Influence of an Early Human Milk Diet on the Duration of Parenteral Nutrition and Incidence of Late-Onset Sepsis in Very Low Birthweight (VLBW) Infants: A Systematic Review

Roisin Coyne; William Hughes; Helen Purtill; Deirdre McGrath; Colum P Dunne; Roy K Philip

doi:10.1089/bfm.2023.0290

Influence of an Early Human Milk Diet on the Duration of Parenteral Nutrition and Incidence of Late-Onset Sepsis in Very Low Birthweight (VLBW) Infants: A Systematic Review

Breastfeed Med. 2024 Apr 23. doi: 10.1089/bfm.2023.0290. Online ahead of print.

Authors

Roisin Coyne¹, William Hughes², Helen Purtill³, Deirdre McGrath⁴, Colum P Dunne^{5

6}, Roy K Philip^{1

5}

Affiliations

¹ Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick (UMHL), Limerick, Ireland.
² Department of Sports and Health Sciences, Technological University of the Shannon: Midlands Midwest Athlone, Athlone, Ireland.
³ Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland.
⁴ Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
⁵ University of Limerick School of Medicine, Limerick, Ireland.
⁶ Centre for Interventions in Infection, Inflammation, and Immunity (4i), University of Limerick, Limerick, Ireland.

PMID: 38651604
DOI: 10.1089/bfm.2023.0290

Abstract

Introduction: Human milk is the preferred source of enteral nutrition for very low birthweight (VLBW) infants, and it possibly decreases dependence on parenteral nutrition (PN) and reduces incidence of late-onset sepsis (LOS). No systematic review to date has specifically addressed the value of early versus late introduction of human milk diet (HMD) on duration of PN and incidence of LOS among VLBW infants. Objective: To review the evidence for an early versus late introduction of HMD on duration of PN and incidence of LOS in VLBW infants. Method: Preferred reporting items for systematic reviews and meta-analysis-guided search of EMBASE and PubMed/Medline databases was conducted for this systematic review using phrases addressing population, intervention, comparator, and outcome framework to identify articles published over the past two decades without language restrictions. Full-text articles (both observational and randomized) that studied an early versus late initiation of HMD were included. Mean difference (MD) and relative risk (RR) with 95% confidence intervals (CIs) were calculated for PN and LOS. Quality of evidence was analyzed using UK National Service Framework and the risk-of-bias was assessed using Robvis^®. Results: One randomized controlled trial (RCT) and two observational studies (two English and one Chinese) recruited 474 VLBW infants (455 analyzed). Among an intrauterine growth-restricted cohort enrolled in the RCT (n = 72), early HMD resulted in statistically significant reduction in PN dependence. However, no statistically significant difference was found in LOS. Two observational studies found similar reductions in PN duration and LOS incidence among the early HMD cohort. One observational study reported significant PN reduction; however, the incidence of LOS did not reach statistical significance in either case. Conclusion: An early HMD may reduce the duration of PN for a growth-restricted VLBW cohort. Observational studies suggesting reduced PN and LOS from early HMD endorse the need for bioactivity-focused human milk research. Variations in feeding guidelines among VLBW infants have the potential to influence neonatal outcomes significantly.

Keywords: breastfeeding; early human milk diet; human milk; late-onset sepsis; parenteral nutrition; systematic review; very low birthweight.

Publication types

Review