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Type: Journal article
Title: Safety and efficacy of human milk-based fortifier in enterally fed preterm and/or low birthweight infants: a systematic review and meta-analysis
Author: Grace, E.
Hilditch, C.
Gomersall, J.
Collins, C.T.
Rumbold, A.
Keir, A.K.
Citation: Archives of disease in childhood. Fetal and neonatal edition, 2021; 106(2):142-137
Publisher: BMJ
Issue Date: 2021
ISSN: 1359-2998
Statement of
Erin Grace, Cathie Hilditch, Judith Gomersall, Carmel T Collins, Alice Rumbold, Amy K Keir ... et al.
Abstract: OBJECTIVE:To conduct a systematic review and meta-analysis of the efficacy and safety of fortification of human milk with human milk-based fortifier versus cow's milk-based fortifier for use in preterm and/or very low birthweight infants. DESIGN:Randomised or quasi-randomised controlled trials comparing the effect of human milk fortification with human milk-based milk fortifier versus cow's milk-based fortifier in infants born <34 weeks' gestation and/or with birth weight <1500 g were identified by searching databases, clinical trial registries and reference lists until 5 November 2019. Two authors independently extracted data and assessed evidence quality. Meta-analyses were conducted using fixed or random effects models, as appropriate. MAIN OUTCOME MEASURES:Necrotising enterocolitis (Bell's stage II or higher) and late-onset sepsis. RESULTS:Of 863 unique records identified, 16 full-text trials were screened and 2 trials involving 334 infants were included. Primary outcome data were available for 332 infants. Use of human milk-based fortifier compared with cow's milk-based fortifier reduced the risk of necrotising enterocolitis (risk ratio 0.47, 95% CI 0.22 to 0.98). There was no clear evidence of an effect on late-onset sepsis or any other outcomes. The quality of evidence was low to very low due to imprecision and lack of blinding in one study. CONCLUSIONS:Findings suggest that there is a reduction in the incidence of necrotising enterocolitis with human milk-based fortifiers compared with cow's milk-based fortifiers. The overall quality of evidence is low. Further appropriately powered trials are required before this intervention can be routinely recommended for preterm infants.
Keywords: mortality; neonatology
Rights: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
RMID: 1000026361
DOI: 10.1136/archdischild-2020-319406
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Appears in Collections:Paediatrics publications

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