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Efficacy of Donated Milk in Early Nutrition of Preterm Infants: A Meta-Analysis
Yu Li1,2, Cheng Chi2, Cheng Li2
1School of Nursing, Weifang Medical University, Weifang 261042, China.
Insights
Donated breast milk significantly reduces necrotizing enterocolitis (NEC) and parenteral nutrition duration in preterm infants. With fortifiers, it supports growth comparable to formula.
Area of Science:
- Neonatal Nutrition and Gastroenterology
- Public Health and Epidemiology
- Evidence-Based Medicine
Background:
- Preterm birth presents significant global health challenges, leading to numerous infant complications.
- Human milk is optimal for preterm infants, but maternal milk scarcity necessitates alternatives like formula and donated breast milk.
- Donated breast milk offers bioactive components, including human milk oligosaccharides, as a valuable alternative.
Purpose of the Study:
- To systematically review and conduct a meta-analysis comparing the nutritional effects of donated breast milk versus formula in preterm infants.
- To evaluate the impact of donated breast milk on key health outcomes and growth parameters in premature neonates.
Main Methods:
- A systematic literature search was performed across major databases (Medline, Web of Science, Embase, etc.) and clinical trial registries.
- Included studies were randomized controlled trials (RCTs) focusing on preterm infants receiving donated breast milk or formula.
- Meta-analysis was used to synthesize data from 11 RCTs involving 1390 patients.
Main Results:
- Donated breast milk significantly reduced the incidence of necrotizing enterocolitis (NEC) (RR = 0.67) and shortened the duration of parenteral nutrition (MD = -2.39 days).
- Time to full enteral feeding was also reduced with donated breast milk (MD = -0.33 days), though with wider confidence intervals.
- Formula significantly enhanced infant growth, including weight gain (MD = -3.45), head circumference (MD = -0.07), and body length (MD = -0.13), and reduced time to regain birth weight (MD = 6.60 days).
Conclusions:
- Donated breast milk offers significant benefits in reducing NEC incidence and shortening parenteral nutrition and enteral feeding durations for preterm infants.
- Formula demonstrates superior efficacy in promoting physical growth parameters (weight, head, length) and faster regain of birth weight.
- Supplementing donated breast milk with fortifiers may optimize its growth-promoting effects, potentially matching formula's efficacy.
Abstract:
Background: Preterm birth is associated with an increased risk of many complications, which is a main public health problem worldwide with social and economic consequences. Human milk from breast feeding has been proved to be the optimal nutrition strategy for preterm infants when available. However, the lack of human milk from mothers makes formula widely used in clinical practice. In recent years, donated breast milk has gained popularity as an alternative choice which can provide human milk oligosaccharides and other bioactive substances. Objective: We aimed to conduct a systematic review and meta-analysis to evaluate the nutritional effects of donated breast milk on preterm infants compared with formula. Method: In the present study, we searched Medline, Web of Science, Embase, clinicaltrials.gov, the China national knowledge infrastructure, and the Cochrane central register of controlled trials for candidate randomized controlled trials (RCTs). Results: A total of 1390 patients were enrolled in 11 RCTs and meta-analysis results showed that donated breast milk is also more advantageous in reducing the incidence of necrotizing enterocolitis (NEC, RR = 0.67, 95% CI = 0.48 to 0.93, p = 0.02), reducing the duration of parenteral nutrition (MD = −2.39, 95% CI = −3.66 to −1.13, p = 0.0002) and the time of full enteral feeding (MD = −0.33, 95% CI = −3.23 to 2.57, p = 0.0002). In comparison, formula significantly promotes the growth of premature infants, including their weight gain (MD = −3.45, 95% CI = −3.68 to −3.21, p < 0.00001), head growth (MD = −0.07, 95% CI = −0.08 to −0.06, p < 0.00001) and body length (MD = −0.13, 95% CI = −0.15 to −0.11, p < 0.00001), and reduces the time it takes for premature infants to regain birth weight (MD = 6.60, 95% CI = 6.11 to 7.08, p < 0.00001. Conclusion: Compared with formula, donated breast milk could significantly reduce the incidence of NEC, the duration of parenteral nutrition, and the time of full enteral feeding. Adding fortifiers in donated milk could make it as effective as formula in promoting the physical growth of premature infants.
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