Mother's Own Milk and Its Relationship to Growth and Morbidity in a Population-based Cohort of Extremely Preterm Infants.

Anna‐My Lund,Magnus Domellöf,Ingrid Hansen‐Pupp,Ann Hellström,Aldina Pivodic,Elisabeth Stoltz Sjöström

doi:10.1097/mpg.0000000000003352

Abstract

ABSTRACTObjectives:The aim of the study was to evaluate the relationships between intake of mother's own milk (MOM), compared with intake of pasteurized donor milk (DM), and postnatal growth, incidence of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD), in extremely preterm infants.Methods:Swedish population-based cohort of surviving extremely preterm infants born 2004 to 2007. Exposure to MOM and DM was investigated from birth until 32 weeks postmenstrual age (PMA) in 453 infants. Primary outcome variables were change in z-score (Δ) from birth to 32 weeks PMA for weight, length, and head circumference (HC). Secondary outcomes were incidence of ROP and BPD. Mixed models adjusting for confounders were used to investigate the association between exposures and outcomes.Results:Infants’ mean gestational age (GA) was 25.4 weeks. Unadjusted, MOM (per 10 mL · kg−1 · day−1) was associated with Δweight and ΔHC with beta estimates of 0.03 z-score units (95% CI, 0.02–0.04, P < 0.001) and 0.03 z-score units (95% CI, 0.01–0.05, P = 0.003), respectively. After adjustment for predefined confounders, the association remained significant for Δweight and ΔHC. A similar pattern was found between Δweight and each 10% increase of MOM. Unadjusted, a higher intake of MOM (mL · kg−1 · day−1) was significantly associated to a lower probability of any ROP and severe ROP; however, these associations did not remain in the adjusted analyses. No associations were found between MOM (mL · kg−1 · day−1) and BPD. Moreover, no associations were found between DM and growth or morbidity outcomes.Conclusions:An increased intake of MOM, as opposed to DM (and not formula feeding), was associated with improved postnatal weight gain and HC growth from birth until 32 weeks PMA in extremely preterm infants. Interventions aiming at increasing early intake of unpasteurized MOM for extremely preterm infants should be encouraged.

Highlights

The advancement of medical, nursing and nutritional care of extremely preterm infants continues to improve the survival of these vulnerable infants [1,2,3]
The average of energy and macronutrients originating from enteral, parenteral and total nutritional intakes, human milk intakes and parenteral nutrition (PN)%, as well as the proportion of days for which the infants received any human milk fortifier, from birth until 32 weeks postmenstrual age (PMA) are presented in Table 2
This association remained significant in multivariable models after adjustment for gestational age (GA), respective birth anthropometry z-score, mechanical ventilation, postnatal steroid treatment, health care region and PN%

Summary

Introduction

The advancement of medical, nursing and nutritional care of extremely preterm infants continues to improve the survival of these vulnerable infants [1,2,3]. The incidence of neonatal morbidities remains high [2,3,4]. Inadequate growth in the postnatal period has been associated with incidence and severity of neonatal morbidities such as retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and poor neurodevelopmental outcomes [6,7,8]. In spite of the improvement of parenteral nutrition (PN) solutions and infant formulas it remains clear that human milk is the optimal nutrition for the preterm infant provided that it is fortified to meet nutritional requirements

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Discussion

Conclusion