Formula milk versus preterm human milk for feeding preterm or low birth weight infants

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Abstract
Preterm human breast milk, compared with artificial formula milk, may provide insufficient nutrition for preterm or low birth weight infants. However, human milk may confer advantages in terms of a decreased incidence of gastrointestinal and neurodevelopmental adverse outcomes. To determine if formula milk compared with preterm human milk leads to improved growth and development without significant adverse effects in preterm or low birth weight infants. The standard search strategy of the Cochrane Neonatal Review Group was used. This included electronic searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE and previous reviews including cross references. Randomised controlled trials comparing feeding with formula milk versus preterm human milk in preterm or low birth weight infants. Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author and synthesis of data using relative risk and mean difference. Only one small trial fulfilled the pre-specified inclusion criteria (Gross 1983). In preterm and low birth weight infants, enteral feeding with protein-enriched standard calorie formula milk compared with unfortified donated preterm human milk resulted in a greater rate of short term weight gain, but not of increase in length or head circumference. In the group randomised to receive formula milk, there was an increase in the risk of feed intolerance of borderline statistical significance, but no evidence of an effect on necrotising enterocolitis. There are no data on long term growth parameters or on neurodevelopmental outcomes. There are no randomised comparisons of feeding with the preterm milk of the infant's mother versus formula milk. There are very limited data from randomised trials of feeding preterm or low birth weight infants with formula milk compared with preterm human milk. This may relate to a perceived difficulty of allocating an alternative enteral feed to an infant in cases where the infant's mother wishes to feed with expressed breast milk.