Oropharyngeal Colostrum for Preterm Infants: A Systematic Review and Meta-Analysis

Abstract

Administration of oropharyngeal colostrum (OPC) is safe, feasible, and potentially beneficial in preterm infants. We aimed to assess the effects of OPC in preterm infants. A systematic review of randomized controlled trials (RCTs) and non-RCTs of OPC administration in preterm infants was conducted. We searched MEDLINE via PubMed and Ovid, EMBASE, the Cochrane Central Register of Controlled Trials, Emcare databases, abstracts of Pediatric Academic Societies meetings, and gray literature in April 2018. Six RCTs (n = 269) and 4 non-RCTs (n = 737) were included. One RCT (n = 40) focused on enteral bovine colostrum and hence was excluded from our review. Five of the 6 RCTs had unclear risk of bias in many domains of assessment. Meta-analysis (random effects model) of RCT data showed no significant difference in ≥stage 2 necrotizing enterocolitis (RR: 0.83; 95% CI: 0.39, 1.75; P = 0.62), late-onset sepsis (RR: 0.78; 95% CI: 0.50, 1.22; P = 0.28), all-cause mortality (RR: 0.74; 95% CI: 0.27, 2.06; P = 0.56); duration of hospital stay (mean difference [MD]: -1.65 d; 95% CI: -10.09, 6.80; P = 0.70), and time to full feeds (MD: -2.86 d; 95% CI: -6.49, 0.77; P = 0.12). Meta-analysis of data from non-RCTs also showed no benefit for any of these outcomes. OPC increased secretory IgA and lactoferrin concentrations (4 RCTs), and had only a transient effect on the oral microbiome (1 RCT). There were no adverse effects (e.g., aspiration) of OPC. The overall quality of evidence (Grades of Recommendation, Assessment, Development, and Evaluation analysis) was very low. Adequately powered RCTs are needed to confirm the nutritional and immunomodulatory benefits of OPC in preterm infants.

Trial registration: ClinicalTrials.gov NCT03513146.

Keywords: human colostrum; meta-analysis; oropharyngeal colostrum; preterm infants; systematic review.

Copyright © American Society for Nutrition 2019.

Figures

FIGURE 1

Flow diagram showing study selection process.

FIGURE 2

Forest plot illustrating the overall risk ratio of necrotizing enterocolitis risk in preterm infants administered oropharyngeal colostrum compared with controls in randomized controlled trials. There was no significant difference in the 2 groups. This analysis was conducted using a random effects model. M-H, Mantel–Haenszel test; OPC, oropharyngeal colostrum.

FIGURE 3

Forest plot illustrating the overall risk ratio of late-onset sepsis in preterm infants administered oropharyngeal colostrum compared with controls in randomized controlled trials. There was no significant difference in the 2 groups. This analysis was conducted using a random effects model. M-H, Mantel–Haenszel test; OPC, oropharyngeal colostrum.