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Donor human milk protects against bronchopulmonary dysplasia | LATCH

Article Review: Donor Human Milk Protects Against Bronchopulmonary Dysplasia: A Systematic Review and Meta-analysis

Author: Amy Mailand Paradis, NNP

The nutritional and immunological benefits of providing human milk to extremely preterm infants have been increasingly recognized. There is strong evidence that mother’s own milk (MOM) provides a protective effect in reducing the incidence of necrotizing enterocolitis, late-onset sepsis, and retinopathy of prematurity, but there have been fewer reports regarding the benefit to bronchopulmonary dysplasia (BPD). BPD is the most common complication of extremely preterm births. Infants who develop BPD can have lifelong challenges with cardiopulmonary function. Optimal nutritional support is a cornerstone in the treatment and prevention of BPD, and several studies have reported the protective effects of donor human milk (DHM) in the development of the condition.

The article entitled “Donor Human Milk Protects Against Bronchopulmonary Dysplasia: A Systematic Review and Meta-analysis,” published in the journal Nutrients, reported data on the effects of DHM on BPD.

Over 1,000 articles were reviewed for inclusion in this systematic review, with a total of 18 articles meeting the inclusion criteria. Meta-analysis focused on randomized controlled trials (RCTs) could not demonstrate that supplementation of MOM with DHM had a significant effect on BPD when compared with preterm formula. The analysis did note that supplementation with DHM significantly reduced the mean days on mechanical ventilation but not days on oxygen. Further, feeding raw MOM was correlated with greater protection against BPD than pasteurized MOM. However, another analysis focused on the use of an exclusive human milk diet (MOM or DHM with a human milk-based fortifier) showed a correlation between this diet and a significantly reduced risk of BPD, when compared to a diet that included preterm formula or bovine milk-based fortifier.

Overall, the results of the systematic review show that DHM may protect against BPD in very preterm infants but that the process of pasteurization may reduce the beneficial properties of human milk on BPD development. Some of the benefits of raw MOM have been attributed to the microbiome of breastmilk with respect to the prevention of NEC. BPD has been associated with changes in the microbiome of the airways and may even be associated with the gut microbiome. The results of this meta-analysis suggest that DHM is superior to preterm formula in reducing BPD. It should be noted, however, that studies have proven that an exclusive human milk diet including MOM and/or DM reduces the incidence of multiple morbidities.

Providers should therefore support the initiation and maintenance of lactation and make efforts to identify and solve lactation problems in mothers of very-low-birth-weight infants. References

  1. Villamor-Martinez E, Pierro M, Cavallaro G, Mosca F, Kramer B, Villamor E. Donor human milk protects against bronchopulmonary dysplasia: a systematic review and meta-analysis. Nutrients. 2018;10(238):1-16. doi:10.3390/nu10020238
  2. Hair AB, Peluso AM, Hawthorne KM, et al. Beyond necrotizing enterocolitis prevention: improving outcomes with an exclusive human milk–based diet. Breastfeeding Med. 2016;11(2):70-74. doi:1089/bfm.2015.0134