Associations of an Exclusive Human Milk Diet with Morbidity and Mortality in ELBW Infants Born ≤750 Grams: an Individual Participant Data Meta-Analysis.

Background: Survival without major comorbidities remains low among extremely low birthweight (ELBW) infants. An exclusive human milk diet (EHMD) has shown clinical benefits among infants born weighing ≤1,250 g. Methods: Our objective was to determine the associations between an exclusive human milk diet (EHMD) or a diet containing cow milk-based products (CMBD) and common morbidities and mortality among infants born weighing ≤750 g. We conducted a systematic review with individual participant data meta-analysis. After a PubMed search (Jan 2000 to Feb 2022), authors from eligible RCT and observational studies were invited to contribute their data. EHMD was compared to a CMBD, including formula (CMBD+f). Sensitivity analyses compared an EHMD and a base diet of human milk fortified with cow milk-based fortifiers (CMBDf). Adjusted odds ratios (aOR) reported are from complete cases. Results: Six studies were included, totaling 879 infants born between 2007-2015 and weighing ≤750 g. Infants fed an EHMD (n=449) had reduced odds of developing necrotizing enterocolitis (NEC), surgical NEC, and bronchopulmonary dysplasia (BPD) compared to those fed a CMBD+f (n=430). Similar reductions were observed when an EHMD was compared with CMBD-f (n=78). Additionally, an EHMD was associated with 50% lower odds of scoring affirmatively on a mortality and morbidity index (MMI) compared to CMBD+f. Conclusions: In this study, infants born ≤750 g have reduced odds of developing several major comorbidities than those fed cows milk-based nutritional products, even with a base diet of human milk. Registry Number: PROSPERO, identifier: CRD42022319031 [ABSTRACT FROM AUTHOR]