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

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 mother’s milk (OMM) is not enough. Our aim was to compare the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in very preterm infants (VPI) after the introduction of DM. Growth and breastfeeding rates were examined as secondary outcomes. Single center, observational and retrospective cohort study comparing 227 VPI admitted to our neonatal unit before (Group 1, n = 99) and after (Group 2, n = 128) DM introduction. Enteral nutrition was started earlier after DM availability (2.6 ± 1.1 vs. 2.1 ± 1 days, p = 0.001). Incidence of NEC decreased in group 2 (9.1% vs. 3.4%, p = 0.055), especially in those born between 28 and 32 weeks (5.4 vs. 0.0%, p = 0.044). Surgical NEC was also less frequent. Suffering NEC was 4 times more likely in group 1 (multivariate analysis). Availability of DM did not impact breastfeeding rates or preterm growth. Our findings support the protective role of DM against NEC, particularly in non-extreme VPI, a group less frequently included in clinical guidelines and research studies on the use of DM.

The Potential Effects of Human Milk on Morbidity in Very-Low-Birth-Weight Preterm Infants

“…In a large monocentric study designed as an interrupted time series study, Alshaikh et al [ 12 ] showed that a human milk quality improvement initiative to implement the rate of human milk in the neonatal intensive care unit was associated with a lower risk of developing NEC (OR = 0.32; 95% confidence interval 0.11–0.93). Similar results were found in a recent study conducted by Cañizo Vázquez et al [ 13 ], in which infants who received donor human milk had a decreased incidence of NEC compared to formula-fed infants (9.1% vs. 3.4%, p = 0.055), especially among the group of infants born at a gestational age between 28 and 32 weeks (5.4 vs. 0.0%, p = 0.044).…”

Breastfeeding and the Risk of Infant Illness in Asia: A Review

“…In neonatal intensive care units necrotising enterocolitis (NEC) remains a continuing problem. Wherever possible breastmilk is given to the infant and reduces the incidence of NEC [75,76]. A meta-analysis suggests that unlike breastmilk, donor human milk is not effective in the prevention of NEC [77].…”

The Role of Glycosaminoglycans in Protection from Neonatal Necrotizing Enterocolitis: A Narrative Review

“…Donor milk, while arguably preferable to bovine-based formula [19], loses effectiveness through the pasteurization process, and is also not age-matched to the developmental stage of the infant to whom it is donated [20,21]. Thus, studies utilizing donor HM have shown mixed results when examining utility in protection against preterm pathogens, NEC, and mortality [22][23][24].…”