title: Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants.
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) is a frequent cause of mortality and morbidity in very low birth weight (VLBW) infants. Human milk (HM) feeding has been associated with lower risk of NEC. However, mothers of VLBW infants often experience insufficient milk production, resulting in mixed feedings of HM and formula. Moreover, medical complications often limit the volume of feeding they can be given.
  
  
  OBJECTIVE
  To determine if high proportions of (50% or greater) HM enteral feeding within the first 14 days of life are protective against NEC.
  
  
  METHODS
  This was a prospective cohort study of VLBW infants who were grouped according to the HM proportion of enteral feeding in the first 14 days: <50% (low human milk, LHM, n=46) and > or =50% (high human milk, HHM, n=156). The outcome of interest was development of NEC (Bell stage 2 or 3). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) and to assess potential confounding due to perinatal risk factors.
  
  
  RESULTS
  Two hundred and two infants were studied. Confirmed NEC occurred in 5/46 (10.6%) of the LHM group, as compared with 5/156 (3.2%) of the HHM. Gestational age was the only perinatal factor associated with risk of NEC. After adjustment for gestational age, HHM was associated with a lower risk of NEC ((OR=0.17, 95% CI: 0.04 to 0.68), P=0.01).
  
  
  CONCLUSIONS
  Enteral feeding containing at least 50% HM in the first 14 days of life was associated with a sixfold decrease in the odds of NEC.
authors: Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. psisk@wfubmc.edu
authors: P M
authors: PM
authors: Sisk
authors: C A
authors: CA
authors: Lovelady
authors: R G
authors: RG
authors: Dillard
authors: K J
authors: KJ
authors: Gruber
authors: T M
authors: TM
authors: O'Shea
mesh_terms: D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008895:Milk, Human; D016017:Odds Ratio; D011446:Prospective Studies