Does supplemental donor milk instead of formula reduce infections in preterm infants?

The combined incidence of serious infection, the intestinal disease necrotizing enterocolitis and death was similar in very low-birth-weight infants who received either pasteurized donor milk or preterm formula supplementation during their first 10 days of life when their own mother's milk was not sufficiently available, according to an article published online by JAMA Pediatrics.

About 10 percent of infants worldwide are born prematurely and about 15 percent of them weigh less than 1,500 grams and are classified as having very low birth weight (VLBW). Sepsis and necrotizing enterocolitis (NEC) cause illness and death in VLBW infants. A lower incidence of NEC and sepsis is associated with VLBW infants fed their own mother's milk. However, lactation can be delayed after a premature delivery, which results in insufficient amounts of milk during those critical early days.

Johannes B. van Goudoever, Ph.D., of the Emma Children's Hospital - Academic Medical Center and the VU University Medical Center, Amsterdam, and coauthors examined whether providing donor milk instead of formula as supplemental feeding whenever a mother's own milk was insufficiently available during the first 10 days of life would reduce the incidence of serious infection, NEC and death.

The randomized clinical included 373 VLBW infants born in the Netherlands and, of those, 183 received donor milk and 190 received formula. The proportion of their own mother's milk during the first 10 days of life was high in both groups (89.1 percent of the total average intake during the intervention period for the donor milk group and 84.5 percent for the formula group).

The incidence of the combined outcome of serious infection, NEC and death was not significantly different between the two groups (44.7 percent in the formula group vs. 42.1 percent in the donor milk group), according to the study results.

The authors note the intervention period of the clinical trial was short. It also has been suggested that pasteurization and other processing steps may alter the quality of donor milk.

"This double-blind RCT [randomized clinical trial] found no significant effect of pasteurized donor milk during the first 10 days of life for preventing serious infections, NEC and all-cause mortality in premature neonates. The results of this trial stress the importance of providing premature neonates with raw milk from their own mother," the study concludes.