Human Milk Use in the Preoperative Period Is Associated with a Lower Risk for Necrotizing Enterocolitis in Neonates with Complex Congenital Heart Disease

J Pediatr. 2019 Dec;215:11-16.e2. doi: 10.1016/j.jpeds.2019.08.009. Epub 2019 Sep 24.


Objective: To evaluate the hypothesis that feeding volumes exceeding 100 mL/kg/d and exposure to cow's milk formula preoperatively increase the risk for preoperative necrotizing enterocolitis (NEC) in infants with complex congenital heart disease.

Study design: All infants, of any gestational age, with an isolated cardiac lesion at high risk for NEC (ductal-dependent lesions, transposition of the great arteries, truncus arteriosus, and aorto-pulmonary window) admitted to Texas Children's Hospital from 2010 to 2016 were included. NEC was defined based on the modified Bell criteria. Feeding regimen information and relevant covariates were collected. Logistic regression was used to evaluate the association of feeding regimen and other potential risk factors with NEC.

Results: In this single-center, retrospective cohort of 546 infants, 3.3% developed Bell stage I-III NEC preoperatively. An exclusive unfortified human milk diet was associated with a significantly lower risk of preoperative NEC (OR 0.17, 95% CI 0.04-0.84, P = .03) in a multivariable regression model controlling for cardiac lesion, race, feeding volume, birth weight small for gestational age, inotrope use presurgery/pre-NEC, and prematurity. Feeding volumes exceeding 100 mL/kg/d were associated with a significantly greater risk of preoperative NEC (OR 3.05, 95% CI 1.19-7.90, P = .02).

Conclusions: The findings suggest that an unfortified exclusive human milk diet may reduce the risk of preoperative NEC in infants with complex congenital heart disease.

Keywords: cohort study; ductal dependent cardiac lesions.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiac Surgical Procedures*
  • Enterocolitis, Necrotizing / epidemiology*
  • Enterocolitis, Necrotizing / etiology
  • Female
  • Follow-Up Studies
  • Gestational Age
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / surgery*
  • Humans
  • Incidence
  • Infant, Newborn
  • Infant, Very Low Birth Weight
  • Male
  • Milk, Human*
  • Preoperative Period
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Texas / epidemiology