Donor human milk impact on necrotizing enterocolitis surgical procedures in hospital of Lithuanian university of health sciences

Abstract

Introduction Necrotizing enterocolitis (NEC) is a life-threatening illness and one of the most severe diseases of premature newborns. NEC has a mortality rate as high as 50% (1). Existing data suggest neonatal diet is a very important modifiable factor (2). Providing infants with breast milk has been the main way of nutritional therapy in NEC prevention and also shows positive outcomes for infants following surgery in stage III NEC(3). The disease is 6-10 times more common in exclusively formula-fed infants than in those fed only breast milk (4). A donor human milk bank (DHMB) was opened in Lithuanian University of Health Sciences (LUHS) Hospital, in December 2016 (5). Aim The aim of the study was to determine the impact of donor human milk on prevalence, features and surgical needs of necrotizing enterocolitis. Methods We performed a retrospective study of 135 patients’ data. Patients were treated in LUHS Hospital Neonatal intensive care unit in 2010-2021 yrs. Inclusion criteria: 1) gestational age (GA)≤32 weeks 2) diagnosis of NEC 3) no congenital anomalies of the digestive tract. Patients were divided into two groups - control group (n=73) – treated before DHM was available (2010 – 2016yrs.), intervention group (n=62) – after DHM became available (2017-2021 yrs.). Groups were compared considering stages and outcomes of disease, surgical needs, duration of parenteral feeding, and need of erythrocyte mass transfusions. Statistical analysis was performed using IBM SPSS Statistics 27.0. Results were considered significant where p<0,05. Results Patients diagnosed with NEC (n=73) composed 7,52% of all patients (n=971) ≤32 weeks GA before DHM was available and 6,51% (n=62) of all patients (n=843) after DHM became available. . We found 85,7% (n=18) of NEC-related deaths in the control group, respectively –60,86% (n=14) in the intervention group. The difference was not significant. NEC stages varied among groups, however, there was no significant difference. Average number of NEC-related surgical procedures (0,93±1,17 vs 0,52±0,80) was significantly lower in the intervention group (p=0.020). Duration of parenteral feeding (8,00±9,45 vs 8,29±5,35) and number of erythrocyte mass transfusions (3,60±3,38 vs 3,11±3,40) did not differ significantly among groups. Conclusions According to the statistics, the number of NEC-related surgical procedures was significantly lower once DHM became available. NEC prevalence and stages did not differ significantly among groups, as well as NEC-related deaths. Also, there were no significant differences in erythrocyte mass transfusion numbers and duration of parenteral feeding.