Published online August 1, 2005
PEDIATRICS Vol. 116 No. 2 August 2005, pp. 400-406 (doi:10.1542/peds.2004-1974)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (30)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Schanler, R. J.
Right arrow Articles by Smith, E. O.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schanler, R. J.
Right arrow Articles by Smith, E. O.
Related Collections
Right arrow Nutrition & Metabolism
Right arrowRelated AAP Red Book topics:
Yersinia enterocolitica and...

Randomized Trial of Donor Human Milk Versus Preterm Formula as Substitutes for Mothers' Own Milk in the Feeding of Extremely Premature Infants

Richard J. Schanler, MD*,{ddagger}, Chantal Lau, PhD§, Nancy M. Hurst, MSN|| and Elliot O'Brian Smith, PhD

* Division of Neonatal-Perinatal Medicine, Schneider Children's Hospital at North Shore, North Shore University Hospital, Manhasset, New York
{ddagger} Albert Einstein College of Medicine, Bronx, New York
§ Sections of Neonatology
|| Pediatric Gastroenterology
Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas

Objective. Compared with preterm formula (PF), mother's milk (MM) is associated with lower rates of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) among premature infants. Because not all mothers of premature infants produce sufficient milk to supply their infants throughout hospitalization, we reasoned that pasteurized donor human milk (DM) would be a suitable alternative.

Methods. Extremely premature infants (<30 weeks of gestation) whose mothers intended to breastfeed were assigned randomly to receive either pasteurized DM or PF if the supply of their own MM became insufficient during the study (birth to 90 days of age or hospital discharge). Infection-related events (LOS, NEC, meningitis, presumed sepsis, or urinary tract infection) that occurred after the attainment of a milk intake of 50 mL/kg, dietary intake, growth, skin-to-skin contact, and duration of hospital stay were compared. The primary analysis compared groups DM and PF on an intent-to-treat basis. If no differences were noted, then these groups were combined and compared with the reference group, group MM. If differences were noted, then the subsequent analyses compared each group with group MM.

Results. Of 243 infants, 70 (29%) received only MM; group DM included 81 infants and group PF included 92 infants. Because of poor weight gain, 17 infants (21%), all in group DM, were switched to PF. There were no differences in birth weight, gestational age, multiple births, and age at attainment of feeding of 50 mL/kg among groups. There were no differences between group DM and group PF in LOS and/or NEC, other infection-related events, hospital stay, or number of deaths. Group DM received a greater intake of milk and more nutritional supplements but had a slower rate of weight gain, compared with group PF. Compared with groups DM and PF, group MM had fewer episodes of LOS and/or NEC and total infection-related events and a shorter duration of hospital stay. Group MM also had fewer Gram-negative organisms isolated from blood cultures than did the other groups.

Conclusions. In this randomized, blinded trial of feeding of extremely premature infants, we found that, as a substitute for MM, DM offered little observed short-term advantage over PF for feeding extremely premature infants. Advantages to an exclusive diet of MM were observed in terms of fewer infection-related events and shorter hospital stays.

Key Words: human milk • pasteurized human donor milk • premature infant feeding

Abbreviations: DM, donor human milk • PF, preterm formula • MM, mother's milk • LOS, late-onset sepsis • NEC, necrotizing enterocolitis • ROP, retinopathy of prematurity • OR, odds ratio • CI, confidence interval

Accepted Nov 19, 2004.




This article has been cited by other articles:


Home page
 NeoReviewsHome page
T. D. Soltau and R. L. Schelonka
Immune Modification to Prevent Nosocomial Sepsis in Hospitalized Newborns
NeoReviews, May 1, 2008; 9(5): e199 - e205.
[Abstract] [Full Text] [PDF]

Home page
 NeoReviewsHome page
A. L. Patel, P. P. Meier, and J. L. Engstrom
The Evidence for Use of Human Milk in Very Low-birthweight Preterm Infants
NeoReviews, November 1, 2007; 8(11): e459 - e466.
[Abstract] [Full Text] [PDF]

Home page
 NeoReviewsHome page
P. P. Meier and J. L. Engstrom
Evidence-based Practices to Promote Exclusive Feeding of Human Milk in Very Low-birthweight Infants
NeoReviews, November 1, 2007; 8(11): e467 - e477.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
C. D. Heller, M. O'Shea, Q. Yao, J. Langer, R. A. Ehrenkranz, D. L. Phelps, W. K. Poole, B. Stoll, S. Duara, W. Oh, et al.
Human Milk Intake and Retinopathy of Prematurity in Extremely Low Birth Weight Infants
Pediatrics, July 1, 2007; 120(1): 1 - 9.
[Abstract] [Full Text] [PDF]

Home page
 NeoReviewsHome page
R. S. Cohen
Current Issues in Human Milk Banking
NeoReviews, July 1, 2007; 8(7): e289 - e295.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
A. F Williams, C. C Kingdon, and G. Weaver
Banking for the future: investing in human milk
Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2007; 92(3): F158 - F159.
[Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
C. A Boyd, M. A Quigley, and P. Brocklehurst
Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis
Arch. Dis. Child. Fetal Neonatal Ed., May 1, 2007; 92(3): F169 - F175.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Clin. Nutr.Home page
R. J Schanler
Evaluation of the evidence to support current recommendations to meet the needs of premature infants: the role of human milk
Am. J. Clinical Nutrition, February 1, 2007; 85(2): 625S - 628S.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
N. Modi
Donor breast milk banking
BMJ, December 2, 2006; 333(7579): 1133 - 1134.
[Full Text] [PDF]

Home page
 PediatricsHome page
E. Bertino, F. Giuliani, P. Tonetto, C. Fabris, C. Profeti, C. Magnani, G. E. Moro, and S. Arslanoglu
Randomized, Controlled Trial of Breastfeeding Versus Formula Feeding in Extremely Low Birth Weight Infants
Pediatrics, March 1, 2006; 117(3): 985 - 986.
[Full Text] [PDF]

Home page
 PediatricsHome page
N. E. Wight
Donor Milk: Down but Not Out
Pediatrics, December 1, 2005; 116(6): 1610 - 1610.
[Full Text] [PDF]