Arch Dis Child Fetal Neonatal Ed 92:F169-F175 doi:10.1136/adc.2005.089490
  • Original article

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

  1. Catherine A Boyd,
  2. Maria A Quigley,
  3. Peter Brocklehurst
  1. National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
  1. Correspondence to:
    Maria Quigley
    National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK; maria.quigley{at}
  • Accepted 28 February 2006
  • Published Online First 23 March 2006


Objectives: To compare the effect of donor breast milk 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 birthweight infants.

Results: Seven studies (including five randomised controlled trials), all from the 1970s and 1980s, fulfilled the inclusion criteria. All studies compared the effect of sole donor breast milk with formula (combined n = 471). One of these also compared the effect of donor breast milk with 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 RR 0.21, 95% CI 0.06 to 0.76). Donor breast milk was associated with slower growth in the early postnatal period, but 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 is needed to confirm these findings and measure the effect of fortified or supplemented donor breast milk.


  • Published Online First 5 April 2006

  • Funding: This work was undertaken by the National Perinatal Epidemiology Unit which receives funding from the Department of Health. The views expressed in this publication are those of the authors and not necessarily those of the Department of Health.

  • Competing interests: None declared.

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