The debate among parents regarding the use of human milk vs. formula wages on, but according to a recent study, you can chalk one up for the human body. That study, headed by the Johns Hopkins University in Baltimore, concluded that premature babies fed human donor milk were less likely to develop the intestinal condition necrotizing enterocolitis (NEC). Both sides has its advocates, willing to do battle at any time. When it comes to NEC, Mom’s milk has the decided advantage.
What is NEC?
Necrotizing enterocolitis. Never heard of it? It is a frequent cause of mortality and morbidity in very low birth weight (VLBW) infants. The condition is typically seen in premature infants, and the timing of its onset is generally inversely proportional to the gestational age of the baby at birth, i.e. the earlier a baby is born, the later the signs of NEC are typically seen.
Initial symptoms include feeding intolerance, increased gastric residuals, abdominal distension and bloody stools. Symptoms may progress rapidly to abdominal discoloration with intestinal perforation and peritonitis and systemic hypotension requiring intensive medical support.
The diagnosis is usually suspected clinically but often requires the aid of diagnostic imaging modalities. Radiographic signs of NEC include dilated bowel loops, paucity of gas, a “fixed loop” (unaltered gas-filled loop of bowel), pneumatosis intestinalis (gas cysts in the bowel wall), portal venous gas, and pneumoperitoneum (extraluminal or “free air” outside the bowel within the abdomen). The pathognomic finding on plain films is pneumatosis intestinalis . More recently ultrasonography has proven to be useful as it may detect signs and complications of NEC before they are evident on radiographs. Diagnosis is ultimately made in 5-10% of very low-birth-weight infants (<1,500g).
The role of human milk in both prevention and treatment of NEC has long been recognized. The familiar arguments, cost, inconvenience, etc., are largely inapplicable to the very low birth weight infant. Mothers of very low birth weight infants often experience insufficient milk production, resulting in mixed feedings of human milk and formula. Moreover, medical complications often limit the volume of feeding these infants can be given. The analysis shifts, therefore, with the new focus on the medical needs of the child and not simply on whether or not breast feeding is convenient for Mom or whether formula is too expensive for the household budget.
Human milk, whether mother’s own or from a donor, provides significant protection against many of the known risk factors of NEC as well as therapeutic protection for the infant recovering from NEC. The study shows that enteral feeding containing at least 50% human milk in the first 14 days of life was associated with a sixfold decrease in the odds of NEC. The stark differences in the risk of NEC, its complications and the need for surgery between babies who receive human donor milk and those who get formula signal the need for a change in feeding practices across neonatal intensive care units,” said lead investigator Elizabeth Cristofalo, a neonatologist at the Johns Hopkins Children’s Center.
Those numbers are encouraging, particularly for the vulnerable very low birth weight infant. In the absence of mother’s own milk, donor human milk could be life saving for fragile preterm infants, who are at the highest risk of developing NEC. Undoubtedly the use of non-human milk (formula) remains an option that many parents may choose to exercise. The study, however, suggests that it is the inappropriate choice for some. I have a sneaking suspicion that they are not interested in participating in the human vs. non-human milk debate.
Question: Have you made a decision about human vs. non-human milk? Why did you choose one over the other?
Image courtesy of breastfeedingtechniques.com