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Milk feed osmolality and adverse events in newborn infants and animals: a systematic review

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  • Zoë-Marie Ellis
  • Hui Shan Grace Tan
  • Nicolas D Embleton
  • Per Torp Sangild
  • Ruurd M van Elburg
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BACKGROUND: High feed osmolality (or osmolarity) is often suggested to be linked with adverse gastrointestinal events in preterm infants.

AIM: To systematically review the literature on milk feed osmolality and adverse gastrointestinal events in newborn and low birthweight infants and animals.

METHODS: MEDLINE, Embase, CAB Abstracts, Current Contents, BIOSIS Previews and SciSearch were searched from inception to May 2018 to identify potentially relevant studies.

INCLUSION CRITERIA: randomised controlled or observational studies of newborn and low birthweight infants or animals investigating the effects of milk-based feeds with different osmolalities. Only full-text, English-language papers were included.

RESULTS: Ten human and six animal studies met the inclusion criteria. Of human studies, seven reported no differences in adverse events with varying feed osmolalities; one reported delayed gastric emptying with feed osmolarity of 539 mOsm/L compared with lower levels; one reported higher necrotising enterocolitis (NEC) incidence with feed osmolarity of 650 mOsm/L compared with 359 mOsm/L; one found higher NEC incidence with the lowest feed osmolality (326 mOsm/kg compared with 385 mOsm/kg). Of animal studies, two reported delayed gastric emptying with feed osmolarity >624 mOsm/L, one reported decreased survival due to dehydration with dietary osmolarities ≥765 mOsmol/L and none reported increased NEC incidence with differing feed osmolalities. No clear mechanisms were found, and diet composition differences limited the interpretations regarding the independent impact of osmolality.

CONCLUSIONS: There is no consistent evidence that differences in feed osmolality in the range 300-500 mOsm/kg are associated with adverse gastrointestinal symptoms in neonates.

Original languageEnglish
JournalArchives of Disease in Childhood. Fetal and Neonatal Edition
Volume104
Issue number3
Pages (from-to)F333-F340
ISSN1359-2998
DOIs
Publication statusPublished - May 2019

    Research areas

  • Animals, Animals, Newborn, Enterocolitis, Necrotizing/etiology, Gastric Emptying, Gastrointestinal Diseases/etiology, Humans, Infant Formula/adverse effects, Infant, Low Birth Weight, Infant, Newborn, Milk/adverse effects, Milk, Human/chemistry, Osmolar Concentration

ID: 59422223