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

Lookup NU author(s): Professor Nicholas EmbletonORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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.

Publication metadata

Author(s): Ellis Z-M, Tan HSG, Embleton ND, Sangild PT, Van Elburg RM

Publication type: Article

Publication status: Published

Journal: Archives of Disease in Childhood: Fetal and Neonatal Edition

Year: 2018

Volume: 104

Issue: 3

Pages: F333-F340

Print publication date: 01/05/2019

Online publication date: 06/12/2018

Acceptance date: 05/11/2018

Date deposited: 11/01/2019

ISSN (print): 1359-2998

ISSN (electronic): 1468-2052

Publisher: BMJ Publishing Group


DOI: 10.1136/archdischild-2018-315946


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