Role of human milk in extremely low birth weight infants' risk of necrotizing enterocolitis or death

Division of Neonatology, Department of Pediatrics, Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA.
Journal of perinatology: official journal of the California Perinatal Association (Impact Factor: 2.07). 09/2008; 29(1):57-62. DOI: 10.1038/jp.2008.117
Source: PubMed


To determine the association between human milk (HM) intake and risk of necrotizing enterocolitis (NEC) or death among infants 401 to 1000 g birth weight.
Analysis of 1272 infants in the National Institute of Child Health and Human Development Neonatal Network Glutamine Trial was performed to determine if increasing HM intake was associated with decreased risk of NEC or death. HM intake was defined as the proportion of HM to total intake, to enteral intake and total volume over the first 14 days. Known NEC risk factors were included as covariates in Cox proportional hazard analyses for duration of survival time free of NEC.
Among study infants, 13.6% died or developed NEC after 14 days. The likelihood of NEC or death after 14 days was decreased by a factor of 0.83 (95% confidence interval, CI 0.72, 0.96) for each 10% increase in the proportion of total intake as HM. Each 100 ml kg(-1) increase in HM intake during the first 14 days was associated with decreased risk of NEC or death (hazard ratio, HR 0.87 (95% CI 0.77, 0.97)). There appeared to be a trend towards a decreased risk of NEC or death among infants who received 100% HM as a proportion to total enteral intake (HM plus formula), although this finding was not statistically significant (HR 0.85 (95% CI 0.60, 1.19)).
These data suggest a dose-related association of HM feeding with a reduction of risk of NEC or death after the first 2 weeks of life among extremely low birth weight infants.

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    • "Interestingly , the most highly ranked gene for identifying BF versus FF infants was Endothelial PAS domain-containing protein 1 (EPAS- 1; also known as Hypoxia-inducible factor-2a [HIF-2a]). It is well known that human milk protects preterm infants from the development of NEC, one of the most common causes of morbidity and mortality in very low birth weight infants [62] [63]. We postulate that induction of this gene may provide a mechanism whereby the intestines of premature infants fed human milk are better able to tolerate episodes of hypoxia and are thereby less likely to develop NEC. "
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    • "The benefits of human milk compared to the use of commercial infant formulas are largely realized because of its bioactive components, including prebiotics, immune proteins and the microbiome of human milk itself. Breastfeeding is associated with a decreased incidence of gastrointestinal (GI) tract infections [1,2], which is corroborated by several studies that have correlated breastfeeding with a lower incidence of necrotizing enterocolitis in humans and animal models [3-5]. Breastfeeding is also associated with an altered fecal microbiome; two studies showed at two weeks of age over 90% of the total fecal bacteria of a breast-fed (BF) infant is Bifidobacteria, whereas in most formula-fed (FF) infants Bifidobacteria is non-detectable [6,7]. "
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