The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT

Abstract

ContextSupplementation of breast milk is difficult once infants suckle the breast and is often discontinued at end of hospitalisation and after discharge. Thus, breastfed preterm infants are exposed to an increased risk of nutritional deficit with a possible consequence on neurodevelopmental outcome.ObjectiveTo assess the relationship between breast feeding at time of discharge, weight gain during hospitalisation and neurodevelopmental outcome.DesignObservational cohort study.SettingTwo large, independent population-based cohorts of very preterm infants: the Loire Infant Follow-up Team (LIFT) and the EPIPAGE cohorts.Patients2925 very preterm infants alive at discharge.Main outcome measureSuboptimal neurodevelopmental outcome, defined as a score in the lower tercile, using Age and Stages Questionnaire at 2 years in LIFT and Kaufman Assessment Battery for Children Test at 5 years in EPIPAGE. Two propensity scores for breast feeding at discharge, one for each cohort, were used to reduce bias.ResultsBreast feeding at time of discharge concerned only 278/1733 (16%) infants in LIFT and 409/2163 (19%) infants in EPIPAGE cohort. Breast feeding is significantly associated with an increased risk of losing one weight Z-score during hospitalisation (LIFT: n=1463, adjusted odd ratio (aOR)=2.51 (95% CI 1.87 to 3.36); EPIPAGE: n=1417, aOR=1.55 (95% CI 1.14 to 2.12)) and with a decreased risk for a suboptimal neurodevelopmental assessment (LIFT: n=1463, aOR=0.63 (95% CI 0.45 to 0.87); EPIPAGE: n=1441, aOR=0.65 (95% CI 0.47 to 0.89) and an increased chance of having a head circumference Z-score higher than 0.5 at 2 years in LIFT cohort (n=1276, aOR=1.43 (95% CI 1.02 to 2.02)) and at 5 years in EPIPAGE cohort (n=1412, aOR=1.47 (95% CI 1.10 to 1.95)).ConclusionsThe observed better neurodevelopment in spite of suboptimal initial weight gain could be termed the ‘apparent breastfeeding paradox’ in very preterm infants. Regardless of the mechanisms involved, the current data provide encouragement for the use of breast feeding in preterm infants.

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

“…Although Vohr adjusted for several sociodemographic variables, that US cohort was substantially more diverse in race, ethnicity, education, and marital status as compared with our more homogeneous Australian cohort, raising the possibility that residual confounding explains the Vohr study's positive results. Consistent with Vohr, another study (14) of preterm infants <32 wk gestation identified a positive, linear trend in mental processing scores at 5 y of age according to duration of breastfeeding, categorized as: no mother's milk; mother's milk during hospitalization only; weaned <2 mo after discharge; weaned at or after 2 mo. It is possible that developmental assessment at 18 mo-as in our study-is too early to detect subtle effects of human milk on higher order cognitive processes better reflected in school age outcomes.…”

“…Some studies in contemporary preterm cohorts have found positive associations of human milk intake with neurodevelopment (13)(14)(15), while others were largely null (16)(17)(18). A recent meta-analysis (19) identified several methodologic limitations of prior studies that may account for these inconsistent findings, including a lack of data on the dose and duration of human milk intake and the potential for residual confounding, particularly by neonatal complications and socio-demographic variables.…”

Breast Milk Lipidome Is Associated with Early Growth Trajectory in Preterm Infants

“…This negative correlation 7 between birth weight and weight Z-score at time of discharge has long been known, and was 8 previously reported in the large LIFT cohort of 2277 preterm infants by our team [41] and in 9 another cohort [42]. This would lead to an inconsistent stratification of our preterm infants in 10 the LACTACOL cohort if birth anthropometry homogeneity was considered jointly with an 11 opposite growth velocity. Difference between discharge and birth weight Z-score (SD) Difference between discharge and birth length Z-score (SD) Difference between discharge and…”

Beneficios a Corto, Medio Y Largo Plazo De La Ingesta De Leche Humana en Recien Nacidos De Muy Bajo Peso

“…respecto a la lactancia artificial desaparece a los dos años. Se observa la misma paradoja que la ya publicada por Rozé y cols., es decir, mejor desarrollo cognitivo a los cinco años a pesar de menor longitud al alta del primer ingreso tras el nacimiento (21). Es de reseñar que el consumo de LM en los pacientes estudiados se asocia con menor estancia hospitalaria, una vez corregida por peso al nacimiento y edad gestacional, principales determinantes de la morbilidad neonatal.…”