Neurodevelopmental Outcome in Very Low Birth Weight Infants Exposed to Donor Milk

Abstract

Objective This study was aimed to evaluate the impact of donor milk (DM) received in the first 28 days of life (DOL) on neurodevelopmental (ND) outcome at 20-months corrected age (CA) in very low birth weight (VLBW) infants.

Study Design A total of 84 infants born in 2011 to 2012 who received only mother's own milk (MOM) and/or preterm formula (PF) was compared with 69 infants born in 2013 to 2014 who received MOM and/or DM. Daily enteral intake of MOM, DM, and PF was collected through 28 DOL. ND outcomes were assessed with the Bayley-III. Multiple regression analyses adjusted for the effect of social and neonatal risk factors alongside era of birth on ND outcome.

Results Infants exposed to DM were born to older mothers (p < 0.01) and had higher incidence of severe brain injury (p = 0.013). Although DM group infants received first feed at earlier DOL (p < 0.001), there were no differences in MOM intake at DOL 14 or 28 between the two groups. In regression analyses, DM group did not predict 20-month ND outcome.

Conclusion There were no differences in ND outcome between infants born before and after the introduction of DM. This may have been due to the similar percent of MOM at DOL 14 and 28 in the two eras.

Key Points

• Donor milk use is increasing in VLBW infant. The impact of donor milk on neurodevelopment is unclear.

• Provision of mother's own milk was high at days of life 14 and 28 for both groups of infants.

• Donor milk was not associated with improved neurodevelopmental outcome.

Keywords

donor milk - neurodevelopmental outcome - VLBW infant

Publication History

Received: 20 April 2020

Accepted: 02 December 2020

Article published online:
06 January 2021

• References

• 1 Johnson TJ, Patel AL, Bigger HR, Engstrom JL, Meier PP. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology 2015; 107 (04) 271-276
• 2 Patel AL, Johnson TJ, Engstrom JL. et al. Impact of early human milk on sepsis and health-care costs in very low birth weight infants. J Perinatol 2013; 33 (07) 514-519
• 3 Patel AL, Johnson TJ, Robin B. et al. Influence of own mother's milk on bronchopulmonary dysplasia and costs. Arch Dis Child Fetal Neonatal Ed 2017; 102 (03) F256-F261
• 4 Johnson TJ, Patra K, Greene MM, Meier PP, Patel AL. The relationship between human milk and healthcare utilization and costs after NICU discharge in VLBW infants. J Perinatol 2019; 39 (01) 120-128
• 5 Vohr BR, Poindexter BB, Dusick AM. et al; NICHD Neonatal Research Network. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics 2006; 118 (01) e115-e123
• 6 Vohr BR, Poindexter BB, Dusick AM. et al; National Institute of Child Health and Human Development National Research Network. Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age. Pediatrics 2007; 120 (04) e953-e959
• 7 Gibertoni D, Corvaglia L, Vandini S. et al. Positive effect of human milk feeding during NICU hospitalization on 24 month neurodevelopment of very low birth weight infants: an Italian cohort study. PLoS One 2015; 10 (01) e0116552
• 8 Furman L, Wilson-Costello D, Friedman H, Taylor HG, Minich N, Hack M. The effect of neonatal maternal milk feeding on the neurodevelopmental outcome of very low birth weight infants. J Dev Behav Pediatr 2004; 25 (04) 247-253
• 9 Jacobi-Polishook T, Collins CT, Sullivan TR. et al. Human milk intake in preterm infants and neurodevelopment at 18 months corrected age. Pediatr Res 2016; 80 (04) 486-492
• 10 Patra K, Hamilton M, Johnson TJ. et al. NICU human milk dose and 20-month neurodevelopmental outcome in very low birth weight infants. Neonatology 2017; 112 (04) 330-336
• 11 Meier P, Patel A, Esquerra-Zwiers A. Donor human milk update: evidence, mechanisms, and priorities for research and practice. J Pediatr 2017; 180: 15-21
• 12 Committee on Nutrition, Section on Breastfeeding, Committee on Fetus and Newborn. Donor human milk for the high-risk infant: preparation, safety, and usage options in the United States. Pediatrics 2017; 139 (01) 139
• 13 Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev 2018; 6 (06) CD002971
• 14 Boyd CA, Quigley MA, Brocklehurst P. Donor breast milk versus infant formula for preterm infants: systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2007; 92 (03) F169-F175
• 15 Colaizy TT. Donor human milk for very low birth weights: patterns of usage, outcomes, and unanswered questions. Curr Opin Pediatr 2015; 27 (02) 172-176
• 16 O'Connor DL, Gibbins S, Kiss A. et al; GTA DoMINO Feeding Group. Effect of supplemental donor human milk compared with preterm formula on neurodevelopment of very low-birth-weight infants at 18 months: a randomized clinical trial. JAMA 2016; 316 (18) 1897-1905
• 17 Madore LS, Bora S, Erdei C, Jumani T, Dengos AR, Sen S. Effects of donor breastmilk feeding on growth and early neurodevelopmental outcomes in preterm infants: an observational study. Clin Ther 2017; 39 (06) 1210-1220
• 18 Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010; 125 (02) e214-e224
• 19 Bell MJ, Ternberg JL, Feigin RD. et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
• 20 Amiel-Tison C, Stewart A. Follow up studies during the first five years of life: a pervasive assessment of neurological function. Arch Dis Child 1989; 64 (4 Spec No): 496-502
• 21 Bayley N. Bayley Scales of Infant Development. Third edition.. San Antonio, TX: The Psychological Corporation; 2006
• 22 Hoban R, Schoeny ME, Esquerra-Zwiers A. et al. Impact of donor milk on short- and long-term growth of very low birth weight infants. Nutrients 2019; 11 (02) 241
• 23 Blesa M, Sullivan G, Anblagan D. et al. Early breast milk exposure modifies brain connectivity in preterm infants. Neuroimage 2019; 184: 431-439
• 24 Sherman MP, Zaghouani H, Niklas V. Gut microbiota, the immune system, and diet influence the neonatal gut-brain axis. Pediatr Res 2015; 77 (1,2): 127-135
• 25 Keunen K, van Elburg RM, van Bel F, Benders MJ. Impact of nutrition on brain development and its neuroprotective implications following preterm birth. Pediatr Res 2015; 77 (1,2): 148-155
• 26 Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am 2013; 60 (01) 49-74