Effect of Breast Milk Oral Care on Mechanically Ventilated Preterm Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

BackgroundThe benefits of breast milk oral care in mechanically ventilated preterm infants remain controversial. This study aimed to systematically review the evidence on the benefits of breast milk oral care in mechanically ventilated preterm infants.MethodsThe randomized controlled trials of breast milk oral care for mechanically ventilated preterm infants were searched in EMBASE, PubMed, Cochrane Library, Web of Science, WANFANG Date and China National Knowledge Infrastructure databases. The retrieval language was limited to Chinese and English, and the final search was conducted until March 2022. Outcome measures included ventilator-associated pneumonia (VAP), mechanical ventilation time (MVT), length of stay (LOS), necrotizing enterocolitis (NEC), late-onset sepsis, mortality during hospitalization, time of full intestinal feeding and time of full oral feeding. Two researchers independently screened the literature, extracted the data, and conducted the literature quality assessment. Meta-analysis was mainly performed using RevMan 5.3.ResultsEight articles involving 1,046 preterm infants were included. Our meta-analysis showed that compared with the control group, breast milk oral care could reduce the incidence of VAP [RR = 0.41, 95% CI (0.23, 0.75), P = 0.003] and NEC [RR = 0.54, 95% CI (0.30, 0.95), P = 0.03], and shorten the MVT [MD = −0.45, 95% CI (−0.73, −0.18), P = 0.001] and LOS [MD = −5.74, 95% CI (−10.39, −1.10), P = 0.02]. There were no significant differences in the mortality during hospitalization [RR = 0.94, 95% CI (0.67, 1.33), P = 0.74], the incidence of late-onset sepsis [RR = 0.79, 95% CI (0.40, 1.59), P = 0.51], the time of full intestinal feeding [MD = −2.42, 95% CI (−5.37, 0.52), P = 0.11] and the time of full oral feeding [MD = −3.40, 95% CI (−10.70, 3.91), P = 0.36] between the two groups.ConclusionsOral care of breast milk can reduce the incidence of VAP and NEC, shorten MVT and LOS in mechanically ventilated preterm infants. However, due to the quality and quantity limitations of the included studies, larger sample size and more strictly designed clinical trials are still needed in the future to further confirm the findings of this study.

Colostrum immunotherapy and length of hospital stay in preterm infants: an intervention study

“…In the present study, we foundan association between OCI and a smaller median of length of hospitalization in the group of preterm newborns ≥ 28 gestational age weeks. This finding is in line with the result of the last published meta-analyses, 11,20,21 which assessed only controlled clinical trials 5,6,8,12,14,15,[17][18][19] and reported lower length of hospitalization in the group of preterm newborns <34 and ≥32 weeks of gestational age in OCI, respectively. 11,20,21 However, the result that we found differs from other meta-analysis 22 that had favorable outcomes for the control group.…”

“…6,8,9,12,[16][17][18][19] Meta-analysis researches, published between 2020 and 2023, found out that hospitalization was significantly reduced in the treatment group. 11,20,21 however, previous studies have demonstrated favorable outcome for the control group 22 or did not observe significant difference. 2,3,10,13 The divergence between results reinforce the need for further investigations regarding the effect of OCI in the length of hospital stay of preterm newborns, a relevant subject for public health.…”

Human Milk Feeding for Septic Newborn Infants Might Minimize Their Exposure to Ventilation Therapy

“…They found that the fresh HM group had a shorter duration of mechanical ventilation than the control group. Finally, a 2022 metaanalysis shows that not only HM feeding, but also oral care of preterm infants with mother's milk shortens the mechanical ventilation time [17]. It is remarkable that despite large differences in the way the various research groups provide HM to infants in neonatal care, HM is associated in all cases with a reduction of respiratory support.…”

Human Milk Feeding for Septic Newborn Infants Might Minimize Their Exposure to Ventilation Therapy

“…They found that the fresh HM group had a shorter duration of mechanical ventilation than did the control group. Finally, a 2022 meta-analysis showed that not only HM feeding but also oral care of preterm infants with mother’s milk shortens the mechanical ventilation time [ 24 ]. It is remarkable that despite large differences in the way various research groups provide HM to infants in neonatal care, HM is associated with reduced respiratory support in all cases.…”