Abstract
There is a beneficial association between human breast milk exposure in the neonatal period and cardiac mechanics in adults who were born preterm. It is unknown whether this benefit is apparent in infants in the first year of age. To test the hypothesis that higher consumption of mother's own milk in preterm infants is associated with enhanced cardiac performance during the first year of age. This cross-sectional study of cardiac and nutritional data at an academic medical center included 80 individuals born preterm and 100 individuals in the control group born full-term. All births were between 2011 and 2013. Two-dimensional echocardiograms were performed at 32 weeks' and 36 weeks' postmenstrual age and at 1 year's corrected age in individuals born preterm and at 1 month and 1 year of age in individuals born full-term. Statistical analysis was performed from January to May 2021. Consumption of mother's own milk. Main study outcomes included echocardiography measures of right and left ventricle longitudinal strain (function), left ventricle mass index and right ventricular areas (morphology), and pulmonary vascular resistance (pulmonary hemodynamics) at age 1 year. Of 180 infants included in the study, 97 (54%) were Black infants and 89 (49%) were female infants. Among the 80 infants born in the preterm cohort, 43 (54%) were female infants and 43 (54%) were Black infants. The median gestational age at birth of the preterm infants was 27.0 weeks (interquartile range, 26.0-28.0 weeks) and the median birth weight was 960 g (interquartile range, 800-1138). For each week of exposure to mother's own milk, preterm infants had greater magnitudes of right ventricular strain (eg, right longitudinal strain: β, 0.021; 95% CI, 0.002-0.041; P < .001) and left ventricular strain (eg, left longitudinal strain: β, 0.065; 95% CI, 0.049-0.080; P = .01), larger right ventricle areas (eg, systolic area: β, 0.026; 95% CI, 0.011-0.042; P = .009), larger left ventricle mass index (β, 0.045; 95% CI, 0.024-0.073; P = .003), and decreased pulmonary vascular resistance (eg, pulmonary artery acceleration time: β, 0.041; 95% CI, 0.018-0.063; P < .001) at 1 year's corrected age, even after accounting for gestational age and common neonatal morbidities. Cardiac values approached those seen in controls born full-term with increased mother's own milk exposure. There were no differences in any of the cardiac indices at 32 weeks' postmenstrual age, but with each week of exposure, right ventricle function (eg, right longitudinal strain: β, 0.016; 95% CI, 0.002-0.031; P < .001) was greater and pulmonary pressured (eg, pulmonary artery acceleration time: β, 0.0032; 95% CI, 0.0013-0.0062; P < .001). This study found that preterm infants with higher consumption of mother's own milk had enhanced cardiac performance at age 1 year, suggesting that mother's own milk consumption may play a dynamic modulator role on cardiac mechanics in preterm-born infants and help in normalization of the preterm cardiac phenotype.
Highlights
IntroductionCardiac mechanics begin to undergo maturational changes during the early neonatal period with preterm infants exhibiting impaired right ventricular (RV) performance, persistent pulmonary vascular disease (PVD) and alterations in left and right heart structure that persist to age 1 year.[10] Bronchopulmonary dysplasia (BPD) and late onset pulmonary hypertension (PH) leave a further negative impact of cardiac performance over the same time period.[11,12] this postnatal developmental window provides an early opportunity for interventions to modulate the long-term cardiac phenotypes,[8] to our knowledge, the association of breast milk with cardiovascular performance over the first year of age has not been described
This study found that preterm infants with higher consumption of mother’s own milk had enhanced cardiac performance at age 1 year, suggesting that mother’s own
left ventricular (LV) Performance At 1 year’s corrected age (CA), multivariate analysis demonstrated that for each additional week of mother’s own milk (MoM) exposure there was enhanced LV function, as measured by LV longitudinal strain (β, 0.065; 95% CI, 0.049 to 0.080; P = .01), larger LV mass indexed (LVMi) (β, 0.045; 95% CI, 0.024 to 0.073; P = .003), and decreased relative wall thickness (RWT) (β, −0.052: 95% CI, (−0.092 to −0.011; P < .001) even after adjustments for gestational age at birth, sex, heart rate, and common comorbidities (BPD, late pulmonary hypertension (PH), and necrotizing enterocolitis) (Table 2)
Summary
Cardiac mechanics begin to undergo maturational changes during the early neonatal period with preterm infants exhibiting impaired right ventricular (RV) performance, persistent pulmonary vascular disease (PVD) and alterations in left and right heart structure that persist to age 1 year.[10] Bronchopulmonary dysplasia (BPD) and late onset pulmonary hypertension (PH) leave a further negative impact of cardiac performance over the same time period.[11,12] this postnatal developmental window provides an early opportunity for interventions to modulate the long-term cardiac phenotypes,[8] to our knowledge, the association of breast milk with cardiovascular performance over the first year of age has not been described. The objective of the study was to assess the association between exposure to MoM and cardiopulmonary performance at 1 year’s CA in preterm infants
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