Study on premature infants advances understanding of healthcare

STOCKHOLM: Infants born extremely prematurely require enrichment in addition to breast milk. But, when it comes to the danger of severe consequences in children, does it matter if the enrichment is prepared from breast milk or cow’s milk?

A big clinical investigation led by Linkoping, Sweden, has looked into this.

Infants born between weeks 22 and 27 of pregnancy are among the most vulnerable patients in the healthcare system. The possibility of major problems is extremely high.

Almost one out of every four severely preterm babies dies before reaching the age of one.

Breast milk, rather than cow’s milk formula, has been shown in studies to be superior to formula derived from cow’s milk. Cow’s milk-based formula is known to raise their risk of severe intestinal inflammation and sepsis (severe blood-borne infection).

“In Sweden, all extremely preterm infants receive breast milk from their mother or donated breast milk. Despite this, almost one in ten children get a severe inflammation of the intestine called necrotising enterocolitis. It’s one of the worst diseases you can have. At least three out of ten children die and those who survive often have neurological problems afterwards,” said Thomas Abrahamsson, professor at Linkoping University and senior physician at the neonatal department at the University Hospital in Linkoping, who led the current study.

Historically, there have been very few studies on extremely preterm infants where treatments have been compared against each other. Therefore, there is a great need for clinical studies that can provide scientific support for how these children should be treated to have better chances of survival and a good life.

In some countries, such as Sweden, infants are fed exclusively with either their mother’s breast milk or donated breast milk. However, for extremely preterm infants to grow as well as possible, they need more nutrition than breast milk contains. This is why breast milk is supplemented with extra protein, so-called enrichment.

The enrichment has previously been made from cow’s milk. However, there have been suspicions that cow’s milk-based enrichment increases the risk of severe complications.

Today, there is enrichment that is based on donated breast milk, and which has begun to be used in healthcare in some places. The big question is whether it can reduce the risk of diseases in extremely preterm infants.

The current study, called N-Forte (the Nordic study on human milk fortification in extremely preterm infants), is the largest that has been carried out to seek answers to this question. The results have been eagerly awaited by pediatricians and others caring for these fragile infants.

“We concluded that it doesn’t matter whether extremely preterm infants get enrichment made from cow’s milk or made from donated breast milk,” says Thomas Abrahamsson.

Although the study indicates that there was no difference between the two options, its results can be useful. The breast milk-based product is estimated to cost more than SEK 100,000 per child, which would be equivalent to around SEK 40 million if the product were to be used in Swedish healthcare.

“On the one hand, we’re disappointed that we didn’t find a positive effect of enrichment based on breast milk. On the other hand, it’s a large and well-done study and we can now say with great certainty that it doesn’t affect this patient group. This is also important knowledge so that we don’t invest in expensive products that don’t have the desired effect,” said Thomas Abrahamsson.