Necrotizing enterocolitis and breast milk

American Family Physician,  May, 1991  

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Necrotizing enterocolitis is the most common serious complication encountered in neonatal intensive care units. Mortality rates are as high as 40 percent. Although most cases of necrotizing enterocolitis occur in premature or low-birth-weight infants, up to 10 percent of cases occur in full-term infants. The etiology is unknown, but feeding practices have been implicated in several outbreaks. Some clinicians suggest that breast milk has a protective effect against necrotizing enterocolitis. To determine whether feeding with breast milk has an effect on the incidence of necrotizing enterocolitis, Lucas and Cole conducted a study in five neonatal intensive care units in Great Britain.

A total of 926 preterm infants were included in the study. All of the infants weighed less than 1,850 g (4 lb, 1 oz) at birth. Mean gestation at birth was 31 weeks. Within 48 hours of birth, the infants were randomly assigned to one of three feeding routines: formula only, breast milk only or formula plus breast milk.

Overall, 51 infants (5.5 percent) developed clinical features of necrotizing enterocolitis. The diagnosis was more stringently confirmed in 31. Eight infants died, and 11 infants required surgery. Confirmed necrotizing enterocolitis was six times more common in the infants receiving only formula, compared with those receiving only breast milk. Confirmed disease was three times more common in infants receiving both formula and breast milk, compared with the infants receiving only breast milk. In infants who were fed formula exclusively, a delay in the first feeding was associated with a lower incidence of necrotizing enterocolitis. This was not apparent in the infants who were fed breast milk only.

Other significant risk factors were very low gestational age, umbilical artery catheterization, respiratory disease and polycythemia. After adjustment for these factors, the rate of confirmed necrotizing enterocolitis was ten times higher in the infants who were fed formula, compared with infants receiving breast milk only.

The authors believe that their study provides evidence of a strong link between early diet and necrotizing enterocolitis. Feeding policies in neonatal intensive care units may need to be reappraised. (Lancet, December 22/29, 1990, vol. 336, p. 1519.)

COPYRIGHT 1991 American Academy of Family Physicians
COPYRIGHT 2008 Gale, Cengage Learning