A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants

Miller, Jacqueline; Tonkin, Emma; Damarell, Raechel; McPhee, Andrew J; Suganuma, Machiko; Suganuma, H; Middleton, Philippa; Makrides, Maria; Collins, Carmel T

doi:10.3390/nu10060707

Cited by 317 publications

(278 citation statements)

References 83 publications

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“…Studies of human milk are particularly relevant in this population. Human milk feeding decreases the risk of NEC (28). Meta-analyses suggest a benefit in feeding mother's own milk (29) and pasteurized donor human milk (30) in the prevention of BPD.…”

Section: Discussionmentioning

confidence: 99%

Intestinal Dysbiosis and the Developing Lung: The Role of Toll-Like Receptor 4 in the Gut-Lung Axis

et al. 2020

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Background: In extremely premature infants, postnatal growth restriction (PNGR) is common and increases the risk of developing bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). Mechanisms by which poor nutrition impacts lung development are unknown, but alterations in the gut microbiota appear to play a role. In a rodent model, PNGR plus hyperoxia causes BPD and PH and increases intestinal Enterobacteriaceae, Gram-negative organisms that stimulate Toll-like receptor 4 (TLR4). We hypothesized that intestinal dysbiosis activates intestinal TLR4 triggering systemic inflammation which impacts lung development. Methods: Rat pups were assigned to litters of 17 (PNGR) or 10 (normal growth) at birth and exposed to room air or 75% oxygen for 14 days. Half of the pups were treated with the TLR4 inhibitor TAK-242 from birth or beginning at day 3. After 14 days, pulmonary arterial pressure was evaluated by echocardiography and hearts were examined for right ventricular hypertrophy (RVH). Lungs and serum samples were analyzed by western blotting and immunohistochemistry. Results: Postnatal growth restriction + hyperoxia increased pulmonary arterial pressure and RVH with trends toward increased plasma IL1β and decreased IκBα, the inhibitor of NFκB, in lung tissue. Treatment with the TLR4 inhibitor attenuated PH and inflammation. Conclusion: Postnatal growth restriction induces an increase in intestinal Enterobacteriaceae leading to PH. Activation of the TLR4 pathway is a promising mechanism by which intestinal dysbiosis impacts the developing lung.

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Section: Discussionmentioning

confidence: 99%

Intestinal Dysbiosis and the Developing Lung: The Role of Toll-Like Receptor 4 in the Gut-Lung Axis

et al. 2020

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“…The systematic review and meta-analysis published by Miller [7] summarized the available evidence in relation to the dose-dependent effect of human milk feeding on decreasing morbidity in infant born <28 weeks' gestation and/or birth weight <1500 g. Recent studies have assessed the different impact of human milk and preterm infant formula (PTF) feeding on one single outcome, thus limiting the in-depth analysis of the synergic protective co-effects led by the different nutritional and non-nutritional components of human milk against the most frequent comorbidities that affect premature infants. Remarkably, Miller considered the combination of five major morbidities (necrotizing enterocolitis, late onset sepsis, bronchopulmonary dysplasia, retinopathy of prematurity and neurodevelopment), pointing out the clear protective effect of human milk against necrotizing enterocolitis and possible reduction in late onset sepsis, severe retinopathy of prematurity and severe necrotizing enterocolitis.…”

