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Intervention Review

Formula milk versus term human milk for feeding preterm or low birth weight infants

  1. G Henderson,
  2. MY Anthony,
  3. W McGuire

Editorial Group: Cochrane Neonatal Group

Published Online: 23 OCT 2001

DOI: 10.1002/14651858.CD002971

How to Cite

Henderson G, Anthony MY, McGuire W. Formula milk versus term human milk for feeding preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD002971. DOI: 10.1002/14651858.CD002971.

Author Information

*Mrs Ginny Henderson, Neonatal Nurse, Neonatal Unit, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK. g.w.henderson@dundee.ac.uk.

Publication History

  1. Published Online: 23 OCT 2001

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Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Term (mature) human breast milk, compared with artificial formula milks, may provide insufficient nutrition for growth and development in preterm or low birth weight infants. However, human milk may confer advantages to infants in terms of a decreased incidence of adverse outcomes.

Objectives

To determine if formula milk compared with term human breast milk leads to improved growth and development without significant adverse effects in low birth weight or preterm infants.

Search strategy

The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2003), MEDLINE 1966 - October 2003, EMBASE 1980 - October 2003, CINAHL 1982 - October 2003 and previous reviews including cross references.

Selection criteria

Randomised controlled trials comparing feeding with formula milk versus term human milk in low birth weight or preterm infants.

Data collection and analysis

Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk, risk difference and weighted mean difference.

Main results

Six trials, all initiated more than 20 years ago, fulfilled the pre-specified inclusion criteria. Four small trials compared feeding with standard calorie formula milk versus unfortified term human milk. Two trials compared feeding with calorie-enriched formula milk versus unfortified term human milk. No trials comparing feeding with formula milk versus nutrient-fortified term human milk were found. Only one trial reported longer term follow up of growth and development.

In preterm and low birth weight infants, enteral feeding with formula milk compared with unfortified term human milk resulted in a greater rate of growth in the short term. We did not find a statistically significant difference in the incidence of necrotising enterocolitis, but this was evaluated as a pre-defined outcome in only one trial. The single trial that evaluated longer-term outcomes did not find evidence of an effect on longer-term growth and neurodevelopment.

Authors' conclusions

In preterm and low birth weight infants, feeding with formula milk, compared with unfortified term human milk, leads to a greater rate of growth in the short term. The limited data available do not allow definite conclusions on whether adverse outcomes, including necrotising enterocolitis, are increased in infants who receive formula milk compared with term human milk. There are no data from randomised trials on the comparison of feeding with formula milk versus nutrient-fortified breast milk. This limits the implications for practice of this review as nutrient fortification of breast milk is now a common practice in neonatal care. Future trials may compare growth, development and adverse outcomes in infants who receive adapted "preterm" formula milks versus nutrient-fortified human breast milk.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Plain language summary

Formula milk compared with breast milk for promoting growth in preterm or low birth weight infants

Breast milk may provide protective factors for a newborn baby's immune system. This milk may not, however, provide enough nutrition for babies born early or with a low birth weight. Artificial formula milks may better suit the specific nutritional needs of these infants. This review compared feeding preterm or low birth weight infants with formula milk versus term breast milk (the milk of mothers who have delivered a term infant) in six studies involving 481 infants. The results showed a greater rate of growth in the short term when fed formula milk instead of unfortified breast milk but no evidence of effect on long-term growth or development. Differences in feeding intolerance, diarrhoea, diseases of the small intestine and colon, vitamin D deficiency or fractures were not significant, partly due to small numbers of infants in the studies. Studies were undertaken in resource-rich countries only. They were initiated 20 years ago so that management of preterm and low birth weight babies and the content of formula has changed considerably since then.