Exclusive human milk for infants with gastroschisis: A systematic review and meta-analysis

BackgroundInfants with gastroschisis often experience prolonged stays in hospital as they transition from parenteral nutrition to enteral feeds. The purpose of this study was to assess the evidence for the use of exclusive human milk compared to formula in these patients.MethodsA structured search was performed using Medline, Embase, and Cochrane Central from inception until March 2025. We included comparative studies of infants with gastroschisis who received exclusive human milk versus supplemental or exclusive formula. Screening and data extraction were completed by two independent reviewers. Results from included studies were meta-analyzed using a random-effects model and reported as risk ratios (RR) with 95% confidence intervals (CI). Risk of bias assessments were performed using the Newcastle-Ottawa Scale. Outcomes included time to enteral autonomy, necrotizing enterocolitis, sepsis, cholestasis, and mortality. Certainty of evidence was summarized using Grading of Recommendations, Assessment, Development and Evaluations criteria.ResultsWe identified 3661 infants with gastroschisis from six retrospective cohort studies and one case-control study. Exclusive human milk was associated with a reduced risk of mortality (RR = 0.38, 95% CI: 0.15-0.99, I² = 0%). There were no statistically significant differences between groups for necrotizing enterocolitis, cholestasis, or sepsis. These findings were supported by low quality evidence based on retrospective data.ConclusionsThe best available evidence suggests that exclusive breast milk is associated with reduced mortality compared to formula among infants with gastroschisis. This estimate is based on data from retrospective studies. Further research is needed to clarify the role of donor human milk.