Human milk intake in preterm infants and neurodevelopment at 18 months corrected age

Abstract

Background:The effect of human milk intake on neurodevelopment in preterm infants is uncertain. Methods: We analyzed data from 611 participants in the DHA for Improvement of Neurodevelopmental Outcomes study, enrolled at ≤33 wk gestation from five Australian perinatal centers. The main exposures were (i) average daily human milk intake during the neonatal hospitalization and (ii) total duration of human milk intake before and after discharge. Outcomes were Bayley Scales of Infant Development, 2nd Edition Mental (MDI), and Psychomotor (PDI) Development Indexes. results: Adjusting for confounders in linear regression, human milk intake was not associated with higher MDI (0.2 points per 25 ml/kg/d; 95% confidence interval (CI): −0.6, 1.0) or PDI (−0.3 points; 95% CI: −1.1, 0.4). Longer duration of human milk intake was also not associated with MDI (0.1 points per month; 95% CI: −0.2, 0.3) or PDI (−0.2 points per month; 95% CI: −0.5, 0.01) scores, except in infants born 29-33 wk gestation (n = 364, MDI 0.3 points higher per additional month, 95% CI: 0.1, 0.6). conclusions: We found no associations of human milk intake during the neonatal hospitalization with neurodevelopment at 18 mo corrected age.

NICU Human Milk Dose and 20-Month Neurodevelopmental Outcome in Very Low Birth Weight Infants

“…[12] However, these infants were of higher GA and BW, had lower rates of most NICU morbidities and were born to a predominantly Caucasian, educated group of mothers who had a much higher rate of continuing HM feedings for their infants at NICU discharge (73% vs. 35%) as compared to our cohort. It is possible that post-discharge parenting practices and home environment had a greater influence for these infants than NICU HM dose, which may play a more significant role for higher risk populations such as ours.…”

“…Although human milk (HM: from the infant’s own mother, excluding donor milk) feeding during the NICU hospitalization has been associated with improvements in ND outcome in premature infants, these earlier studies are limited by older cohorts and imprecise definitions of HM intake [4–9]. Studies that have found no association between HM and ND outcome have been limited by calculation of HM dose for only portions of the NICU stay [10–12]. A number of these studies are comprised of homogenous cohorts and/or lower rates of HM use in minority populations, limiting generalizability to patients who might most benefit from higher HM intake [4–12].…”

“…Studies that have found no association between HM and ND outcome have been limited by calculation of HM dose for only portions of the NICU stay [10–12]. A number of these studies are comprised of homogenous cohorts and/or lower rates of HM use in minority populations, limiting generalizability to patients who might most benefit from higher HM intake [4–12]. We, therefore, sought to assess the relationship between the daily measured HM intake from the NICU hospitalization and 20 month ND outcome data for a diverse, contemporary cohort of VLBW infants in the LOVE MOM ( L ongitudinal O utcomes in V ery Low Birthweight Infants E xposed to M others’ O wn M ilk) cohort.…”

Human Milk and Preterm Infant Brain Development

“…14,15 However, another cohort study in premature infants born £33 weeks gestation (N = 611) found no association between human milk intake and neurodevelopmental outcomes at 18 months. 16 The inconsistent results reported in these and other published studies evaluating the potential benefits of human milk in preterm infants may be due to differences in study populations, older nutrition practices that did not account for the greater needs of preterm infants, and the assessment of infant and toddler outcomes, which are poorly predictive of later cognitive abilities.…”

Protecting the premature brain: current evidence-based strategies for minimising perinatal brain injury in preterm infants

“…First-week protein and energy intakes are associated with 18-month developmental outcomes,119 and meta-analysis has shown that increasing early enteral nutrition may reduce neurodevelopmental impairment 120. Preterm infants fed with predominantly breast milk had higher deep nuclear grey matter volume at term corrected age,121 improved developmental scores at 18 months122 as well as higher IQ and academic achievement at 7 years,121 although this has not been seen in all studies 123. Research is ongoing into optimal nutritional regimens; however, it is hypothesised the benefits of early nutrition and breast milk, including fortification, outweigh the risks 124…”