Oropharyngeal Colostrum Administration for the Prevention of Necrotising Enterocolitis in Preterm Infants: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Abstract

Background: Necrotising enterocolitis is a major gastrointestinal emergency of prematurity. Oropharyngeal colostrum may provide mucosal immune protection when enteral feeding is delayed, but its clinical effect remains uncertain.

Objective: To determine whether oropharyngeal colostrum reduces necrotising enterocolitis at Bell stage 2 or above and whether the effect varies by administration regimen.

Methods: PubMed/MEDLINE, Europe PMC, CENTRAL, and ClinicalTrials.gov were searched through September 9 2026, with citation searching, for randomised trials in infants born before 37 weeks. Two reviewers independently screened records, extracted data, and assessed risk of bias using RoB 2. Random-effects models with Hartung–Knapp intervals were used.

Results: Nineteen trials were included; fifteen trials involving 1,541 infants entered the primary analysis. Colostrum reduced necrotising enterocolitis (36/786 vs 73/755; risk ratio 0.50, 95% confidence interval 0.33–0.76; p=0.003; I²=0.0%), with a number needed to treat of 21 (15–43). Late-onset sepsis, mortality, and ventilator-associated pneumonia were also reduced. Estimates did not differ significantly between administration protocols, and no intervention-related adverse events were reported.

Conclusion: Oropharyngeal colostrum approximately halved necrotising enterocolitis without evidence of harm. Its low cost and feasibility support use in preterm infants who cannot yet be fed enterally, while adequately powered trials define the optimal regimen.