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Grand Rounds

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

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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

METHODS: 

  • 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

RESULTS: 

  • 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

CONCLUSION: 

  • 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

Learn More – Primary Sources: 

Formula versus donor breast milk for feeding preterm or low birth weight infants

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The 30-Year CARDIA Study: Does Breast Feeding Reduce the Risk for Diabetes?
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Cesarean or Vaginal Delivery for Preterm Fetal Growth Restriction?
Antenatal Corticosteroids – When to Administer?

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