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Breast Milk Enhances Growth of Enteroids: An Ex Vivo Model of Cell Proliferation
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The fifty billion dollar question: does formula cause necrotizing enterocolitis?

Mark A Underwood1

  • 1Emeritus Professor of Pediatrics, University of California Davis, Sacramento, CA, USA. munderwood@ucdavis.edu.

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Summary

Preterm infant formulas do not cause necrotizing enterocolitis (NEC). The absence of human milk, not formula components, is linked to increased NEC risk in premature infants.

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Area of Science:

  • Neonatal nutrition
  • Gastroenterology
  • Infant health

Background:

  • Necrotizing enterocolitis (NEC) is a critical concern for premature infants.
  • The role of preterm infant formulas in NEC causation is debated and subject to litigation.
  • Current evidence linking formula components to NEC is primarily preclinical.

Purpose of the Study:

  • To evaluate the hypothesis that toxic components in preterm infant formula cause NEC.
  • To clarify the relationship between human milk, preterm infant formula, and NEC risk.
  • To provide evidence-based guidance for feeding practices in preterm infants.

Main Methods:

  • Review of existing preclinical and clinical data on NEC and infant feeding.
  • Analysis of human infant data regarding NEC incidence and feeding types.
  • Assessment of the scientific literature on the safety and efficacy of preterm infant formulas.

Main Results:

  • Limited preclinical data supports the hypothesis of toxic formula components causing NEC.
  • Human infant data is lacking to substantiate the claim that preterm formulas cause NEC.
  • The absence of human milk is identified as a significant factor increasing NEC risk.

Conclusions:

  • Human milk is the preferred nutrition for most preterm infants.
  • Preterm infant formula serves as a crucial alternative when human milk is unavailable.
  • Increased NEC risk in preterm infants is primarily associated with the lack of human milk, not inherent toxicity of formulas.