Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants

A Corrigendum to this article was published on 22 November 2007



Necrotizing enterocolitis (NEC) is a frequent cause of mortality and morbidity in very low birth weight (VLBW) infants. Human milk (HM) feeding has been associated with lower risk of NEC. However, mothers of VLBW infants often experience insufficient milk production, resulting in mixed feedings of HM and formula. Moreover, medical complications often limit the volume of feeding they can be given.


To determine if high proportions of (50% or greater) HM enteral feeding within the first 14 days of life are protective against NEC.


This was a prospective cohort study of VLBW infants who were grouped according to the HM proportion of enteral feeding in the first 14 days: <50% (low human milk, LHM, n=46) and 50% (high human milk, HHM, n=156). The outcome of interest was development of NEC (Bell stage 2 or 3). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) and to assess potential confounding due to perinatal risk factors.


Two hundred and two infants were studied. Confirmed NEC occurred in 5/46 (10.6%) of the LHM group, as compared with 5/156 (3.2%) of the HHM. Gestational age was the only perinatal factor associated with risk of NEC. After adjustment for gestational age, HHM was associated with a lower risk of NEC ((OR=0.17, 95% CI: 0.04 to 0.68), P=0.01).


Enteral feeding containing at least 50% HM in the first 14 days of life was associated with a sixfold decrease in the odds of NEC.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others


  1. Llanos A, Moss M, Pinzon M, Dye T, Sinkin R, Kendeg J . Epidemiology of neonatal necrotizing enterocolitis: a population based study. Paediatri Perinat Epidemiol 2002; 16: 342.

    Article  Google Scholar 

  2. Fanaroff A, Hack M, Walsh M . The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol 2003; 27: 281–287.

    Article  Google Scholar 

  3. Lemons J, Bauer C, Korones S, Papile L, Stoll B, Verter J et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics 2001; 107: E1.

    Article  CAS  Google Scholar 

  4. Luig M, Lui K . Epidemiology of necrotizing enterocolitis – Part 1: changing regional trends in extremely premature infants over 14 years. J Paediatr Child Health 2005; 41: 169–173.

    Article  Google Scholar 

  5. Guthrie S, Gordon P, Thomas V, Thorp J, Peabody J, Clark R . Necrotizing enterocolitis among neonates in the United States. J Perinatol 2003; 23: 278–285.

    Article  Google Scholar 

  6. Lin P, Stoll B . Necrotizing enterocolitis. Lancet 2006; 368: 1271–1283.

    Article  Google Scholar 

  7. Salhab W, Perlman J, Silver L, Broyles R . Necrotizing enterocolitis and neurodevelopmental outcome in extremely low birth weight infants. J Perinatol 2004; 24: 534–540.

    Article  Google Scholar 

  8. Ladd A, Rescorla F, West K, Scherer IL, Engum S, Grosfeld J . Long-term follow-up after resection for necrotizing enterocolitis: factors affecting outcome. J Pediatr Surg 1998; 33: 967–972.

    Article  CAS  Google Scholar 

  9. Walsh M, Kleigman R, Hack M . Severity of necrotizing enterocolitis: influence on outcome at 2 years of age. Pediatrics 1989; 84: 808–814.

    CAS  Google Scholar 

  10. Vohr BR, Wright L, Dusick A . Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Developmental Neonatal Research Network, 1993–1994. Pediatrics 2000; 105: 1216–1226.

    Article  CAS  Google Scholar 

  11. Sonntag J, Grimmer I, Scholz T, Metze B, Wit J, Obladen M . Growth and neurodevelopmental outcome of very low birth weight infants with necrotizing enterocolitis. Acta Paediatr 2000; 89: 528–532.

    Article  CAS  Google Scholar 

  12. Claud E, Walker W . Hypothesis: inappropriate colonization of the premature intestine can cause neonatal necrotizing enterocolitis. FASEB J 2001; 15: 1398–1403.

    Article  CAS  Google Scholar 

  13. Lucas A, Cole T . Breast milk and neonatal necrotising enterocolitis. Lancet 1990; 336: 1519–1523.

    Article  CAS  Google Scholar 

  14. Schanler R, Shulman R, Lau C . Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 1999; 103: 1150–1157.

    Article  CAS  Google Scholar 

  15. Schanler R, Lau C, Hurst N, O'Brian Smith E . Randomized trial of donor human milk versus preterm formula as substitutes for mothers' own milk in the feeding of extremely premature infants. Pediatrics 2005; 116: 400–406.

