Mother's milk preferred for premature infants, but infant formulas 'critically important,' federal agencies say

FDA, CDC, NIH: Mother's milk preferred, but preterm infant formulas 'critically important' | Image Credit: © ondrooo - © ondrooo - stock.adobe.com.

The FDA, Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH) have released a consensus statement regarding premature infant nutrition and necrotizing enterocolitis (NEC).¹

The consensus in part reads, "while there is a preference for human milk, all infants should be fed as soon as is medically feasible through whatever appropriate nutritious food source is available."¹

According to the statement, NEC is a condition that results in the tissue lining the intestine to become inflamed and die, leading to life-threatening infection. NEC is a leading cause of illness and death among preterm infants, especially those born at a very low birth weight.¹

Estimates reveal that 1 baby dies every day in the United States from NEC, while those who survive could undergo "traumatic" surgeries, be neurodevelopmentally impaired, and have lifelong consequences, according to the statement.¹

The statement comes after the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) convened a “Necrotizing Enterocolitis in Preterm Infants Working Group” of the National Advisory Council of Child Health and Human Development (NACHHD), an existing Federal Advisory Committee. This was at the request of the US Secretary of the Department of Health and Human Services.^2.

As infant nutrition is critically important for brain and organ development, "There has been ongoing public discussion about the current state of science and research gaps regarding NEC, particularly as it relates to preterm infant formulas," the consensus statement reads.¹

Per the advisory council, the relationship between feeding and NEC development is unclear, and that available evidence supports the hypothesis that it is the absence of any human milk in an infant's diet that is associated with higher risk of NEC.²

Evidence also supports that human milk significantly reduces, but does not eliminate, the risk of NEC and that it is unclear why NEC does occur in infants who are exclusively fed human milk diets. Further, the statement reads that available evidence suggests it is the absense of human milk that is associated with increased risk of NEC, rather than the exposure to premature infant formula itself.¹

The collective federal agencies acknowledged that while mother's milk is the preferred source of nutrition, with pasteurized donor human milk as the next best option, preterm infant formulas are a crucial option for premature infants.¹

"For infants where the supply of human milk is insufficient, these formulas are part of the standard of care for premature infants," wrote the authors of the consensus statement.¹

The entities listed a pair of key points related to feeding practices and NEC¹:

• There is no conclusive evidence that preterm infant formula causes NEC
• There is strong evidence that human milk is protective against NEC

"Evidence to date suggests that preterm birth is the primary risk factor for developing NEC, but important scientific gaps exist for understanding the epidemiology of NEC, biologic mechanisms of NEC and the exposures and feeding practices that may be positively or negatively associated with the risk of NEC development, severity and mortality," stated the agencies in the consensus statement.¹

References:

1. FDA, CDC, NIH consensus statement on recent Advisory Council report on premature infants and necrotizing enterocolitis. US Department of Health and Human Services. October 9, 2024. Accessed October 9, 2024. https://www.hhs.gov/about/news/2024/10/03/fda-cdc-nih-consensus-statement-recent-advisory-council-report-premature-infants-necrotizing-enterocolitis.html?utm_medium=email&utm_source=govdelivery

2. Necrotizing Enterocolitis (NEC) in Preterm Infants Working Group of the National Advisory Council of Child Health and Human Development (NACHHD). National Institute of Child Health and Human Development. September 16, 2024. Accessed October 9, 2024.