Availability of Donor Milk for Very Preterm Infants Decreased the Risk of Necrotizing Enterocolitis without Adversely Impacting Growth or Rates of Breastfeeding

Nutrients
Q1
Aug 2019
Citations:31
Influential Citations:1
Observational Studies (Human)
81
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Methods
Single-center, observational retrospective cohort study of very preterm infants (≤32 weeks gestation) admitted to a level III NICU. Two periods: 2009–2010 (Group 1, n=99) before donor milk introduction and 2012–2013 (Group 2, n=128) after donor milk introduction. Inclusion: birth ≤32 weeks GA; admission within 24 hours of life; survival >7 days. Exclusion: major congenital malformations or chromosomal/genetic/metabolic abnormalities or missing clinical records.
Intervention
Donor milk used as enteral feed supplement when mother's own milk supply was insufficient; donor milk maintained until one month of age if baby born before 28 completed weeks or weighing <1000 g; for 28–32 weeks infants >1 kg, donor milk used during the first 3–7 days; all human milk fortified with Enfamil Human Milk Fortifier Powder from an intake of 80–100 mL/kg/day.
Results
Donor milk availability was associated with earlier initiation of enteral feeding (2.6 ± 1.1 vs 2.1 ± 1.0 days; p=0.001). NEC incidence decreased from 9.1% to 3.4% (p=0.055), with a notable reduction among 28–32 weeks gestation (5.4% vs 0%; p=0.044). Surgical NEC also declined. Weight z-score at day 28 declined less in DM group (−0.96 ± 0.66 vs −1.18 ± 0.41; p=0.003) and differences were not evident at discharge. Availability of DM did not affect exclusive breastfeeding rates or overall growth. Conclusion: Donor milk feeding appears safe and may reduce NEC risk in very preterm infants, especially those born at 28–32 weeks, without compromising growth or breastfeeding; results support a protective role for donor milk beyond the most extremely preterm.
Limitations
Single-center, retrospective before–after design; modest sample size; potential unmeasured confounding; not capable of proving causality; not powered to assess differential effects by gestational-age subgroups; cause of prematurity not analyzed; relatively high rates of exclusive maternal breastfeeding may limit detection of additional DM benefits.

Abstract

Human milk contains non-nutritional factors that promote intestinal maturation and protect against infectious and inflammatory conditions. In the Neonatal Intensive Care Unit (NICU) setting, donor milk (DM) is recommended when availability of own mot...