Recommendations Many international and national organizations

strongly support the provision of pasteurized donor milk to LBW infants. In contrast, many developed country neonatal units preferen- tially provide artificial infant formula rather than donor human milk to LBW infants.

Donor human milk may be a feasible option in ability of donor banks. Equipment and train- many developing countries and should be con-

ing for heat treatment and milk banking may sidered as an important alternative to artificial

be difficult to obtain in some countries. The infant formula. Feasibility of providing donor

findings from this review support these rec- human milk is influenced by the amount that

ommendations.

can be expressed by mothers and the avail-

SUMMARY TABLE 2.1.3 Effects of donor human milk compared with formula feeding on infection or necrotising enterocolitis in LBW infants

Study, Design

Approximate proportion of

(Level of Inclusion participants with gestation age a Outcome Effect measure evidence)

Comparison groups

measure [95% CI]

McGuire & Birth weight

Possible RR 0.34 Anthony (174) <1850 g.

Unsupplemented term or

pre-term drip breastmilk only necrotising [0.12, 0.99] Meta-analysis Allocated to milk

enterocolitis of RCTs (LI)

(n=167) compared with

feeds as sole diet

standard or pre-term infant formula (n=176)

Confirmed RR 0.25 necrotising

[0.06, 0.98] enterocolitis

Schanler et al Gestation <30

If supply of own mother’s milk Septicaemia OR 1.04 (178 )

[0.53, 2.05] RCT (LII)

weeks. Mothers

was insufficient, infants were

who intended to

provided with at least

breastfeed.

50 ml/kg of supplemented

Confirmed RR 0.53

pasteurized donor milk

necrotising [0.14, 1.82]

(n=81) compared with pre-

enterocolitis

term formula (n=92) from birth to day 90.

a If gestational age was not available in the publication, infants with birth weight <1500 g are assumed to be <32 wk gestation, those weighing 1501–2000 g to be 32–36 wk gestation and those weighing 2001–2500 g to have a gestation of 37 weeks or more

32 OPTIMAL FEEDING OF LOW-BIRTH-WEIGHT INFANTS: TECHNICAL REVIEW

SUMMARY TABLE 2.1.4 Effects of donor human milk compared with formula feeding on neurodevelopment in LBW infants

Study, Design

Approximate proportion of

(Level of Inclusion participants with gestation age a Effect measure evidence)

Comparison groups

Outcome measure [95% CI]

Lucas et al Birth weight

Unsupplemented term Bayley psychomotor WMD 1.20 (16)

development index [-4.4, 6.8] RCT (LII)

<1850 g, received

drip breast milk

feed as sole diet

(n=62) compared

score at 18 months

with pre-term formula (n=52)

Bayley mental WMD 0.5 development index

[-6.2, 7.1] score at 18 months

Tyson et al Birth weight

Unsupplemented term Brazelton neonatal WMD -2.50 (177)

[-3.65, -1.35] RCT (LII)

<1500 g, received

drip breast milk

behavioural

feed as sole diet

(n=34) compared

assessment scale with pre-term formula (response to inanimate (n=42)

objects) at 37 weeks gestational age

Brazelton neonatal WMD -0.80 behavioural assess-

[-1.34, -0.26] ment scale (response to auditory and visual stimuli) at 37 weeks gestational age

Lucas et al Birth weight

Bayley psychomotor WMD 8.8 (16)

Standard infant

development index [3.3, 14.3] Cohort (LIII-2) feed as sole diet

<1850 g, received

formula only

score at 18 months non-random

(n=55) compared

with unsupplemented

comparison term drip breast milk Bayley mental WMD 2.1 within two

development index [-4.4, 8.7] RCTs

only (n=62)

score at 18 months a If gestational age was not available in the publication, infants with birth weight <1500 g are assumed to be <32 wk gestation, those weighing 1501–2000 g to be 32–36 wk gestation, and those weighing 2001–2500 g to have a gestation of 37 weeks or more.

SUMMARY TABLE 2.1.5 Effects of donor human milk compared with formula feeding on feed tolerance in LBW infants

Study, Design

Approximate proportion of

(Level of Inclusion participants with gestation age a Outcome Effect measure evidence)

Comparison groups

measure [95% CI]

Feed RR 0.30 al (18 )

Henderson et Birth weight

Unsupplemented term drip

<1600 g, received breast milk (n=58) compared intolerance [0.07, 1.37] Meta-analysis feed as sole diet

with standard infant formula by hospital of RCTs (LI)

discharge a If gestational age was not available in the publication, infants with birth weight <1500 g are assumed to be <32 wk gestation, those weighing 1501–2000 g to be 32–36 wk gestation, and those weighing 2001–2500 g to have a gestation of 37 weeks or more.

(n = 70)

RESULTS

34 OPTIMAL FEEDING OF LOW-BIRTH-WEIGHT INFANTS: TECHNICAL REVIEW

Recommendations Many international and national organizations