Preterm infants should be exclusively fed human milk rather than formula milk to prevent necrotizing enterocolitis, even if the milk does not come from the mother, a study published online in the Journal of Pediatrics confirmed.
Preterm infants fed only pasteurized donor human milk (with pasteurized donor human milk–based human milk fortifier added as needed to meet nutritional needs) were less likely to develop the potentially life-threatening gastrointestinal condition than were those given a bovine milk–based formula. Indeed, there was only one (3%) case of necrotizing enterocolitis in the infant group fed the donor human milk, versus five (21%) cases in those fed the preterm formula milk.
Importantly, there were no cases of necrotizing enterocolitis requiring surgical intervention in the donor human milk group, compared with four cases in the formula milk group.
"These data support those reported in our previous study (J. Pediatr. 2010;156:562-7) of pasteurized donor human milk vs. preterm formula used as supplements to a mother’s own milk diet," Dr. Elizabeth Cristofalo of Johns Hopkins University, Baltimore, and her associates noted (J. Pediatr. 2013 Aug. 22 [doi:10.1016/j.jpeds.2013.07.011]).
The findings also concur with current guidance issued by the American Academy of Pediatrics on the benefits of human breast milk (Pediatrics 2012;129:e827-41). This guidance states that all preterm infants should receive human milk, preferably from the mother. If that is not possible or the mother does not wish to breastfeed, then pasteurized human donor milk should be used.
"Pasteurized donor human milk has emerged as an alternative for mother’s own milk," Dr. Cristofalo and her associates observed. "It has been unclear, however, if pasteurized donor human milk confers the same health benefits as does mother’s own milk."
Their current study involved 53 preterm infants who were fed either pasteurized milk from human donors or a bovine milk–based preterm formula. The infants, with birth weights between 500g and 1,250g, were enrolled at seven neonatal care units and had received parenteral nutrition within 48 hours of their birth and enteral feedings before 21 days of age.
Altogether, 29 infants were randomized to receive donor human milk and 24 to receive the bovine milk–based preterm formula milk. The primary outcome of the study was the duration of parenteral nutrition, which was significantly reduced in those fed the donor human milk (median of 27 vs. 36 days).
Growth rates were slightly lower in the donor human milk group than in the bovine milk–based formula group, but differences were only significant for the infants’ gain in length (0.84 cm/week vs. 1.12 cm/week, P = .006). We "believe these small differences can be prevented by further adjustments in fortifier content to support improved rates of growth," Dr. Cristofalo and her colleagues proposed.
With regard to necrotizing enterocolitis, the team found that all six cases not requiring surgical intervention occurred within the first 29 days of birth. The number of infants needed to be fed an exclusive human milk diet to prevent one case of surgical necrotizing enterocolitis was six.
The researchers concluded that there is a "greater need for enhanced lactation support in the neonatal intensive care unit" and suggested "an imperative to establish more human milk banks."
Necrotizing enterocolitis affects between 7% and 12% of infants born with a low birth weight (less than 1,500 g) in the United States each year. The exact cause is unclear, but it may be the result of multiple factors, including ischemic injury and abnormal microbial colonization.
The condition is well known to have a detrimental effect on survival and also lead to longer-term complications, particularly if surgery is required. Recent findings have suggested that necrotizing enterocolitis costs U.S. health care services a mean of $5,112 per infant between 6 months and 1 year or age, with higher costs for treating surgical necrotizing enterocolitis of $18,274 between 6 and 12 months, $14,067 between 1 and 2 years, and $8,501 between 2 and 3 years (BMC Pediatr. 2013;13:127).
Dr. Cristofalo and her coinvestigators received financial support from Prolacta Bioscience, the manufacturers of the pasteurized donor milk used in the study. Two of the investigators are employees of the company, and one author is a paid consultant of the company.