In RCTs , pasteurized human donor milk , as opposed to formula , reduced NEC but not infections or mortality .
Pooled data of small trials and a recent large RCT suggested that bovine lactoferrin reduced rates of fungal sepsis without impact on other infections , NEC , or mortality .
Pooled data of RCTs assessing the use of prebiotic oligosaccharides found reduced infection but not mortality .
A meta- analysis sensitivity approach found multiple-strain ( but not single-strain ) probiotics to be highly effective in reducing NEC and mortality .
Thus , selected food components may help to improve outcomes in preterm infants
Observational studies demonstrating reduced rates of infections , necrotizing enterocolitis ( NEC ) , and mortality in preterm infants fed their own mother ’s milk , as opposed to formula , have prompted endeavors to achieve similar effects with the right choice of food and food additives .
In a systematic review of meta-analyses and r and omized controlled trials ( RCTs ) , we considered nutritional interventions aim ed at reducing the rates of infections , NEC , or mortality in very preterm infants .
Nutrient enrichment of human milk with human and bovine milk-based fortifiers for infants born weighing <1250 g: a randomized clinical trial.
Background Human milk-based fortifiers ( HMBFs ) are being adopted in neonatal care to enrich the nutrients in human milk for very low birth weight ( VLBW ) infants despite being costly and there being limited efficacy data . No r and omized clinical trial has evaluated the use of HMBF compared with bovine milk-based fortifiers ( BMBFs ) in the absence of formula feeding . Objective To determine if HMBF compared with BMBF for routine nutrient enrichment of human milk improves feeding tolerance , reduces morbidity , reduces fecal calprotectin ( a measure of gut inflammation ) , and supports the growth of infants < 1250 g. Design In this blinded r and omized clinical trial , infants born weighing < 1250 g were recruited from neonatal units in Ontario , Canada between August 2014 and November 2015 . The infants were fed mother 's milk and donor milk as required . Fortification commenced at 100 mL/kg per day of HMBF ( 0.81 kcal/mL ) or BMBF ( 0.72 kcal/mL ) and advanced at 140 mL/kg per day to 0.88 and 0.78 kcal/mL , respectively . The primary outcome was percentage of infants with a feeding interruption for ≥12 h or a > 50 % reduction in feeding volume . Secondary outcomes included a dichotomous mortality and morbidity index ( i.e. , affirmative for any one of death , late-onset sepsis , necrotizing enterocolitis , chronic lung disease , or severe retinopathy of prematurity ) , fecal calprotectin , and growth . Results Of 232 eligible infants , 127 ( 54.7 % ) were r and omized ( n = 64 HMBF , n = 63 BMBF ) . Mean ± SD birth weight and gestational age of infants were 888 ± 201 g and 27.7 ± 2.5 wk , respectively . No statistically significant differences were identified in feeding interruptions [ 17/64 HMBF , 20/61 BMBF ; unadjusted risk difference : -6.2 % ( 95 % CI : -22.2 % , 9.8 % ) ] . There was no statistically significant difference in the mortality and morbidity index ( 48.4 % HMBF , 49.2 % BMBF , adjusted P = 0.76 ) , changes in fecal calprotectin , or growth z scores . Conclusions Among infants born weighing < 1250 g and exclusively fed human milk , the use of HMBF did not improve feeding tolerance or reduce mortality and morbidity compared with BMBF . This trial was registered at clinical trials.gov as NCT02137473
In RCTs , pasteurized human donor milk , as opposed to formula , reduced NEC but not infections or mortality .
Pooled data of small trials and a recent large RCT suggested that bovine lactoferrin reduced rates of fungal sepsis without impact on other infections , NEC , or mortality .
Pooled data of RCTs assessing the use of prebiotic oligosaccharides found reduced infection but not mortality .
A meta- analysis sensitivity approach found multiple-strain ( but not single-strain ) probiotics to be highly effective in reducing NEC and mortality .
Thus , selected food components may help to improve outcomes in preterm infants
Observational studies demonstrating reduced rates of infections , necrotizing enterocolitis ( NEC ) , and mortality in preterm infants fed their own mother ’s milk , as opposed to formula , have prompted endeavors to achieve similar effects with the right choice of food and food additives .
In a systematic review of meta-analyses and r and omized controlled trials ( RCTs ) , we considered nutritional interventions aim ed at reducing the rates of infections , NEC , or mortality in very preterm infants .