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Formula feeding results in better growth and weight gain compared to donor breast milk in preterm and low birthweight infants, with a greater risk in necrotising enterocolitis

Design: Systematic review and meta-analysis of 12 studies using multiple electronic data sources including Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, OVID maternity and infant care database and cumulative index to Nursing and Allied Health Literature as well as Clinicaltrials.gov and WHO’s international trials registry and platform. Randomised or quasi-randomised controlled trials were included.

Patients: Infants born before 37 weeks gestation or with a birth weight of less than 2500 g. A total of 1879 infants in 12 separate trials (six randomised, six quasi-randomised) were included

Intervention: Enteral feeding with formula versus donor breast milk as the sole diet or supplementary to maternal breast milk

Outcome measures: Growth, neurodevelopment, all-cause mortality, necrotising enterocolitis and invasive infections

Follow-up: Variable; majority of studies used data until discharge from hospital, of the four studies that had longer-term outcome data, follow-up ranged from 15 months corrected age to 7.5–8 years.

Formula-fed infants had a significantly higher rate of weight gain with subgroup analysis showing the greatest difference in infants receiving preterm …