The Impact of Human Milk on Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis

Abstract

Background. Premature infants receiving breastfeed have a lower incidence of NEC than those fed preterm formula. This study aimed: (1) to update a systematic review and meta-analyses to evaluate the relationship between feeding and necrotizing enterocolitis (NEC) in low weight premature infants; (2) to conduct meta-regression analyses by subgroups; (3) to describe geographical distribution of milk banks in the world. Methods. Papers included in the meta-analysis were updated as of June 2019. Relative risks were used as a measure of effect size. Random effect models were used to account for different sources of variation among studies. For milk banks, the data reviewed by the literature were integrated with the information collected from countries’ institutional sites and milk bank networks. Results. Thirty-two papers were included in meta-analysis: six randomized controlled trials (RCTs) and 26 observational studies (OS). The census has found 572 milk banks around in the world. Brazil has the most active milk banks. RCTs meta-analysis indicates a risk reduction of NEC using human milk respect to formula: Relative risk (RR) = 0.62 (0.42–0.93). Seven OS compared quantities lower than human milk or higher than the 50th quantile showing a risk reduction of NEC:RR = 0.51 (0.31–0.85); 3 OS that evaluated human milk versus mixed feeding showing that human milk has a protective role on the development of NEC:RR = 0.74 (0.63–0.91). Results of subgroups analysis show that the risk reduction is statistically significant only for studies in which premature infants are given both their own and donated breastmilk. Conclusions. The possibility of preserving human milk and promoting donations guarantees an improvement in the health of newborns.

Maternal aryl hydrocarbon receptor activation protects newborns against necrotizing enterocolitis

“…The therapeutic potential of the current findings was revealed by our identification of the AHR ligand A18 to prevent NEC when fed to mice during pregnancy, and by showing its ability to reduce TLR4 signaling in human bowel ex vivo. In view of the fact that the absence of breast milk is a major risk factor for NEC [35][36][37][38] , these findings suggest the possibility that the development of NEC may reflect impaired AHR signaling in the neonatal intestine, and also show that strategies to enhance the delivery of AHR ligands either directly to the neonate, or secondarily through the mother, may offer new strategies for the prevention or treatment of NEC.…”

Racial Disparities in Necrotizing Enterocolitis

“…Such racial disparities in prenatal care are important as several maternal factors have been associated with NEC, including premature rupture of membranes ( 31 ), chorioamnionitis ( 32 ), intrauterine growth restriction ( 33 ), placental abruption ( 34 ), and inadequate antenatal steroid administration for possible pre-term delivery ( 35 ). In another study, Kogan et al ( 36 ) analyzed racial disparities in prenatal care and found that non-Hispanic Black women were more likely to report not receiving advice about important topics such as breastfeeding – a well-known protective mediator in NEC ( 37 ). Several studies have also identified inequality in the care of very low birth weight infants by race, with non-Hispanic Black and Hispanic infants receiving care at lower-quality hospitals compared to non-Hispanic White infants ( 38 – 41 ).…”

Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis

“…Evidence of the protective role of human milk (HM) against NEC in preterm infants is robust [ 2 , 3 , 4 , 5 ]. In recent years, the role of probiotic administration in preventing NEC has been also investigated through observational studies and randomized controlled trials (RCTs), whose results have been summarized in numerous systematic reviews and meta-analyses [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ].…”