Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis

Huang, Jian; Zhang, Li; Tang, Jun; Shi, Jing; Qu, Yi; Xiong, Tao; Mu, Dezhi

doi:10.1136/archdischild-2017-314205

Cited by 75 publications

(61 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Interestingly, breastfed infants have more abundant Lactobacilli and less abundant Proteobacteria compared to formula-fed infants (21), a similar differentiating feature of BPD-resistant infants compared to BPD-susceptible infants (16). Additionally, a meta-analysis comparing human milk to formula milk found decreased odds of BPD development in human milk-exposed infants (OR 0.78; 95% CI 0.68-0.88); however, the quality of evidence was low (26). More evidence is needed relating human milk to the airway microbiome given the overlap in microbial composition observed in breast milk-fed infants and BPD-resistant infants.…”

Section: What Factors Influence the Airway Microbiome?mentioning

confidence: 99%

Predicting BPD: Lessons Learned From the Airway Microbiome of Preterm Infants

Gentle

Lal

2020

Front. Pediatr.

View full text Add to dashboard Cite

Bronchopulmonary dysplasia (BPD) is the chronic lung disease of prematurity with an operational definition, various different clinical phenotypes, and a complex, multifactorial etiology. Newer unbiased systems biology approaches have identified various "omic" factors associated with the pathogenesis and prediction of BPD. Recent microbi "omic" studies have discovered that airways of newborns harbor a low biomass but distinct microbiome signature as early as at the time of birth. This early airway microbiome may serve to prime the host immune system and may play a role in modulating the infant's future susceptibility to severe BPD development. Temporal changes are observed in airway microbiome of preterm infants from birth to the diagnosis of BPD, with an overall decrease in bacterial diversity, and development of a relative dysbiosis marked by increased Gammaproteobacteria and decreased Lactobacilli abundance. This review will summarize previous investigations of the airway microbiome in preterm infants, appraise the utility of using the airway microbiome to predict BPD development, discuss possible molecular mechanisms involved, and speculate on future microbiome-mediated therapeutics for BPD.

show abstract

Section: What Factors Influence the Airway Microbiome?mentioning

confidence: 99%

Predicting BPD: Lessons Learned From the Airway Microbiome of Preterm Infants

Gentle

Lal

2020

Front. Pediatr.

View full text Add to dashboard Cite

show abstract

“…Until recently, data suggesting a bene cial impact of maternal milk feeding on BPD were limited. Some investigators had concluded that maternal milk decreased incidence of BPD [7,[11][12][13][14], but others had not thought it useful [15]. Thus we can make two postulations: either high-volume maternal milk feeding daily directly impacts BPD or BPD has an obvious effect on volume maternal milk feeding .…”

Section: Discussionmentioning

confidence: 99%

“…Several meta-analyses comparing human milk or own mother's milk and any maternal milk with exclusive formula draw different conclusions, although most have found that exclusive breast milk feeding was associated with decreased incidence of BPD. Partially receiving breast milk has also been shown to provide a protective effect compared with exclusive formula feeding, but the level of evidence is not high [7,17]. Patel et al [18] revealed a 9.5% reduction in the odds of BPD for each 10% increase in enteral feedings consisting of mothers' milk received from birth to 36 weeks PMA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Dose Effect of Maternal Milk on Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

