Administration of breast milk cell fractions to neonates with birthweight equal to or less than 1800 g: a randomized controlled trial

Abstract

Background Most premature and very low birthweight infants cannot tolerate breast milk feeding in the first few days of life and are deprived of its benefits. This study evaluates the clinical outcomes of administering breast milk cell fractions to neonates with a birthweight of ≤1800 g. Methods We conducted a randomized controlled trial on 156 infants in the neonatal intensive care unit of Mahdieh Maternity Hospital in Tehran, Iran, from May 2019 to April 2020. All neonates with a birthweight ≤1800 g were enrolled and divided into intervention and control groups using stratified block randomization. Neonates in the intervention group received the extracted breast milk cell fractions (BMCFs) of their own mother’s milk after being centrifuged in the first 6 to 12 h after birth. The control group received routine care, and breastfeeding was started as soon as tolerated in both groups. Study outcomes were necrotizing enterocolitis (NEC), death, and in-hospital complications. Results We divided participants into two groups: 75 neonates in the intervention group and 81 neonates in the control group. The mean birthweight of neonates was 1390.1 ± 314.4 g, and 19 (12.2%) neonates deceased during their in-hospital stay. The incidence of NEC was similar in both groups. After adjustment for possible confounders in the multivariable model, receiving BMCFs were independently associated with lower in-hospital mortality (5 [26.3%] vs. 70 (51.1%]; odds ratio (OR): 0.24; 95% confidence interval [CI] 0.07, 0.86). Also, in a subgroup analysis of neonates with birthweight less than 1500 g, in-hospital mortality was significantly lower in the intervention group (4 [9.5%] vs. 13 [30.2%]; OR: 0.24; 95% CI 0.07, 0.82). There were no differences in major complications such as bronchopulmonary dysplasia and retinopathy of prematurity between the two groups. No adverse effects occurred. Conclusions Our research demonstrated a significantly lower mortality rate in neonates (with a birthweight of ≤1800 g) who received breast milk cell fractions on the first day of life. Since this is a novel method with minimal intervention, we are looking forward to developing and evaluating this method in larger studies. Trial registration IIranian Registry of Clinical Trials. Registered 25 May 2019, IRCT20190228042868N1.

Study on improving collection feeding safety and quality of colostrum for very (extremely) low birth weight infants

“…Compared to international studies, the time to first colostrum collection of the experimental group in this study still has a large space for improvement. Research teams (25)(26)(27) reported that colostrum from their respective experimental groups was collected within 24 h after birth. The limitation of this study is that there was a lack of trained peer counselors, and the application rate of hospital-level breast pumps was low (8.5%), which provide a clinical basis for further process re-optimization.…”

Reply to the commentary “Liquid gold: do we need to fraction fresh colostrum for oral immunotherapy in premature infants?”

“…We would like to thank Pillai et al for their thoughtful comments and appreciate their interest in our study [ 1 ]. We welcome this opportunity to respond to the comments raised in their letter.…”

“…In relation to information bias, the blinding was not possible since the control group did not receive any intervention, and breastfeeding was started as soon as tolerated in both groups. We believe lack of double-blinding may have influenced the study results, as we have pointed out this as a study limitation in our discussion section [ 1 ]. The suggestion by Pillai et al to give colostrum directly to the control group in the same manner as the intervention could be used as a solution to do blinding in future studies.…”

Liquid gold: do we need to fraction fresh colostrum for oral immunotherapy in premature infants?

“…We read with interest the trial on administration of breast milk cell fractions to premature neonates with birth weight equal to or less than 1800 g by Fallahi et.al [ 1 ]. The authors reported a significant decrease in mortality with administration of breast milk fractions to neonate.…”