41 Neonatal outcomes with exclusive breast milk in infants with gastroschisis: A systematic review and meta-analysis

Abstract Background Infants with gastroschisis may experience prolonged stays in hospital as they transition from parenteral nutrition to enteral feeds. Some studies suggest that patients who receive exclusive breast milk experience better outcomes than those who receive supplemental or exclusive formula. These findings are inconsistent and the evidence for exclusive breast milk remains uncertain. Objectives To systematically review and meta-analyze the effectiveness of exclusive breast milk in infants with gastroschisis. Design/Methods We searched Medline, Embase, and Cochrane without language restriction from inception until June 2023. Manual searches of trial registries and reference lists of relevant articles were also performed. We included studies that assessed the effectiveness of exclusive breast milk compared to formula among infants with gastroschisis. Title, abstract, full-text screening, and data extraction were completed by two independent reviewers. The Newcastle-Ottawa Scale was used to assess the risk of bias. Our outcomes of interest were time to full enteral feeds, days of parenteral nutrition, length of stay, necrotizing enterocolitis (NEC), cholestasis, and mortality. RevMan was used to meta-analyze treatment effects using a random effects model whenever possible. Summary statistics were reported as relative risk (RR) with 95% confidence intervals (95% CI). Results We identified 130 studies of which six were selected for review. All included studies were observational and retrospective. Only 3 studies (n=3211 participants) reported outcome data that were amenable to meta-analysis. All participants received exclusive breast milk (n=1009) or supplemental or exclusive formula (n=2202). Exposure to exclusive breast milk was associated with a lower risk of mortality compared to those who received formula (unadjusted RR=0.36; 95% CI: 0.13-0.96, 2 studies, n=3157, I2=0%). Exposure to exclusive breast milk was not associated with a decrease in NEC (unadjusted RR=0.20; 95% CI: 0.03-1.14; 3 studies, n=3211, I2=0%). The primary source of bias among included studies was lack of adjustment for confounders. We identified one randomized controlled trial comparing exclusive breast milk to formula. This study was stopped due to low recruitment. Conclusion The use of exclusive breast milk among infants with gastroschisis may be associated with a reduction in mortality; however, this estimate is based on small numbers from observational studies. Estimates may change as more data become available. Further research is needed to establish best feeding practices, including the role of human donor milk.