Recommendations Policy statements from WHO, UNICEF and
Recommendations Policy statements from WHO, UNICEF and
other international and national organizations confirm the importance of providing mother’s own milk to pre-term and SGA infants. Stand- ard practice in neonatal units is to promote mother’s own milk as the feed of choice for all LBW infants. The findings of this review sup- port this recommendation.
SUMMARY TABLE 2.1.1 Effects of mother’s own 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]
Systemic or RR 0.44 et al (146)
Narayanan Birth weight
Unsupplemented expressed
local infection [0.24, 0.82] RCT (LII)
<2500 g, at high
breastmilk during day and
risk of infection standard infant formula during from birth to night (n=32) compared with
hospital
standard infant formula only
discharge
(n=38)
Narayanan Birth weight
Systemic or RR 0.39 et al (147)
10 ml colostrum 3 times a
<2500 g, at high day until 72 hours of age along local infection [0.19, 0.81] RCT (LII)
risk of infection with standard infant formula from birth to (n=33) compared with
hospital
standard infant formula only
discharge
(n=33)
Lucas & Cole Birth weight
Necrotising Adjusted b (148 )
Unsupplemented expressed
enterocolitis OR 0.09 Cohort (LIII-2)
<1850 g
breast milk only (n=253)
compared with standard or
from birth to [0.03 to 0.33]
pre-term formula only hospital (n=236)
discharge
Formula plus breastmilk
Necrotising Adjusted b
(n=437) compared with
enterocolitis OR 0.29 standard or pre-term formula from birth to [0.12 to 0.67] only (n=236)
hospital discharge
Hylander et Pre-term infants 95%
Fortified expressed breast milk Systemic or Adjusted c al (149 )
None
local infection OR 0.43 Cohort (LIII-2) <1500g
with birth weight
along with pre-term formula
(n=123) compared with
from start of [0.23 to 0.81] pre-term formula only (n=89) enteral feeding to hospital discharge
Schanler et al 26–30 wk
Late onset RR 0.56 (150 )
Predominantly fed fortified
gestation, expressed breastmilk (n=62) sepsis or [0.36 to 0.89] Cohort (LIII-2) postnatal age
necrotising ≤96 hours
compared with pre-term
formula only (n=46)
enterocolitis
a If gestational age was not available in the publication, infants with birth weight <1500 g are assumed to be <32 wk gestation, those with 1501–2000
g to be 32–36 wk gestation, and those with 2001–2500 g to have a gestation of 37 weeks or more. b Adjusted for length of gestation, birth weight, sex, birth asphyxia, previous blood transfusions, use of theophylline and frusemide, polycythaemia, res-
piratory disease, duration of umbilical artery catheterization, age at first enteral feed, rate of progression of early feed volumes, and maternal steroid treatment.
c Adjusted for gestational age, 5-minute APGAR score, mechanical ventilation and days without enteral feedings.
28 OPTIMAL FEEDING OF LOW-BIRTH-WEIGHT INFANTS: TECHNICAL REVIEW
SUMMARY TABLE 2.1.2 Effects of mother’s own milk compared with formula feeding on neurodevelopment in LBW infants
Study, Design
Approximate proportion of
(Level of Inclusion participants with gestation age a Comparison Effect measure evidence)
Outcome measure
groups [95% CI]
Cognitive Adjusted b al (156)
Anderson et
3 studies, one
Breastfed (n=1254)
development difference in Meta-analysis weight <1850 g,
each with: birth
compared with formula-fed
scores mean scores of cohort
(n=751)
5.18 [3.59, studies (LIII-2) <2537 g
500–1500 g and
6.77] Rao et al (153 ) Term SGA infants 0
Total IQ score Adjusted c Cohort (LIII-2)
0 100%
Exclusively breastfed for
>12 wk (n=81) compared
on Wechler difference in with exclusively breastfed for Preschool and mean scores ≤12 wk (n=139)
Primary Scales 5.0 [0.7 to 9.3] of Intelligence
Bayley mental Adjusted d (159 )
Morley et al Term SGA infants 0
0 100%
Mother chose to breastfeed
development difference in Cohort (LIII-2)
(n=137) compared with
mother chose to formula
score at 18 mean scores
feed (n=235)
8.2 [5.0 to 11.4] Bayley
months age
Adjusted d psychomotor difference in development mean scores score at 18
5.8 [2.8 to 8.7] months age 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.
b Results included from studies that adjusted for at least 5 of the following variables: duration of breastfeeding, sex, maternal smoking history, mater- nal age, maternal intelligence, maternal education, maternal training, paternal education, race or ethnicity, socioeconomic status, family size, birth
order, birth weight, gestational age, and childhood experiences. c Adjusted for site of enrolment, maternal education, maternal IQ, maternal smoking, admission to a neonatal care unit, kindergarten attendance,
gender and asymmetric intrauterine growth retardation.
d Adjusted for child’s gender and birth order, maternal age, education score, social class, maternal head circumference, and height and whether mother smoked during pregnancy.
(2) DONOR HUMAN MILK
Effects on severe morbidity – infection
Results
A meta-analysis was located of all available RCTs till the year 2003, which examined the
The feeding options for LBW infants, par- impacts of donor human milk and formula
ticularly when breastfeeding is not possible, milk on rates of necrotising enterocolitis in
include donor milk and artificial infant for- pre-term infants <1850 g (Level I evidence)
mula. To make appropriate choices, it is impor- (148, 174–177). All four trials, conducted in
tant to consider the relative advantages and developed countries in the 1980s and early
disadvantages of these milks. The results of 1990s, compared infants who were fed unsup-
studies comparing the effect of donor human plemented drip donor milk with those fed
milk with that of artificial infant formula on standard or calorie-enriched formula; the
important outcomes are summarized below. milk feed comprised the infant’s sole diet for
at least 1 month during the initial phases of hospital admission.