchopulmonary dysplasia; CI, confidence interval; MH, Mantel-Haenszel.
Figure 3
Figure 3
Meta-analysis of exclusive MOM vs. exclusive PF and risk of BPD. MOM, mother's own milk; PF, preterm formula; BPD, bronchopulmonary dysplasia; CI, confidence interval; MH, Mantel-Haenszel.
Figure 4
Figure 4
Meta-analysis of mainly MOM vs. mainly PF and risk of BPD. MOM, mother's own milk; PF, preterm formula; BPD, bronchopulmonary dysplasia; CI, confidence interval; MH, Mantel-Haenszel.
Figure 5
Figure 5
Meta-regression of MD in GA between the MOM and PF group, and risk of BPD. CI, confidence interval; BPD, bronchopulmonary dysplasia.
Figure 6
Figure 6
Meta-analysis of Any MOM vs. Exclusive PF and risk of BPD. MOM, mother's own milk; PF, preterm formula; BPD, bronchopulmonary dysplasia; CI, confidence interval; MH, Mantel-Haenszel.
Figure 7
Figure 7
Meta-analysis of Any MOM vs. Exclusive PF, mean difference (MD) in gestational age (GA) between groups. MOM, mother's own milk; PF, preterm formula.
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