Formula milk versus preterm human milk for feeding preterm or low birth weight infants
Abstract
Background
Preterm human breast milk, compared with artificial formula milk, may provide insufficient nutrition for preterm or low birth weight infants. However, human milk may confer advantages in terms of a decreased incidence of gastrointestinal and neurodevelopmental adverse outcomes.
Objectives
To determine if formula milk compared with preterm human milk leads to improved growth and development without significant adverse effects in preterm or low birth weight infants.
Search methods
The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of the Cochrane Central Register of Controlled Trials Register (CENTRAL, The Cochrane Library, Issue 4, 2003), MEDLINE (1966 ‐ October 2003) and EMBASE (1980 ‐ October 2003) and CINAHL (1982 to October 2003) (all accessed via OVID) and previous reviews including cross references.
Selection criteria
Randomised controlled trials comparing feeding with formula milk versus preterm human milk in preterm or low birth weight infants.
Data collection and analysis
Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and mean difference.
Main results
Only one small trial fulfilled the pre‐specified inclusion criteria (Gross 1983). In preterm and low birth weight infants, enteral feeding with protein‐enriched standard calorie formula milk compared with unfortified donated preterm human milk resulted in a greater rate of short term weight gain, but not of increase in length or head circumference. In the group randomised to receive formula milk, there was an increase in the risk of feed intolerance of borderline statistical significance, but no evidence of an effect on necrotising enterocolitis. There are no data on long term growth parameters or on neurodevelopmental outcomes. There are no randomised comparisons of feeding with the preterm milk of the infant's mother versus formula milk.
Authors' conclusions
There are very limited data from randomised trials of feeding preterm or low birth weight infants with formula milk compared with preterm human milk. This may relate to a perceived difficulty of allocating an alternative enteral feed to an infant in cases where the infant's mother wishes to feed with expressed breast milk.
PICOs
Plain language summary
Limited evidence to compare preterm breast milk with formula milk for preterm or low birthweight babies
Breast milk may provide protective factors for a newborn baby's immune system. However, this milk may not provide enough nutrition for babies born early or with a low birthweight. Artificial formula milks may better suit the specific nutritional needs of these infants. This review compared feeding preterm or low birthweight infants with formula milk versus preterm breast milk (the milk of mothers who have delivered a preterm infant). A separate review will compare formula milk with term breast milk (the milk of mothers who have delivered a term infant). The limited data available from one small study suggested that feeding with artificial formula milk leads to greater weight gain in the first two months of life. However, there were no data on longer‐term growth or development. There was also a suggestion that formula milk is less likely to be tolerated than preterm human milk. More research is needed.
