Donor breast milk versus infant formula for preterm infants: a systematic review and meta-analysis

Catherine A Boyd ¹, Maria A Quigley ^2* and Peter Brocklehurst ²

¹ Oxford University, United Kingdom
² National Perinatal Epidemiology Unit, United Kingdom

^* To whom correspondence should be addressed. E-mail: maria.quigley{at}npeu.ox.ac.uk.

Accepted 28 February 2006

Abstract

Objectives: To determine the effect of donor breast milk compared with infant formula in preterm infants. Separate comparisons with formula were made for donor breast milk that was: 1. given as a sole diet; 2. given as a supplement to mother's own breast milk; and 3. fortified with macronutrients and micronutrients. The main outcomes were death, necrotising enterocolitis (NEC), infection, growth, and development.

Data sources: Electronic databases - Cochrane, CENTRAL, MEDLINE, EMBASE, CINAHL, and HMIC: DH.

Review methods:Systematic review and meta- analysis of trials and observational studies of preterm or low birth weight infants.

Results:Seven studies (including 5 randomised controlled trials), all from the 1970s and 1980s, fulfilled the inclusion criteria. All studies assessed the effect of sole donor breast milk versus formula (combined n=471). One of these studies also assessed the effect of donor breast milk versus formula given as a supplement to mother's own milk (n=343). No studies examined fortified donor breast milk. A meta-analysis based on three studies found a lower risk of NEC in infants receiving donor breast milk compared with formula (combined risk ratio=0.21, 95% confidence interval: 0.06-0.76). Donor breast milk was associated with slower growth in the early postnatal period; its long-term effect is unclear.

Conclusion:Donor breast milk is associated with a lower risk of NEC and slower growth in the early postnatal period, but the quality of the evidence is limited. Further research needs to confirm these findings and measure the effect of fortified or supplemented donor breast milk.

Keywords: breastfeeding, meta-analysis, necrotising enterocolitis, review

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