SynthesisFrontiers in nutrition2026
Exclusive human milk diet and mortality before discharge in premature and very low birthweight infants: a systematic review and meta-analysis.
Synthesis in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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3 authors.
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Abstract
Background: Survival to hospital discharge remains a critical outcome for premature and very low birthweight infants (VLBW), who often require fortification of human milk to meet nutritional needs within tolerated feeding volumes. Although exclusive human milk diets (EHMD) that include human milk-derived fortifiers have been proposed as an alternative to cow milk-derived fortification or formula supplementation, evidence for their association with improved survival remains inconsistent across studies. Objective: To evaluate the association between an EHMD and survival to hospital discharge among premature and low birthweight infants, synthesizing evidence from randomized and non-randomized studies. Methods: PubMed, Scopus, and Web of Science were searched through July 2025 for studies comparing an EHMD (human milk fortified with human milk-derived fortifier) with diets containing cow milk-derived products. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Pooled odds ratios (OR) were calculated using random-effects meta-analysis, with subgroup analyses by study design. Results: Five randomized and 9 non-randomized studies were included, encompassing 4,713 infants born between 2004 and 2021. Mean birthweights ranged from 741 to 1,361 g, and mean gestational ages ranged from 25.5 to 29.7 weeks. In pooled analyses, EHMD was associated with lower odds of death before discharge (pooled OR 0.80, 95% CI 0.65-0.98; Conclusion: EHMD was associated with lower odds of death before discharge in pooled analyses. Although no significant differences emerged in the subgroup analyses, the consistency in effect direction across study designs supports the possibility of a clinically meaningful association. Adequately powered randomized and pragmatic trials are needed to confirm this association. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251059764, PROSPERO: CRD420251059764.
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