Costs of Necrotizing Enterocolitis and Cost-Effectiveness of Exclusively Human Milk-Based Products in Feeding Extremely Premature Infants

This chapter describes historic steps in feeding techniques and knowledge about the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920: tube feeding by gavage, medicine droppers and pipettes, feeding bottles with air inlet, and beaked spoons for nasal feeding. Indwelling nasogastric tubes were in use from 1951. For alleged safety concerns, postnatal feeding was postponed until a week of starvation was reached in the 1950s and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been known since 1919. However, nutritional practice lagged behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants fed formula than in those fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Compared to other aspects of neonatal medicine, there is little evidence on how to feed preterm infants.

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Cost and Cost-Effectiveness of Donor Human Milk to Prevent Necrotizing Enterocolitis: Systematic Review

Breastfeeding Medicine ◽

10.1089/bfm.2017.0057 ◽

2017 ◽

Vol 12 (9) ◽

pp. 528-536 ◽

Cited By ~ 18

Author(s):

Abigail Buckle ◽

Celia Taylor

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Human Milk ◽

Necrotizing Enterocolitis ◽

Donor Human Milk

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Feeding the feeble: steps towards nourishing preterm infants

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0054 ◽

2015 ◽

Vol 43 (5) ◽

Cited By ~ 1

Author(s):

Michael Obladen

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Premature Infants ◽

Tube Feeding ◽

Theoretical Knowledge ◽

Air Inlet ◽

Nutritional Needs ◽

The 1960S ◽

Feeding Techniques

AbstractThis paper describes historic steps in feeding techniques and knowledge on the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920, including tube feeding by gavage, medicine droppers and pipettes, feeding bottles with an air inlet, and beaked spoons for nasal feeding. Indwelling nastrogastric tubes were in use from 1951. For alleged safety concerns in the 1950s, postnatal feeding was postponed until a week of starvation was reached, and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been established since 1919. However, these remained controversial, and nutritional practices continued to lag behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants who were fed formula than in those who were fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Nevertheless, compared with other aspects of neonatal medicine, there is still remarkably little evidence on how to feed preterm infants.

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The Impact of Human Milk on Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu12051322 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1322 ◽

Cited By ~ 2

Author(s):

Emma Altobelli ◽

Paolo Matteo Angeletti ◽

Alberto Verrotti ◽

Reimondo Petrocelli

Keyword(s):

Systematic Review ◽

Human Milk ◽

Risk Reduction ◽

Necrotizing Enterocolitis ◽

Premature Infants ◽

Meta Analysis ◽

Preterm Formula ◽

The World ◽

Milk Banks ◽

The Impact

Background. Premature infants receiving breastfeed have a lower incidence of NEC than those fed preterm formula. This study aimed: (1) to update a systematic review and meta-analyses to evaluate the relationship between feeding and necrotizing enterocolitis (NEC) in low weight premature infants; (2) to conduct meta-regression analyses by subgroups; (3) to describe geographical distribution of milk banks in the world. Methods. Papers included in the meta-analysis were updated as of June 2019. Relative risks were used as a measure of effect size. Random effect models were used to account for different sources of variation among studies. For milk banks, the data reviewed by the literature were integrated with the information collected from countries’ institutional sites and milk bank networks. Results. Thirty-two papers were included in meta-analysis: six randomized controlled trials (RCTs) and 26 observational studies (OS). The census has found 572 milk banks around in the world. Brazil has the most active milk banks. RCTs meta-analysis indicates a risk reduction of NEC using human milk respect to formula: Relative risk (RR) = 0.62 (0.42–0.93). Seven OS compared quantities lower than human milk or higher than the 50th quantile showing a risk reduction of NEC:RR = 0.51 (0.31–0.85); 3 OS that evaluated human milk versus mixed feeding showing that human milk has a protective role on the development of NEC:RR = 0.74 (0.63–0.91). Results of subgroups analysis show that the risk reduction is statistically significant only for studies in which premature infants are given both their own and donated breastmilk. Conclusions. The possibility of preserving human milk and promoting donations guarantees an improvement in the health of newborns.

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