An interesting and well-written article in nature (or, at least, a supplement called “nature outlook”) by a scientific journalist Sarah DeWeerdt has appeared, discussing the acquisition of the intestinal microbiome by newborn infants. She discusses premature infants and the role of the microbiome in necrotising enterocolitis, and, as well as me, she also quotes Nick Embelton and Mark Underwood, so I am in good company!

She notes that breast milk decreases the incidence of NEC compared to formula; which brings me to this analysis of data from the Domino trial Trang S, et al. Cost-Effectiveness of Supplemental Donor Milk Versus Formula for Very Low Birth Weight Infants. Pediatrics. 2018.

You may remember that this was a trial in VLBW preterm babies that randomized the infants to receive either banked human breast milk or preterm formula when mother’s milk was not available. The primary outcome was cognitive scores on Bayley3 testing at 18 months. Hidden away near the end of the results section of that article was the finding that NEC occurred in 6.6% of formula supplemented babies and 1.7% of donor milk babies, a finding not likely due to chance (p=0.02). This is among the best data available, in the era of modern neonatology, that confirms this benefit of breast milk banking for preterm infants.

The new article is a cost analysis which, of course, depends very much on how costly a case of NEC really is. Donor human milk, with all the standards that are now imposed, is quite expensive; this study asked, from a cost point of view, does using donor human milk, rather than formula (which is pretty cheap) lead to cost savings or increased costs? The answer is that overall, depending on how you cost various factors, human milk banking is probably cost-effective.  Costs under most scenarios were relatively neutral, which, in one reasonable interpretation of these data, means that preventing NEC by providing donor breast milk, is free!