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Mother's Own Milk and Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis
Eduardo Villamor-Martínez1, Maria Pierro2, Giacomo Cavallaro3
1Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.
Insights
Exclusive use of mother's own milk (MOM) in preterm infants may reduce the risk of bronchopulmonary dysplasia (BPD). However, this effect requires further investigation in adequately powered studies.
Area of Science:
- Neonatal Medicine
- Pediatric Nutrition
- Respiratory Medicine
Background:
- Bronchopulmonary dysplasia (BPD) is a common, serious complication of very preterm birth.
- Optimal nutrition is crucial for preventing and treating BPD in vulnerable infants.
- Mother's own milk (MOM) is linked to better outcomes, but its specific role in BPD prevention needs systematic evaluation.
Conclusions:
- This systematic review suggests exclusive mother's own milk (MOM) feeding may decrease bronchopulmonary dysplasia (BPD) incidence.
- The observed benefit of exclusive MOM requires cautious interpretation and needs confirmation in further research.
- Additional well-powered studies are necessary to adjust for confounders and definitively establish MOM's role in BPD prevention.
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.
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