#Grand Rounds

Cochrane Review: Formula or Donor Breast Milk for Preterm or LBW Infants?

BACKGROUND AND PURPOSE:

Quigley et al. (Cochrane Reviews, 2018) examined compared benefits of donor breast milk vs formula for growth and development in preterm or low birth weight (LBW) infants

Systematic review and meta-analysis
- RCTs comparing feeding with formula vs donor breast milk in preterm or LBW infants
Two review authors selected and assessed studies to avoid bias
GRADE methods were used to assess quality of evidence

11 studies, totaling 1809 infants
- 4 trials compared standard term formula vs. donor breast milk
- 7 trials compared nutrient-enriched preterm formula vs. donor breast milk
- 4 trials compared nutrient-fortified donor breast milk vs. donor breast milk
Formula-fed infants had higher in-hospital rates of
- Weight gain: Mean difference (MD) 2.51; 95% CI, 1.93 to 3.08 g/kg/day (moderate quality evidence)
- Linear growth: MD 1.21; 95% CI, 0.77 to 1.65 mm/week (moderate quality evidence)
- Head growth: MD 0.85, 95% CI 0.47 to 1.23 mm/week (moderate quality evidence)
There was no difference in long-term growth or neurodevelopment or all cause mortality (moderate quality evidence)
Formula feeding increased the risk of necrotizing enterocolitis (moderate quality evidence)
- Risk ratio (RR) 1.87; 95% CI, 1.23 to 2.85;
- Risk difference (RD) 0.03; 95% CI, 0.01 to 0.06

In preterm and LBW infants, formula feeding resulted in
- Higher rates of weight gain, linear growth, and head growth
- Almost double the risk for necrotizing enterocolitis
Authors caution that there is limited evidence comparing formula vs nutrient-fortified human milk

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