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Breast milk and neonatal necrotising enterocolitis
Insights
Necrotising enterocolitis (NEC) is significantly more common in preterm infants fed formula exclusively. Breast milk, whether maternal or donor, offers protection against this serious condition.
Area of Science:
- Neonatalogy
- Pediatric Gastroenterology
- Public Health Nutrition
Background:
- Necrotising enterocolitis (NEC) is a severe gastrointestinal emergency in preterm infants.
- Dietary interventions play a crucial role in infant health outcomes.
- Breast milk is recognized for its protective properties in neonates.
Purpose of the Study:
- To investigate the association between infant diet and the incidence of necrotising enterocolitis in preterm infants.
- To compare the risks of NEC among exclusively formula-fed, partially breast-fed, and exclusively breast-fed preterm infants.
- To identify other risk factors for NEC in this population.
Main Methods:
- Prospective multicentre study involving 926 preterm infants.
- Infants were formally assigned to specific early diets.
- Data collected on diet, NEC development, mortality, gestational age, and other clinical factors.
Main Results:
- NEC developed in 5.5% of infants; mortality was 26% in confirmed cases.
- Exclusively formula-fed infants had 6-10 times higher NEC rates than those fed breast milk alone.
- Breast milk (maternal or donor) significantly reduced NEC risk, even when combined with formula.
Conclusions:
- Exclusive formula feeding in preterm infants is associated with a substantially increased risk of necrotising enterocolitis.
- Breast milk, including pasteurised donor milk, is protective against NEC.
- A decline in breast milk use in neonatal units may contribute to preventable NEC cases and deaths.
Abstract:
In a prospective multicentre study on 926 preterm infants formally assigned to their early diet, necrotising enterocolitis developed in 51 (5.5%). Mortality was 26% in stringently confirmed cases. In exclusively formula-fed babies confirmed disease was 6-10 times more common than in those fed breast milk alone and 3 times more common than in those who received formula plus breast milk. Pasteurised donor milk seemed to be as protective as raw maternal milk. Among babies born at more than 30 weeks' gestation confirmed necrotising enterocolitis was rare in those whose diet included breast milk; it was 20 times more common in those fed formula only. Other risk factors included very low gestational age, respiratory disease, umbilical artery catheterisation, and polycythaemia. In formula-fed but not breast-milk-fed infants, delayed enteral feeding was associated with a lower frequency of necrotising enterocolitis. With the fall in the use of breast milk in British neonatal units, exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year. About 100 of these infants would die.