{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:14:30Z","timestamp":1790615670169,"version":"4.1.0"},"reference-count":40,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>High feed osmolality (or osmolarity) is often suggested to be linked with adverse gastrointestinal events in preterm infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To systematically review the literature on milk feed osmolality and adverse gastrointestinal events in newborn and low birthweight infants and animals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 &gt;624\u2009mOsm\/L, one reported decreased survival due to dehydration with dietary osmolarities \u2265765\u2009mOsmol\/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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is no consistent evidence that differences in feed osmolality in the range 300\u2013500 mOsm\/kg are associated with adverse gastrointestinal symptoms in neonates.<\/jats:p><\/jats:sec>","DOI":"10.1136\/archdischild-2018-315946","type":"journal-article","created":{"date-parts":[[2018,12,6]],"date-time":"2018-12-06T22:20:14Z","timestamp":1544134814000},"page":"F333-F340","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":56,"title":["Milk feed osmolality and adverse events in newborn infants and animals: a systematic review"],"prefix":"10.1136","volume":"104","author":[{"given":"Zo\u00eb-Marie","family":"Ellis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui Shan Grace","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas D","family":"Embleton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per Torp","family":"Sangild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruurd M","family":"van Elburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,12,6]]},"reference":[{"key":"2020050721234184000_104.3.F333.1","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1001\/jamapediatrics.2017.5323","article-title":"Cognitive outcomes of children born extremely or very preterm since the 1990s and associated risk factors: a meta-analysis and meta-regression","volume":"172","author":"Twilhaar","year":"2018","journal-title":"JAMA Pediatr"},{"key":"2020050721234184000_104.3.F333.2","doi-asserted-by":"publisher","DOI":"10.1111\/apa.13128"},{"key":"2020050721234184000_104.3.F333.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2013.04.052"},{"key":"2020050721234184000_104.3.F333.4","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1159\/000454667","article-title":"Medications that increase osmolality and compromise the safety of enteral feeding in preterm infants","volume":"111","author":"Chandran","year":"2017","journal-title":"Neonatology"},{"key":"2020050721234184000_104.3.F333.5","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2003.037192"},{"key":"2020050721234184000_104.3.F333.6","doi-asserted-by":"crossref","unstructured":"Waitzberg DL , Torrinhas RS . 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