Written by Jasmeet Kataria-Hale, MD and Amy Hair, MD
Necrotizing enterocolitis (NEC) is a devastating intestinal disease that primarily affects babies born prematurely or with a medical condition. NEC is likely caused by many factors, with the lack of blood flow to the intestine possibly playing a key role. Babies with certain medical conditions, such as complex congenital heart disease (CHD), are at a higher risk of developing NEC, even when they are born at term. Changes in blood flow from the heart disease may compromise blood flow to the intestine and potentially lead to necrotizing enterocolitis. Human milk protects against NEC in premature babies, but more research is needed to fully understand the effects of human milk on term babies with CHD.
Researchers at Texas Children’s Hospital retrospectively studied babies with CHD who needed heart surgery after birth and before discharge. The team hypothesized that feeding these babies cow’s milk formula before their heart surgery would increase their risk of NEC. A total of 546 infants were included in the study.
The results of the study suggest that an exclusive unfortified human milk diet is associated with a significantly lower risk of NEC before heart surgery. The researchers controlled for cardiac lesion, race, feeding volume, birth weight small for gestational age, inotrope use pre-surgery/pre-NEC, and prematurity. Higher feeding volumes (exceeding 100 mL/kg/day), regardless of what or how the baby was fed, were associated with a significantly greater risk of NEC.
The protective effects of human milk for CHD babies may be similar to that for premature babies at increased of NEC, owing to its beneficial components. This study did not look at how feeding human milk prior to heart surgery could influence the development of NEC after the infant’s heart surgery, an important outcome that must be considered. It would also be interesting to determine the effect of human milk on other important outcomes such as days to reach full feeding after heart surgery and length of hospital stay.
While more research on human milk, CHD, and NEC is critically needed, this work suggests that CHD babies benefit from human milk and that human milk protects these vulnerable infants from devastating outcomes like necrotizing enterocolitis.