Oral Application of Mother's Own Milk for Reducing Necrotizing Enterocolitis in Preterm Infants: An Updated Meta-Analysis of RCTs

Overview

Journal Evid Based Complement Alternat Med

Specialty Rehabilitation Medicine

Date 2023 Apr 17

PMID 37064945

Authors

Bo Peng

Lei Yu

Jing Qian

Baoying Zheng

Yi Zhang

Chunmei Zhu

Affiliations

Soon will be listed here.

Abstract

Background: Necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) are the major contributors to mortality and morbidity in preterm infants. This updated meta-analysis was aimed to assess the effects of mother's milk on the incidence of NEC, LOS, and other clinical outcomes in preterm infants.

Methods: PubMed, Embase, and the Cochrane library were searched for papers published up to October 2022.

Results: A total of 13 RCTs with 1330 infants were included in the final analysis. Significant difference in NEC (stage 2 or 3) was found between the intervention group and the control group (RR = 0.508, 95% CI: 0.314-0.822, and =0.008). The incidence of proven LOS (RR = 0.809, 95% CI: 0.610-1.071, and =0.139) and death (RR = 0.800, 95% CI: 0.571-1.122, and =0.196) was comparable between the two groups. Statistical differences in the incidence of proven or probable LOS (RR = 0.705, 95% CI: 0.577-0.862, and =0.001) and length of hospitalization (WMD = -4.868, 95% CI: -6.608 to -3.128, and < 0.001) between the intervention group and the control group were observed.

Conclusions: The results of this updated meta-analysis showed that compared to the placebo, mother's milk provides better effects in reducing the incidences of NEC, proven or probable LOS, and the length of stay, whereas no significant benefit of mother's milk was observed in reducing the incidence of proven LOS and death.

Citing Articles

Effects of human donor milk on gut barrier function and inflammation: study of the beneficial properties to the newborn.

Rodriguez-Camejo C, Puyol A, Arbildi P, Sonora C, Fazio L, Sire G Front Immunol. 2023; 14:1282144.

PMID: 38022652 PMC: 10663376. DOI: 10.3389/fimmu.2023.1282144.

References

Abd-Elgawad M, Eldegla H, Khashaba M, Nasef N . Oropharyngeal Administration of Mother's Milk Prior to Gavage Feeding in Preterm Infants: A Pilot Randomized Control Trial. JPEN J Parenter Enteral Nutr. 2019; 44(1):92-104. DOI: 10.1002/jpen.1601. View

Burge K, Hannah L, Eckert J, Gunasekaran A, Chaaban H . The Protective Influence of Chondroitin Sulfate, a Component of Human Milk, on Intestinal Bacterial Invasion and Translocation. J Hum Lact. 2019; 35(3):538-549. PMC: 6615959. DOI: 10.1177/0890334419845338. View

Walsh M, Kliegman R . Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986; 33(1):179-201. PMC: 7131118. DOI: 10.1016/s0031-3955(16)34975-6. View

Hozo S, Djulbegovic B, Hozo I . Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5:13. PMC: 1097734. DOI: 10.1186/1471-2288-5-13. View

Sohn K, Kalanetra K, Mills D, Underwood M . Buccal administration of human colostrum: impact on the oral microbiota of premature infants. J Perinatol. 2015; 36(2):106-11. DOI: 10.1038/jp.2015.157. View

Selcuk A . A Guide for Systematic Reviews: PRISMA. Turk Arch Otorhinolaryngol. 2019; 57(1):57-58. PMC: 6461330. DOI: 10.5152/tao.2019.4058. View

Romano-Keeler J, Azcarate-Peril M, Weitkamp J, Slaughter J, McDonald W, Meng S . Oral colostrum priming shortens hospitalization without changing the immunomicrobial milieu. J Perinatol. 2016; 37(1):36-41. PMC: 5215726. DOI: 10.1038/jp.2016.161. View

Sterne J, Savovic J, Page M, Elbers R, Blencowe N, Boutron I . RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. DOI: 10.1136/bmj.l4898. View

Aggarwal R, Plakkal N, Bhat V . Does oropharyngeal administration of colostrum reduce morbidity and mortality in very preterm infants? A randomised parallel-group controlled trial. J Paediatr Child Health. 2021; 57(9):1467-1472. DOI: 10.1111/jpc.15529. View

10.

Ouyang X, Yang C, Xiu W, Hu Y, Mei S, Lin Q . Oropharyngeal administration of colostrum for preventing necrotizing enterocolitis and late-onset sepsis in preterm infants with gestational age ≤ 32 weeks: a pilot single-center randomized controlled trial. Int Breastfeed J. 2021; 16(1):59. PMC: 8379587. DOI: 10.1186/s13006-021-00408-x. View

11.

Wang X, Yan X, Zhang L, Cai J, Zhou Y, Liu H . Identification and Peptidomic Profiling of Exosomes in Preterm Human Milk: Insights Into Necrotizing Enterocolitis Prevention. Mol Nutr Food Res. 2019; 63(13):e1801247. DOI: 10.1002/mnfr.201801247. View

12.

Lau P, Cruz S, Ocampo E, Nuthakki S, Style C, Lee T . Necrotizing enterocolitis in patients with congenital heart disease: A single center experience. J Pediatr Surg. 2018; 53(5):914-917. DOI: 10.1016/j.jpedsurg.2018.02.014. View

13.

Maffei D, Schanler R . Human milk is the feeding strategy to prevent necrotizing enterocolitis!. Semin Perinatol. 2016; 41(1):36-40. DOI: 10.1053/j.semperi.2016.09.016. View

14.

Ma A, Yang J, Li Y, Zhang X, Kang Y . Oropharyngeal colostrum therapy reduces the incidence of ventilator-associated pneumonia in very low birth weight infants: a systematic review and meta-analysis. Pediatr Res. 2020; 89(1):54-62. PMC: 7223528. DOI: 10.1038/s41390-020-0854-1. View

15.

Meier P . Human Milk and Clinical Outcomes in Preterm Infants. Nestle Nutr Inst Workshop Ser. 2019; 90:163-174. DOI: 10.1159/000490304. View

16.

Neu J, Walker W . Necrotizing enterocolitis. N Engl J Med. 2011; 364(3):255-64. PMC: 3628622. DOI: 10.1056/NEJMra1005408. View

17.

Sharma D, Kaur A, Farahbakhsh N, Agarwal S . Role of Oropharyngeal Administration of Colostrum in Very Low Birth Weight Infants for Reducing Necrotizing Enterocolitis: A Randomized Controlled Trial. Am J Perinatol. 2019; 37(7):716-721. DOI: 10.1055/s-0039-1688817. View

18.

Cortez J, Makker K, Kraemer D, Neu J, Sharma R, Hudak M . Maternal milk feedings reduce sepsis, necrotizing enterocolitis and improve outcomes of premature infants. J Perinatol. 2017; 38(1):71-74. DOI: 10.1038/jp.2017.149. View

19.

Ronnestad A, Abrahamsen T, Medbo S, Reigstad H, Lossius K, Kaaresen P . Late-onset septicemia in a Norwegian national cohort of extremely premature infants receiving very early full human milk feeding. Pediatrics. 2005; 115(3):e269-76. DOI: 10.1542/peds.2004-1833. View

20.

Patel A, Johnson T, Engstrom J, Fogg L, Jegier B, Bigger H . Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol. 2013; 33(7):514-9. PMC: 3644388. DOI: 10.1038/jp.2013.2. View