R. Cheddadi1, V. Yeramilli1, C.A. Martin1 1Washington University, Department Of Surgery, Division Of Pediatric Surgery, St. Louis, MO, USA
Introduction:
The choice of enteral nutrition for preterm or low birth weight (LBW) infants is a critical factor influencing their health outcomes. The ongoing debate regarding the benefits and risks of donor milk versus formula feeding underscores the need for rigorous evidence synthesis. This meta-analysis aims to compare the effects of donor milk and formula feeding on key health outcomes in this vulnerable population, with a particular focus on necrotizing enterocolitis (NEC), sepsis, all-cause mortality, and neurodevelopmental outcomes.
Methods:
A comprehensive literature search was conducted on March 25, 2024, across multiple databases, including Embase, Ovid Medline, Scopus, Cochrane Central, and Clinicaltrials.gov. We included randomized controlled trials (RCTs) involving preterm infants, focusing on the comparison between donor milk and formula feeding. Data extraction and bias assessment were independently performed by two authors. We calculated risk ratios (RRs) and mean differences (MDs) using a random-effects model, and evaluated the quality of evidence through the GRADE approach.
Results:
The meta-analysis incorporated data from 15 RCTs, including a total of 2,655 preterm infants. The pooled analysis revealed that formula feeding was associated with a significantly higher risk of NEC compared to donor milk (RR 1.963, 95% CI 1.241 to 3.107), indicating a 96.3% increased risk. Conversely, the risk of sepsis was slightly lower with formula feeding (RR 0.91, 95% CI 0.77 to 1.08), though this finding was not statistically significant. Additionally, there was no significant difference in all-cause mortality between the two feeding groups (RR 1.02, 95% CI 0.78 to 1.33). Importantly, neurodevelopmental outcomes showed no statistically significant differences between infants fed donor milk and those fed formula.
Conclusion:
The findings of this meta-analysis highlight the protective effect of donor milk against NEC in preterm infants, with no significant differences in sepsis, mortality, or neurodevelopmental outcomes when compared to formula feeding. These results underscore the importance of tailoring nutritional strategies to the individual needs of preterm infants, considering both the available evidence and the specific clinical context.