title: Adequacy of expressed breast milk for early gwoth of preterm infants. Multicentre trial on feeding low birthweight infants: effects of diet on early growth. Effect of Human Milk or Formula on Gastric Function and Fat Digestion in the Premature Infant1 Growth and biochemical response of preterm infants fed human milk or modified infant formula. A PLANNED PROSPECTIVE EVALUATION OF THE ANTI‐INFECTIVE PROPERTY OF VARYING QUANTITIES OF EXPRESSED HUMAN MILK Breast milk and neonatal necrotising enterocolitis The value of human milk in the prevention of infection in the high-risk low-birth-weight infant. A COMPARATIVE STUDY OF VARYING PROTEIN INTAKE IN LOW BIRTHWEIGHT INFANT FEEDING Nutrient balance, energy utilization, and composition of weight gain in very-low-birth-weight infants fed pooled human milk or a preterm formula.
abstract: Poor weight gain observed in preterm infants who were fed expressed breast milk compared with those fed a cows ' milk formular  prompted a detailed study of early postnatal growth in preterm infants fed these two milks . 68 infants were divided into two categories by gestational age at birth ( i ) 28 - 32 weeks ( n=28 ) , ( ii ) 33 - 36 weeks ( n=40 ) . They were r and omly allocated to a feed of expressed breast milk or a milk formula ( Ostermilk 1 ) . Rates of weight gain , linear growth , and head circumference growth were evaluated over two periods : birth-1 month , 1 - 2 months . The younger group who were fed breast milk showed slower overall growth rates over the first month than those fed formula . In the second month , and for the older infants over both of the 2-monthly periods , growth rates were similar in the two feeding regimens . It is concluded that expressed breast milk is inadequate for the growth of very immature preterm infants during early postnatal life A large multicentre study on the short and long term clinical and developmental outcome of infants r and omised to different diets is being undertaken . This report represents an interim analysis of the early postnatal growth performance of an unselected population of 194 preterm infants ( gestation , mean ( SD ) 31 . 0 ( 2 . 9 ) weeks ; birthweight , mean ( SD ) 1364 ( 294 ) g ) , both ill and well , examined in two ( of four ) parallel trials . One trial compared banked breast milk with a new preterm formula ( primary trial ) ; the other compared these diets as supplements to maternal milk ( supplement trial ) . A major dietary effect on the number of days taken to regain birthweight and subsequent gains in weight , length , and head circumference was observed in the primary trial . Infants fed banked breast milk  and weighing less than 1200 g at birth took a calculated additional three weeks to reach 2000 g compared with those fed on the preterm formula . A significant influence of diet on body proportions was seen in the relation between body weight , head circumference , and length . Similar though smaller differences in growth patterns were seen in the supplement trial . By the time they reach 2000 g , infants of birthweights 1200 to 1849 g fed on banked breast milk and infants below 1200 g fed on either banked breast milk or maternal milk supplemented ( as necessary ) with banked breast milk , fulfilled stringent criteria for failure to thrive ( weight less than 2 SD below the mean for age ) . Only infants fed the preterm formula as their sole diet had maintained their birth centile by discharge from hospital . The misleading nature of comparisons between extrauterine and intrauterine steady state weight gains is emphasised The effect of diet , human milk or formula , on gastric function ( lipase and pepsin activity , pH , and volume ) and intragastric digestion of fat was assessed in 28 appropriate for gestational age preterm infants ( gestational age , 28.9 ± 1.4 , 29.1 ± 0.9 , 29.5 ± 0.6 wk ; birth weight , 1.00 ± 0.14 to 1.18 ± 0.07 kg ) . The infants were fed either human milk ( n = 11 ) , SMA Super Preemie formula ( n = 9 ) , or Similac , Special Care formula ( n = 8) . Fasting and postpr and ial activity of digestive enzymes , pH , and gastric volume ( measured before or during 50 min after gavage feeding ) did not differ as a function of diet among the three groups of infants . Gastric lipase output , 23.1 ± 5.1 , 28.3± 6.6 , and 22.5 ± 6.4 ( U/kg of body weight ) in human milk- , SMA SP- , or Similac SC-fed infants was comparable to the gastric lipase output of healthy adults fed a high fat diet ( 22.6 ± 3.0 ) . Pepsin output was , however , significantly lower ( 597 ± 77 , 743 ± 97 , and 639± 142 U/kg of body weight ) in human milk- , SMA SP- , and Similac SC-fed infants ) than in healthy adults ( 3352 ± 753 U/kg ) . The hydrolysis of dietary fat was 1.7 - 2.5-fold higher ( p < 0.01 ) in human milk-fed infants than in infants fed either formula . We conclude that differences in type of feeding , i.e. different fatty acid profiles(long chain or medium chain triglycerides ) , different emulsions ( natural or artificial ) , and different fat particle sizes do not affect the level of activity of gastric enzymes . However , the triglyceride within milk fat globules appears to be more accessible to gastric lipase than that within formula fat particles . We suggest that the contribution of gastric lipase to overall fat digestion might be greater in the newborn ( a period of pancreatic insufficiency ) than in the adult My colleagues and I compared the biochemical status and rates of growth of three groups of preterm infants : one group was fed  milk obtained early from mothers of preterm infants ;  one group received  milk produced during the mature stage of lactation by mothers of term infants ; and one group received a whey-based infant formula . Sixty healthy preterm infants with birth weights of 1600 g or less were r and omly assigned to one of the three feedings groups . The 20 infants in each group were followed until they reached a weight of 1800 g. The mean ( + /- S.E.M. ) number of days required to regain birth weight was similar for infants receiving the formula ( 10.3 + /- 0.8 ) and those receiving milk from mothers of preterm infants ( 11.4 + /- 0.8 ) ; both were significantly less than the number ( 18.8 + /- 1.7 ) for infants receiving milk from mothers of term infants ( P less than 0.001 ) . Subsequent rates of weight gain were greater for the groups receiving formula ( 27.0 + /- 0.8 g per day ) and milk from mothers of preterm infants ( 23.7 + /- 1.1 ) than for the group receiving milk from mothers of term infants ( 15.8 + /- 0.8 ) ( P less than 0.001 ) . Similarly , the average increments in crown-to-heel length and in the head circumference were significantly greater for the groups given formula and milk from mothers of preterm infants ( P less than 0.005 and P less than 0.001 , respectively ) . These data indicate that feeding with either milk from mothers of preterm infants or a whey-based infant formula results in more appropriate growth in preterm infants than feeding with milk from mothers of term infants ABSTRACT . This paper comprises 261 low birth weight infants who were divided into four groups with different feeding schedules . Group I – expressed human milk for all the feeds ; Group II – human milk for half the feeds and the nursery formula for the rest ; Group III – colostrum , 20 ml three times a day along with the nursery formula ; and Group IV – control – only the nursery formula . The groups were matched by means of a r and omised block design for identifiable factors which could predispose to the occurrence of infection . Infections were found to be significantly less in the groups which received human milk ( p < 0.001 ) In a prospect i ve multicentre study on 926 preterm infants formally assigned to their early diet , necrotising enterocolitis developed in 51 ( 5.5 % ) .  Mortality was 26 % in stringently confirmed cases . In exclusively  formula-fed  babies confirmed disease was 6 - 10 times more common than in those fed breast milk alone and 3 times more common than in those who received formula plus breast milk . Pasteurised donor milk seemed to be as protective as raw maternal milk . Among babies born at more than 30 weeks ' gestation confirmed necrotising enterocolitis was rare in those whose diet included breast milk ; it was 20 times more common in those fed formula only . Other risk factors included very low  gestational age , respiratory disease , umbilical artery catheterisation , and polycythaemia . In formula-fed but not breast-milk-fed infants , delayed enteral feeding was associated with a lower