A comprehensive review and meta-analysis of 12 trials, encompassing 2296 infants, has demonstrated that donor human milk (DHM) significantly reduces the risk of necrotizing enterocolitis (NEC) in very preterm or very low-birth-weight (VLBW) infants. The research, published in the Cochrane Database of Systematic Reviews, provides high-certainty evidence supporting the use of DHM when sufficient maternal milk is not available.
The meta-analysis revealed that DHM reduces the risk of NEC by approximately half (Risk Ratio 0.53, 95% CI 0.37 to 0.76). This finding is particularly significant given the severity and potential complications associated with NEC, a devastating intestinal disease primarily affecting premature infants.
Impact on Infection and Mortality
While DHM demonstrated a clear benefit in reducing NEC, the analysis indicated that it likely has little or no effect on late-onset invasive infection (RR 1.12, 95% CI 0.95 to 1.31) or all-cause mortality before hospital discharge (RR 1.00, 95% CI 0.76 to 1.31). These results suggest that while DHM is highly effective in preventing NEC, it does not significantly alter the risks of infection or overall survival in this population.
Study Details and Methodology
The included trials compared feeding with DHM versus formula in very preterm (< 32 weeks' gestation) or VLBW (< 1500 g) infants. The studies were conducted in neonatal units in Europe and North America, with some trials dating back over 40 years. The primary outcomes assessed were NEC, late-onset invasive infection, and all-cause mortality before hospital discharge. Secondary outcomes included growth parameters and neurodevelopment.
The authors assessed the certainty of evidence using the GRADE approach, rating the evidence for NEC reduction as high certainty and the evidence for infection and mortality as moderate certainty. Some trials had methodological limitations, including potential masking issues and selective reporting.
Clinical Implications
"The evidence shows that donor human milk reduces the risk of NEC by about half in very preterm or VLBW infants," the authors concluded. This finding reinforces the importance of providing DHM to preterm infants when maternal milk is insufficient, as it can significantly decrease the incidence of this life-threatening condition. Given that NEC carries substantial morbidity and mortality, this intervention has the potential to improve outcomes and reduce the burden on healthcare systems.
