Study Finds Black Preemie Infants More Likely to Experience NEC Injuries

Researchers said the spread of the use of human donor milk, as opposed to infant formula, may be bringing NEC infant death rates down.

The findings of a new study suggests that African-American infants born prematurely are more likely to experience a necrotizing enterocolitis (NEC) injury than white children, raising concerns about disparities in healthcare practices and a lack of access to human donor milk in certain communities, which may increase the incidence of black preemie infants developing the disease from infant formula.

Necrotizing enterocolitis is a devastating disease that mostly impacts preterm infants, where the wall of the intestine is invaded by bacteria, leading to destruction of the bowel and often requiring emergency surgery while the baby is still in the NICU. This can leave the infant with severe and life-changing injuries, as well as a substantial risk of premature death.

Over the past few decades, a number of studies have established that cow’s milk formula like Similac and Enfamil cause NEC at at substantially higher rates than is seen among premature babies fed breast milk or donor milk alone, and a number of families are now pursuing NEC lawsuits against the manufacturers of these products, alleging that inadequate warnings and information have been provided for decades about the risk among pre-term babies.

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Premature infants fed Similac or Enfamil cow's milk formula faced increased risk of necrotizing enterocolitis (NEC) or wrongful death.


In this latest study, researchers from Emory University’s School of Medicine and Children’s Healthcare, looked at NEC-related infant mortality rates (NEC-IMR) from 1999 to 2020, finding that rates varied widely throughout the years, but Black infants were always significantly more like to suffer NEC, and die from it. However, they saw improvements in recent years, and questioned whether it was the result of more widespread availability of human donor milk.

The researchers indicated past attempts to examine NEC rates, particularly by race, have suffered due to a lack of data. Some past studies indicated NEC rates have increased from 2000 to 2011, while another reported declining rates between 2006 and 2017.

In a report published earlier this month in the medical journal JAMA Network Open, researchers outlined the findings of an examination of the Centers for Disease Control and Prevention and National Center for Health Statistics’ 2020 data. They looked for infant deaths where the underlying cause was determined to be NEC.

Researchers indicate there were 16.1 NEC infant deaths per 100,000 live births among Black infants in 2020, compared to only 6.4 per 100,000 among White infants. The overall NEC-IMR for all U.S. infants hit a peak in 2005 of 13.2 infant deaths per 100,000 live births, then declined to 8.3 by 2020. However, researchers reported the disparity between Black infant NEC deaths and those of White infants declined over the course of the study. In 1999, Black infants were more than four times more likely to die from NEC than White infants. However, by 2020 that ratio had dropped to 2.5.

The researchers said the overall disparities mirrored data on overall infant mortality rates, but they expressed the possibility of a connection between the infant deaths and access to donor human milk.

“Further studies are warranted to examine factors mediating these changes, including the role of increasing donor milk use,” the researchers noted. “These data may support clinicians, patients, families, and policy makers in understanding national trends in NEC to inform research, care practices, and policies.”

NEC Lawsuits Allege Infant Formula Manufacturers Suppressed Access to Donor Milk

According to allegations raised in a number of Similac NEC lawsuits and Enfamil NEC lawsuits, manufacturers of cow’s milk infant formula have engaged in a widespread marketing scheme that has promoted use of their products among premature infants, and reduced breastfeedings, as well as access to human donor milk.

Despite a growing body of research establishing a link between cow’s milk infant formula and NEC for preemies, the makers of Similac and Enfamil have continued to aggressively promote use of their products as a safe alternative to human milk, even introducing versions specifically designed for premature babies. Lawsuits also allege that the manufacturers withheld warnings about the potential NEC risks from mothers and doctors. However, this information may have been more widely available in certain medical communities.

Last year, the World Health Organization (WHO) released a report that highlighted the problems with baby formula marketing, finding that it has violated international standards and attempted to influence what health care workers recommend to new parents. These marketing efforts have included providing free samples and care packages for families, many of which were more aggressively pushed in minority communities.

In a report published last month in the medical journal The Lancet, researchers described the marketing practices of baby formula manufacturers as “predatory”, and concluded that it has resulted in less breast feeding or use of human donor milk, despite the known health benefits.


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