Zhang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Human breast milk has potential protective effects against bronchopulmonary dysplasia (BPD). However, limited multicenter research has been reported on the association between the dose of maternal milk and BPD in China. In this study, we aimed to evaluate the dose effects of maternal milk on BPD and other neonatal morbidities in very low birth weight (VLBW) infants. Methods We conducted a retrospective cohort study of preterm infants of gestational age ≤ 34 weeks and birth weight < 1500 g admitted to the multicenter clinical research database for breastfeeding quality improvement in Jiangsu province. Multivariate analysis was performed to compare the effect on neonatal outcomes of daily graded doses of maternal milk throughout the first 4 weeks of life versus a reference group receiving no maternal milk. Models were adjusted for potential confounding variables. Results Of 964 included infants, 279 (28.9%) received exclusive preterm formula, another 128 (13.3%) received 1–24 ml/kg, 139 (14.4%) received 25–49 ml/kg, and 418 (43.4%) received ≥ 50 ml/kg maternal milk for the first 4 weeks of life. Compared with infants receiving exclusive formula, those receiving the highest volume of maternal milk daily (≥ 50 ml/kg) had lower incidences of BPD (27.5% in ≥ 50 ml/kg maternal milk vs. 40.1% in formula), moderate and severe BPD (8.9% in ≥ 50 ml/kg maternal milk vs. 16.1% in formula), necrotizing enterocolitis (NEC; 3.8% in ≥ 50 ml/kg maternal milk vs. 10.8% in formula), late-onset sepsis (LOS; 9.3% in ≥ 50 ml/kg maternal milk vs. 19.7% in formula), and extrauterine growth retardation (EUGR; 38.5% in ≥ 50 ml/kg maternal milk vs. 57.6% in formula). Logistic regression indicated that those receiving ≥ 50 ml/kg/day maternal milk had lower odds of BPD (adjusted odds ratio [AOR] 0.453; 95% confidence interval [CI]: 0.309, 0.666), moderate and severe BPD (AOR 0.430; 95% CI: 0.249, 0.742), NEC (AOR 0.314; 95% CI: 0.162, 0. 607), LOS (AOR 0.420; 95% CI: 0.263, 0.673), and EUGR (AOR 0.685; 95% CI: 0.479, 0.979). Conclusions A daily threshold amount of ≥ 50 ml/kg maternal milk in the first 4 weeks of life was associated with lower incidence of BPD as well as NEC, LOS, and EUGR in VLBW infants. Trial registration: ClinicalTrials.gov Identifier: NCT03453502

show abstract

“…Human milk plays a protective role towards the immature lung through various mechanisms including specific nutrients and factors, and through its influence on microbiota. A recent meta-analysis including 22 studies (17 cohort plus 5 RCTs) and 8661 infants [149] showed a trend towards a protective effect of human milk against BPD, calling for larger RCTs the determine a definite answer, which would undoubtedly raise ethical questions given its proven benefits in other diseases of prematurity such as necrotizing enterocolitis. In addition, differences exist between fresh maternal breast milk (MBM) and pasteurized human donor milk (DBM).…”

Section: Human Milkmentioning

confidence: 99%

Nutrients and Microbiota in Lung Diseases of Prematurity: The Placenta-Gut-Lung Triangle

et al. 2020

View full text Add to dashboard Cite

Cardiorespiratory function is not only the foremost determinant of life after premature birth, but also a major factor of long-term outcomes. However, the path from placental disconnection to nutritional autonomy is enduring and challenging for the preterm infant and, at each step, will have profound influences on respiratory physiology and disease. Fluid and energy intake, specific nutrients such as amino-acids, lipids and vitamins, and their ways of administration —parenteral or enteral—have direct implications on lung tissue composition and cellular functions, thus affect lung development and homeostasis and contributing to acute and chronic respiratory disorders. In addition, metabolomic signatures have recently emerged as biomarkers of bronchopulmonary dysplasia and other neonatal diseases, suggesting a profound implication of specific metabolites such as amino-acids, acylcarnitine and fatty acids in lung injury and repair, inflammation and immune modulation. Recent advances have highlighted the profound influence of the microbiome on many short- and long-term outcomes in the preterm infant. Lung and intestinal microbiomes are deeply intricated, and nutrition plays a prominent role in their establishment and regulation. There is an emerging evidence that human milk prevents bronchopulmonary dysplasia in premature infants, potentially through microbiome composition and/or inflammation modulation. Restoring antibiotic therapy-mediated microbiome disruption is another potentially beneficial action of human milk, which can be in part emulated by pre- and probiotics and supplements. This review will explore the many facets of the gut-lung axis and its pathophysiology in acute and chronic respiratory disorders of the prematurely born infant, and explore established and innovative nutritional approaches for prevention and treatment.

show abstract

Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis

Abstract: Both exclusive human milk feeding and partial human milk feeding appear to be associated with lower risk of BPD in preterm infants. The quality of evidence is low. Therefore, more RCTs of this topic are needed.

Cited by 75 publications

References 37 publications

Predicting BPD: Lessons Learned From the Airway Microbiome of Preterm Infants

Predicting BPD: Lessons Learned From the Airway Microbiome of Preterm Infants

The Dose Effect of Maternal Milk on Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

Nutrients and Microbiota in Lung Diseases of Prematurity: The Placenta-Gut-Lung Triangle

Contact Info

Product

Resources

About