Effects of oropharyngeal colostrum and minimal enteral nutrition on respiratory morbidity and necrotizing enterocolitis in preterm infants: A systematic review of randomized trials

Maryam  Zarafrooz; Jamalodin  Begjani

doi:10.18502/npt.v13i2.21465

Maryam Zarafrooz Department of Pediatric Nursing and Neonatal Intensive Care Unit, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Jamalodin Begjani Department of Pediatric Nursing and Neonatal Intensive Care Unit, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/npt.v13i2.21465

Keywords: necrotizing enterocolitis; colostrum; premature birth; early feeding; enteral feeding; neonatal nutrition

Abstract

Background & Aim: Necrotizing enterocolitis is one of the most severe gastrointestinal complications in premature infants, characterized by acute intestinal inflammation and progressive mucosal damage. This systematic review aimed to evaluate the effects of minimal enteral nutrition and oropharyngeal or buccal colostrum administration on respiratory morbidity and the incidence of necrotizing enterocolitis in preterm neonates.

Materials & Methods: A comprehensive search was conducted using PubMed, Web of Science, Scopus, ProQuest, and Google Scholar databases. From 10,460 identified records, twelve randomized controlled trials published between 2015 and 2024 met inclusion criteria and were incorporated into the qualitative synthesis. Data were extracted regarding early growth, feeding tolerance, immune biomarkers, and safety outcomes.

Results: Minimal enteral nutrition was associated with improved early growth and reduced feeding intolerance. Oropharyngeal or buccal exposure to colostrum increased mucosal immune biomarkers, including immunoglobulin A, immunoglobulin M, and lactoferrin, and promoted early colonization of beneficial intestinal microorganisms. Some trials reported reductions in late‑onset sepsis and retinopathy of prematurity. However, neither minimal enteral nutrition nor colostrum‑based interventions significantly reduced the incidence of necrotizing enterocolitis (p > 0.05). Both approaches showed favorable safety profiles without increased adverse effects or clinical instability.

Conclusion: Minimal enteral nutrition and oropharyngeal or buccal colostrum administration appear to be safe, feasible, and biologically plausible strategies for enhancing early nutrition and mucosal immunity in premature infants. Larger, multicenter, and standardized clinical trials are warranted to determine their definitive impact on necrotizing enterocolitis prevention.