Preterm infants: formula spurs growth, carries risk for necrotizing enterocolitis

  • Quigley M & al.
  • Cochrane Database Syst Rev
  • 20 Jun 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Compared with donor breast milk, formula is associated with faster growth rates in preterm infants but at a cost of almost doubled risk for necrotizing enterocolitis.

Why this matters

  • The cost-benefit balance of better growth vs enterocolitis risk is uncertain in these preterm infants for whom maternal breast milk is not available.
  • Formula can be tougher for these babies to digest.
  • This Cochrane review updates a 2014 review , but with little change in conclusions.

Key results

  • All 11 included trials had methodological weaknesses, especially about blinding and randomization.
  • Quality of evidence was moderate.
  • Formula increases necrotizing enterocolitis risk vs donor milk (risk ratio,1.87; 95% CI, 1.23-2.85).
  • Formula is tied to faster weight gain (mean difference, 2.51; 95% CI, 1.93-3.08 g/kg/day).
  • Formula also was linked to faster gains in crown-heel length, head circumference.
  • Older studies have found no difference at later timepoints in weight, length, head circumference, or in neurodevelopmental outcomes.

Study design

  • Cochrane review of 11 randomized or quasirandomized controlled trials comparing formula vs donor feeding in 1809 infants.
  • Funding: None disclosed.

Limitations

  • Limitations are related to those of the original studies.

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