frequency of necrotising enterocolitis . With the fall in the use of breast milk in British neonatal units , exclusive formula feeding could account for an estimated 500 extra cases of necrotising enterocolitis each year . About 100 of these infants would die A controlled prospect i ve study was undertaken of 62 high-risk low-birth-weight infants to evaluate the effect of expressed human milk on the prevention of infection . One half received EHM and the remaining half were administered the nursery formula . There was no statistically significant difference in the predisposing factors in the two groups . Infections , however , were much fewer in babies who received EHM ( Svenningsen , N.W. , Lindroth , M. and Lindquist , B. ( Department of Paediatrics , University of Lund , Sweden ) . A comparative study of varying protein intake in low birthweight infant feeding . Acta Paediatr Sc and . Suppl . 296 : 28 , 1982 . — In a prospect i ve longitudinal study of 48 very low birthweight and preterm infants with mean birthweight 1 385±343 and gestational age 30.8±2.9 w an assessment was made of the impact of varying the protein intake in the postnatal period from the 3rd to 7th week of life . The infants were r and omly allocated to one of three dietary groups with isocaloric energy supply but different protein content — i.e . human milk ( 1.6 g/100 kcal ) , formula 1 ( 2.3 g/100 kcal ) and formula 2 ( 3.0 g/100 kcal ) . In the human milk group 12 of 18 infants were fed their own mother 's breastmilk . During the study period the mean weight gain was slightly higher in the infants fed formula 1 and 2 . There were no group differences in S‐albumin whereas B‐urea‐N and B‐base deficit were significantly increased in the formula fed infants in comparison to infants fed human milk . After the study period until around 15 weeks of age the slope in weight gain remained slightly higher for formula fed infants . However , the gain in body length and head circumference was equal in all three groups . After around 8 months of age there was no difference in any growth parameter . Neurodevelopmental examinations showed no group differences during the follow‐up period to 2 years of age Growth , protein , and energy balances were studied in two groups of very-low-birth-weight premature infants fed pooled pasteurized human milk ( HM ) or a preterm formula ( PF ) .  Each infant was studied at 33 and 36 weeks gestational age with a combined technique of nutrient balance and indirect calorimetry measurement . Weight and length gains were higher with PF than with HM , but head circumference growth was similar with both milks . Although the volume of milk given was lower , energy intake was higher with PF than with HM in both studies ( 126 to 130 vs 103 to 109 kcal/kg/day ) . Percentage of energy absorbed was better with PF than with HM ( 94 % vs 84 % ) at 33 weeks , and similar ( 95 % ) with both milks at 36 weeks . Energy expenditure , which had increased from 33 weeks to 36 weeks , was higher with PF than with HM ( 57 to 63 vs 46 to 52 kcal/kg/day ) during both studies . Energy retention accounted for about 50 % of energy absorbed with both milks , but was higher with PF than with HM ( 60 vs 40 to 50 kcal/kg/day ) in both studies , and result ed in fat accretion well above that seen during intrauterine growth for both milks in both studies . Protein intake was higher with PF than with HM ( 3.1 vs 2.4 gm/kg/day ) in both studies , giving a protein accretion similar to the intrauterine accretion with PF ( 2.2 gm/kg/day ) , but lower with HM . Our results suggest that the nutritional value of pooled pasteurized human milk for VLBW infants should be reconsidered , especially because of its low protein content , and that energy density of preterm formulas must be question ed in view of elevated fat deposition
target: None of the trials individually found any statistically significant difference in the incidence of NEC .
  However , meta- analysis found that feeding with donor human milk was associated with a significantly reduced relative risk ( RR ) of NEC .
background: OBJECTIVES To determine if enteral feeding with donor human milk compared with formula milk reduces the incidence of necrotising enterocolitis ( NEC ) in preterm or low birthweight infants .