    Article  Google Scholar 

  16. McGuire W, Anthony M . Donor human milk versus formula for preventing necrotising enterocolitis in preterm infants: systematic review. Arch Dis Child Fetal Neonatal Ed 2003; 88: F11–F14.

    Article  CAS  Google Scholar 

  17. Lefebvre F, Ducharme M . Incidence and duration of lactation and lactational performance among mothers of lowbirth and term infants. CMAJ 1989; 140: 1159–1164.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Kennedy K, Tyson J . Early versus delayed initiation of progressive enteral feedings for parenterally fed low birth weight or preterm infants. Cochrane Database Syst Rev 2000; 2: CD001970.

    Google Scholar 

  19. Sisk P, Lovelady C, Dillard R, Gruber K . Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics 2006; 117: E67–E75.

    Article  Google Scholar 

  20. Arnold LD . Recommendations for Collection, Storage, and Handling of a Mother's Milk for Her Own Infant in the Hospital Setting, 3rd edn. The Human Milk Banking Association of North America Inc.: Denver, CO, 1999.

    Google Scholar 

  21. Bell M, Ternberg J, Feignin R . Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1–7.

    Article  CAS  Google Scholar 

  22. Boyd C, Quigley M, Brocklehurst P . Donor breast milk versus infant formula for preterm infants: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. (Online 5 April) 2006.

  23. Ronnestad A, Abrahamsen T, Medbo S, Reigstad H, Lossius K, Kaaresen P et al. Late-onset septicemia in a Norwegian National Cohort of extremely premature infants receiving very early full human milk feeding. Pediatrics 2005; 115: E269–E276.

    Article  Google Scholar 

  24. Furman L, Taylor G, Minich N, Hack M . The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med 2003; 157: 66–71.

    Article  Google Scholar 

  25. Hanson L, Korotokova M . The role of breastfeeding in prevention against neonatal infection. Semin Neonatol 2002; 7: 275–281.

    Article  Google Scholar 

  26. Xanthou M . Immune protection of human milk. Biol Neonate 1998; 74: 121–133.

    Article  CAS  Google Scholar 

  27. Nanthakumar N, Fusunyan R, Sanderson I, Walker A . Inflammation in the developing human intestine: a possible pathophysiologic contribution to necrotizing enterocolitis. Proc Natl Acad Sci USA 2000; 97: 6043–6048.

    Article  CAS  Google Scholar 

  28. Martin R, Langa S, Reviriego C, Jiminez E, Marin M, Xaus J et al. Human milk is a source of lactic acid bacteria for the infant gut. J Pediatr 2003; 143: 754–758.

    Article  CAS  Google Scholar 

  29. Martin R, Olivares M, Marin M, Fernandez L, Xaus J, Rodriquez J . Probiotic potential of 3 lactobacilli strains isolated from breast milk. J Hum Lact 2005; 21: 8–17.

    Article  Google Scholar 

  30. Lonnerdal B . Nutritional and physiological significance of human milk proteins. Am J Clin Nutr 2003; 77: 1537S–1543S.

    Article  Google Scholar 

  31. Bisquera J, Cooper T, Berseth CL . Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics 2002; 109: 423–428.

    Article  Google Scholar 

  32. Meier PP, Engstrom JM, Mingolelli SS, Miracle DJ, Keisling S . The Rush Mothers' Milk Club: breastfeeding interventions for mothers with very low birth weight infants. J Obstet Gynecol Neonatal Nurs 2004; 33: 164–174.

    Article  Google Scholar 

Download references


We thank the mothers and infants who participated in the study. We also thank Mary Showalter, IBCLC, for recruitment and lactation counseling, and the research assistants from the Department of Nutrition, University of North Carolina at Greensboro for data collection. This study was supported by International Lactation Consultant's Association, University of North Carolina at Greensboro, Wake Forest University School of Medicine.

Author information

Authors and Affiliations


Corresponding author

Correspondence to P M Sisk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sisk, P., Lovelady, C., Dillard, R. et al. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol 27, 428–433 (2007).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


This article is cited by


Quick links