Human milk is perhaps the single most under-rated strategy to prevent bronchopulmonary dysplasia
Verd & Ginovart, archdischild-2018
Poets and Lorenz have published a thorough review on strategies (Arch Dis Child Fetal Neonatal Ed 2018) likely to reduce bronchopulmonary dysplasia (BPD). They present an overview of the effectiveness and safety of interventions backed by randomised controlled trials (RCT) and aimed at preventing BPD. Their study concludes with nine recommendations for effective BPD prevention. The authors do not include breast feeding among the recommended interventions to prevent BPD. In addition to the research on breast feeding that is discussed by Poets and Lorenz, there are other observational studies that have addressed this topic. First, Dicky et al (Acta Paediatr2017) have analysed a sample of 926 very preterm infants, there was a reduced risk of BPD in the fresh mother’s milk group compared with the pasteurised mother’s milk group (OR 0.392; 95% CI 0.277 to 0.556). In a multicentre cohort study, 1587 very preterm infants who received a bovine-based diet (BOV) were compared with infants who received a newly introduced exclusive human milk feeding protocol (HUM). The HUM group had significantly lower incidence of BPD (OR 0.846; 95% CI 0.769 to 0.931) compared with the BOV group. As expected, no adverse effects were reported in association with these interventions. Conversely, Poets and Lorenz list a number of interventions that must be taken with caution, most of them await confirmation before they can be recommended. Some of them do not achieve very high efficiency, it is the case of nasal continuous positive airway pressure, several meta-analyses report a 17%–28% reduction in BPD on NCPAP but an Australian follow-up shows that BPD increases from 46% to 56% on NCPAP. Other interventions are linked to significant adverse effects, this is the case of postnatal Corticosteroids.
At a pioneer study by Schanler et al (Pediatrics, 2005), there was a significant difference in the incidence of BPD between group donor milk and group preterm formula (RR 1.1697; 95% CI 1.002 to 1.365). It was an RCT, <30 weeks of gestation neonates whose mothers intended to breast feed were assigned randomly to receive either donor milk or formula if the supply of their own mother’s milk became insufficient.
To summarise, previous research has determined that breastfeeding policies are an important part of an effective BPD prevention strategy.