Human milk versus formula milk : the incidence of Necrotising Enterocolitis (NEC) in preterms

Abstract

This dissertation assessed literature regarding a diet of human milk versus formula milk with regards to incidence of Necrotising Enterocolitis (NEC) in preterms. NEC is an acute, inflammatory disease of the bowel and is said to occur as a result of intestinal ischaemia, colonisation by pathogenic bacteria and accumulation of substrate in the intestinal lumen. Lowering the incidence of NEC would result in an enhanced quality of life, shorter hospital stays and lower costs. Consequently, a clinical enquiry using the PICO framework was formulated: “Are preterm infants fed with formula milk at an increased risk of Necrotising Enterocolitis (NEC) than those who are fed with human milk?” Population: Preterm infants Intervention: Human milk Comparison: Formula milk Outcome: Decreased risk of Necrotising Enterocolitis (NEC) A systematic search was conducted using ten databases from HyDi and the Google Scholar search engine. The articles selected for this dissertation investigated the effect of human milk versus formula milk in relation to NEC in preterms. Articles considering the use of the fortifier were also included. The articles chosen were written in the English language, published in the last ten years and peer-reviewed. Studies that did not meet the inclusion criteria were discarded as were studies considering the use of probiotics and studies done on animals. The relevant studies included one SR, three RCTs and three cohorts. These were appraised individually according to their study design using the CASP tools. The final results were categorised into primary and secondary outcomes. For the primary outcome all studies favoured a diet high in human milk especially in the high-risk period (14 days after birth). With regards to secondary outcomes, human milk was also beneficial with the exception of growth; however, the results were not all statistically significant. This implies the need for further research. A recommendation for practice is the establishment of local donor human milk banks.