Does Breastfeeding Help Neonates With Necrotizing Enterocolitis?

Neonates With Necrotizing Enterocolitis

Introductory Statement

I would like to write about preterm infants with necrotizing enterocolitis and breastfeeding, whether it is beneficial to the infant to breastfeed. I became interested in the topic after a clinical experience in the NICU. One infant in the NICU was having difficulty keeping formula down. The neonate gastric pH was being monitored for GER. When the NICU nurse also spoke of assessing for signs of necrotizing enterocolitis in the distressed infant, it sparked my interest. I did not know anything about necrotizing enterocolitis. The NICU nurse told me quite a lot about the problem. Indeed, the wealth of information she shared was a bit overwhelming at the time so I decided to look it up after my clinical experience. What I found was sufficiently interesting to cause me to decide that I wanted to write my evidence-based paper on the topic.

Article Summaries

Sisk, P.M., Lovelady, C.A., Dillard, R.G., Gruber, K.J., and O'Shea, T.M. (2007). Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. Journal of Perintology, 27, 428-433. doi: 10.1038/sj.jp.7211758. Retrieved http://www.nature.com/jp/journal/v27/n7/full/7211758a.html

The authors explore the impact of human milk (HM) on the frequency of incidence of necrotizing entercolitis (NEC) in very low birth weight (VLBW) infants. The mothers of VLBW infants often experience insufficient breast milk production to sustain their infants, which results in mixed formula and HM feedings. Additionally, medical complications frequently limit the volume of formula that can be given to infants with NEC. The research hypothesis was that high proportions (50% or greater) of HM enteral feeding within the first 14 days of life are protective against NEC. The research method was a prospective cohort study of VLBW infants who were grouped by the HM proportion of enteral feeding in the first 14 days. Of the 202 infants studied, two groups were established: 50% (high human milk, HHM, n=156). The outcome measure was the development of NEC (as indicated by Bell stage 2 or 3). Logistical regression was used to estimate the odds ratios (OR), potential confounding due to perinatal risk factors, and 95% confidence intervals (CI). NEC was confirmed in 5 out of 46 (or 10.6%) of the LHM group, compared to 5 out of 156 (3.2%) of the HHM group. The only perinatal factor associated with the risk of NEC was gestational age. After adjusting for gestational age, HHM was associated with a lower risk of NEC as follows: Odds ratios (OR) = 0.17 at 95% confidence intervals of 0.04 to 0.68, P =0.01. The authors concluded that enteral feeding that contained at least 50% HM in the first 14 days of life was associated with a sixfold decrease in the odds of VLBW infants acquiring NEC.

Sullivan, S., Schanler, R.J., Kim, J.H., Patel, J.H., Tawoger, R., Kiechi-Kohlendorfer, U., Chan, G.M., Blanco, C.L., Abrams, S., Cotton, C.M., Laroia, N., Ehrenkranz, R.A., Dudell, G., Cristofalo, E.A., Meier, P., Lee, M.L., Rechtman, D.J., and Lucas, A. (2010, April). An exclusively human milk-based diet is associated wih a lower rate of necrotizing entercolitis than a diet of human milk and bovien milk-based products. The Journal of Pediatrics, 156(4), 562-567e1. Retrieved http://www.sciencedirect.com / science/article/pii/S0022347609010853