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confidence: 99%

Human Milk Feeding in Preterm Infants: What Has Been Done and What Is to Be Done

2019

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Keywords: breastfeeding; human milk; human donor milk; promotion of breastfeeding; preterm infant; VLBW Human milk is recommended as the natural feeding for both term and preterm infants for the several health benefits associated with its consumption. The importance of human milk is not only limited to its nutritional value but it also includes the provision of bioactive factors involved in the optimization of infants' growth and neurodevelopment. A huge amount of researches indicates that the biological effects of human milk are dose dependent. Moreover, an increasing number of studies are showing that breast milk contains stem cells whose implications in infant neurodevelopment are under study. Hence, it is mandatory to promote initiation of breastfeeding as well as to support its duration [1][2][3][4].When taking into consideration feeding options for preterm infants, it should be highlighted that there is a biological hierarchy with milk of own mothers' being the first choice. When own mothers' milk is not available, donor human milk is recommended, whereas formula feeding should be the last choice [2].Human milk feeding represents a cost-effective strategy to reduce disease impact and associated costs in preterm infants, during the neonatal intensive care unit hospitalization [5]. Colaizy estimated that suboptimal feeding of extremely low birth weight infants would cost $27.1 million (CI $24 million, $30.4 million) in direct medical costs, $563,655 (CI $476,191, $599,069) in indirect nonmedical costs, and $1.5 billion (CI $1.3 billion, $1.6 billion) in cost attributable to premature death [6].The systematic review and meta-analysis published by Miller [7] summarized the available evidence in relation to the dose-dependent effect of human milk feeding on decreasing morbidity in infant born <28 weeks' gestation and/or birth weight <1500 g. Recent studies have assessed the different impact of human milk and preterm infant formula (PTF) feeding on one single outcome, thus limiting the in-depth analysis of the synergic protective co-effects led by the different nutritional and non-nutritional components of human milk against the most frequent comorbidities that affect premature infants. Remarkably, Miller considered the combination of five major morbidities (necrotizing enterocolitis, late onset sepsis, bronchopulmonary dysplasia, retinopathy of prematurity and neurodevelopment), pointing out the clear protective effect of human milk against necrotizing enterocolitis and possible reduction in late onset sepsis, severe retinopathy of prematurity and severe necrotizing enterocolitis. The comparison between various combinations of mixed feeding, human milk and preterm infant formula allowed for a specific investigation on the dose effect associated with human milk feeding.However, no conclusive evidence has been drawn on the incidence of bronchopulmonary dysplasia and on neurodevelopment, thus underlining the need for implementing research towards this direction.This systematic review allows for gaining further ins...

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“…The The conclusion of this study that a higher MM decreases the rate of NEC for ELBW/VLBW is consistent with the findings of many other investigations. A meta-analysis published in 2018 showed a considerable reduction in the incidence of NEC caused by the increase in the dose of HM (human milk) [19]. When it comes to HM, one point needs to be stated: HM in this previous meta-analysis included MM and DM (donor milk), whereas in the present analysis, we included only MM.…”

Section: Discussionmentioning

confidence: 92%

Dose relationship between maternal milk proportion and necrotizing enterocolitis development

Lin¹,

Sun²,

Xiong³

et al. 2019

Preprint

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Background: To examine the dose effect of maternal milk (MM) feeding on neonatal necrotizing enterocolitis (NEC) development. Methods: This retrospective study included 305 infants [birth weight<1 500 g, or gestation age (GA)<32 weeks]. Curve estimation was performed to evaluate the dose relationship between MM proportion and NEC. Then infants were grouped based on curve trend and multivariable regression analysis was conducted to prove the curve estimation.Results: Rate of NEC for the sample was 7.9% and age at onset was 25.6(16.0–26.0) days. The curve showed that when MM proportion was increased from zero to 20%, rate of NEC increased from 25% to 40% at first and when MM from 20% to 100%, rate dropped from 40% to near zero. In the MM proportion from zero to 40%, rate of NEC changed greatly. The multiple regression analysis showed that compared with MM proportion >0.70, 0.4<MM proportion £0.7 was associated with a 5.482- fold higher odds of developing NEC（P=0.032）; 0<MM proportion £0.4 was a 24.99-fold increase in the odds of developing NEC（P<0.001）; MM proportion =0 was a 9.348-fold increase in the odds of developing NEC（P=0.003）. Conclusion: This study estimated how rate of NEC changed with MM proportion increase, MM proportion being greater than 40% had a significant protection against NEC. We should encourage mother for breast milk and alert to NEC when the preterm is mixed feeding with MM proportion less than 40%.

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A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants

Cited by 317 publications

References 83 publications

Intestinal Dysbiosis and the Developing Lung: The Role of Toll-Like Receptor 4 in the Gut-Lung Axis

Intestinal Dysbiosis and the Developing Lung: The Role of Toll-Like Receptor 4 in the Gut-Lung Axis

Human Milk Feeding in Preterm Infants: What Has Been Done and What Is to Be Done

Dose relationship between maternal milk proportion and necrotizing enterocolitis development

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