A Systematic Review and Meta-Analysis of Human Milk Feeding and Short-Term Growth in Preterm and Very Low Birth Weight Infants

Abstract

Human milk (HM) is the gold standard for feeding infants but has been associated with slower growth in preterm infants compared with preterm formula. This systematic review and meta-analysis summarises the post-1990 literature to examine the effect of HM feeding on growth during the neonatal admission of preterm infants with birth weight ≤1500 g and/or born ≤28 weeks’ gestation. Medline, PubMed, CINAHL, and Scopus were searched, and comparisons were grouped as exclusive human milk (EHM) vs. exclusive preterm formula (EPTF), any HM vs. EPTF, and higher vs. lower doses of HM. We selected studies that used fortified HM and compared that with a PTF; studies comparing unfortified HM and term formula were excluded. Experimental and observational studies were pooled separately. The GRADE system was used to evaluate risk of bias and certainty of evidence. Forty-four studies were included with 37 (n = 9963 infants) included in the meta-analyses. In general, due to poor quality studies, evidence of the effect of any HM feeds or higher versus lower doses of HM was inconclusive. There was a possible effect that lower doses of HM compared with higher doses of HM improved weight gain during the hospital admission, and separately, a possible effect of increased head circumference growth in infants fed EPTF vs. any HM. The clinical significance of this is unclear. There was insufficient evidence to determine the effects of an exclusive HM diet on any outcomes.

Exclusive Maternal Milk Compared With Exclusive Formula on Growth and Health Outcomes in Very-Low-Birthweight Preterm Infants: Phase II of the Pre-B Project and an Evidence Analysis Center Systematic Review

“…There was no difference in head circumference growth, regardless of whether the human milk was fortified. Similar results were found in the SR conducted by Suganuma et al in 2021, in which there was no significant association between short-term growth outcomes with feeding type (7). The authors reported insufficient evidence to determine effects on any outcomes.…”

“…SRs have been conducted on the outcomes after human milk intake in VLBW infants (7,8). Miller et al conducted an SR in 2018 to evaluate the association between human milk feeding and morbidity, and Saguna conducted an SR in 2021 on the association between human milk feeding and short-term growth in VLBW preterm infants (7,8).…”

“…SRs have been conducted on the outcomes after human milk intake in VLBW infants (7,8). Miller et al conducted an SR in 2018 to evaluate the association between human milk feeding and morbidity, and Saguna conducted an SR in 2021 on the association between human milk feeding and short-term growth in VLBW preterm infants (7,8). Both SRs compared the intake of exclusive human milk with exclusive formula, any milk compared with formula, and pasteurized compared with unpasteurized human milk, as well as dose-response associations with human milk intake.…”