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Commercial preterm formulas with glucose polymers and reduced lactose show higher necrotizing enterocolitis rates than breast milkCommercial preterm formulas carry higher NEC risk than breast milk

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Key Takeaway
Note higher necrotizing enterocolitis rates with commercial preterm formulas versus breast milk.

This comprehensive review evaluates the relationship between commercial preterm formulas containing glucose polymers and reduced lactose content versus breast milk in preterm infants. The primary focus is the risk of developing necrotizing enterocolitis. The analysis indicates that higher rates of necrotizing enterocolitis occur with preterm formulas compared to breast milk. Specific effect sizes or absolute numbers were not reported in the source material. The review does not provide data on adverse events or tolerability. The authors note that the mechanisms by which preterm formulas increase the risk of necrotizing enterocolitis have not been fully elucidated. Funding sources and potential conflicts of interest were not reported. The review addresses the causal relationship between these formulas and necrotizing enterocolitis while cautioning against overstating the pathogenic agent. The authors suggest a complementary research agenda to identify additional protective elements of breast milk and additional nocive elements of preterm formulas. This information is relevant for clinicians managing nutrition in the neonatal intensive care setting.

Preterm infants are incredibly vulnerable. They need the right nutrition to grow and heal. A comprehensive review looks at how different feeding choices affect their risk of a dangerous gut infection called necrotizing enterocolitis. This condition can be life-threatening for babies born too early. The study compared breast milk against commercial preterm formulas that contain glucose polymers and less lactose. The results were clear. Babies fed these specific formulas faced a higher risk of developing necrotizing enterocolitis than those fed breast milk.

The review did not report specific numbers or exact timing for these risks. It also did not find any reported safety signals like serious side effects or reasons to stop the formulas. However, the science behind why these formulas increase the risk is not fully understood yet. Researchers have not completely explained the mechanisms causing this problem.

This finding matters for parents and doctors. It suggests we need more research to find protective elements in breast milk and harmful elements in these formulas. The review calls for a new research agenda to protect these fragile patients. We must understand exactly what makes breast milk so special and what makes these formulas risky.

What this means for you:
Commercial preterm formulas with glucose polymers and reduced lactose show higher NEC risk than breast milk.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
After more than 70 years of research, necrotizing enterocolitis (NEC) remains the most serious gastrointestinal disease among preterm infants and a leading cause of mortality, morbidity, and disability. Although causes of NEC are multifactorial, this contribution reviews the causal relationship between commercial preterm formulas (PTF) and NEC. The responses of the immature preterm intestine to PTF and the relationship to NEC have been extensively investigated using animal models and in human studies, but the mechanisms by which PTF increases the risk of NEC have not been fully elucidated. Two categories of risk factors may contribute to the higher rates of NEC with PTF compared to breast milk: (1) protective elements in breast milk are missing from PTF and (2) specific ingredients of PTF increase NEC risk. Our comprehensive review of animal studies and clinical trials highlights at least one substance in each category. The principle carbohydrate in breast milk is non-nocive lactose; in PTF, 50%–60% of the lactose is replaced by glucose polymers, which are not present in breast milk, and represent a pathogenic agent. We advocate a complementary research agenda to identify additional protective elements of breast milk (besides lactose) that could be added to PTF and additional nocive elements of PTF (besides glucose polymers) that could be removed to reduce the risk of NEC.
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