Elsevier

The Journal of Pediatrics

Volume 177, October 2016, Pages 133-139.e1
The Journal of Pediatrics

Original Articles
Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks' Gestation

https://doi.org/10.1016/j.jpeds.2016.06.045Get rights and content

Objectives

To determine the associations of breast milk intake after birth with neurological outcomes at term equivalent and 7 years of age in very preterm infants

Study design

We studied 180 infants born at <30 weeks' gestation or <1250 grams birth weight enrolled in the Victorian Infant Brain Studies cohort from 2001-2003. We calculated the number of days on which infants received >50% of enteral intake as breast milk from 0-28 days of life. Outcomes included brain volumes measured by magnetic resonance imaging at term equivalent and 7 years of age, and cognitive (IQ, reading, mathematics, attention, working memory, language, visual perception) and motor testing at 7 years of age. We adjusted for age, sex, social risk, and neonatal illness in linear regression.

Results

A greater number of days on which infants received >50% breast milk was associated with greater deep nuclear gray matter volume at term equivalent age (0.15 cc/d; 95% CI, 0.05-0.25); and with better performance at age 7 years of age on IQ (0.5 points/d; 95% CI, 0.2-0.8), mathematics (0.5; 95% CI, 0.1-0.9), working memory (0.5; 95% CI, 0.1-0.9), and motor function (0.1; 95% CI, 0.0-0.2) tests. No differences in regional brain volumes at 7 years of age in relation to breast milk intake were observed.

Conclusion

Predominant breast milk feeding in the first 28 days of life was associated with a greater deep nuclear gray matter volume at term equivalent age and better IQ, academic achievement, working memory, and motor function at 7 years of age in very preterm infants.

Section snippets

Methods

We studied participants in the Victorian Infant Brain Studies longitudinal cohort. Two hundred twenty-four infants born at <30 weeks' gestation or <1250 grams birth weight were enrolled before term equivalent age at the Royal Women's Hospital in Melbourne, Australia between July 2001 and December 2003. Exclusion criteria included congenital anomalies likely to affect brain development or function. Parents provided informed consent for their children to participate.

The Royal Women's Hospital and

Results

Table I shows characteristics of our participants, who had rates of perinatal complications and long-term outcomes typical of their immaturity (mean [SD] gestational age, 27.3 [1.8] weeks) at birth. The mean number of days from day 0-28 on which infants received breast milk as >50% of their feedings was 21 (SD 7). Mean breast milk intake in the first 28 days was 90 mL/kg/d (SD 43). Multiple gestations comprised 45% of the cohort. As compared with singletons, mean breast milk intake for

Discussion

In a contemporary cohort of 180 very preterm infants, we found favorable associations of maternal breast milk intake in the first 28 days of life with neurodevelopmental outcomes at 7 years of age. For example, IQ was 0.5 points higher per additional day that breast milk intake was >50% of total enteral intake, and 0.7 points higher per additional 10 mL/kg/d breast milk ingested. Even if residual confounding explains some of this effect, our results nonetheless suggest a substantial impact of

References (54)

  • J.R. Britton et al.

    Breastfeeding, sensitivity, and attachment

    Pediatrics

    (2006)
  • P. Rahkonen et al.

    Mother-child interaction is associated with neurocognitive outcome in extremely low gestational age children

    Scand J Psychol

    (2014)
  • G. Der et al.

    Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis

    BMJ

    (2006)
  • R.E. Kleinman

    Pediatric nutrition handbook

    (2009)
  • T.T. Colaizy et al.

    Growth in VLBW infants fed predominantly fortified maternal and donor human milk diets: a retrospective cohort study

    BMC Pediatr

    (2012)
  • D.L. O'Connor et al.

    Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula

    J Pediatr Gastroenterol Nutr

    (2003)
  • OuX. et al.

    Sex-specific association between infant diet and white matter integrity in 8-y-old children

    Pediatr Res

    (2014)
  • S. Kafouri et al.

    Breastfeeding and brain structure in adolescence

    Int J Epidemiol

    (2013)
  • E.B. Isaacs et al.

    Impact of breast milk on intelligence quotient, brain size, and white matter development

    Pediatr Res

    (2010)
  • U. Pogribna et al.

    Perinatal clinical antecedents of white matter microstructural abnormalities on diffusion tensor imaging in extremely preterm infants

    PLoS ONE

    (2013)
  • D.K. Shah et al.

    Reduction in cerebellar volumes in preterm infants: relationship to white matter injury and neurodevelopment at two years of age

    Pediatr Res

    (2006)
  • D.K. Thompson et al.

    Optimizing hippocampal segmentation in infants utilizing MRI post-acquisition processing

    Neuroinformatics

    (2012)
  • C. Omizzolo et al.

    Hippocampal volume and memory and learning outcomes at 7 years in children born very preterm

    J Int Neuropsychol Soc

    (2013)
  • D. Weschler

    Weschler Abbreviated Scale of Intelligence (WASI)

    (1999)
  • G. Wilkinson et al.

    Wide range achievement test

    (2006)
  • T. Manly et al.

    The differential assessment of children's attention: the Test of Everyday Attention for Children (TEA-Ch), normative sample and ADHD performance

    J Child Psychol Psychiatry

    (2001)
  • S.J. Pickering et al.

    Working memory test battery for children

    (2001)
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    Funded by Australia's National Health & Medical Research Council; Centre of Clinical Research Excellence (546519 [to L.D. and P.A.]); Centre of Research Excellence in Newborn Medicine (1060733 [to L.D., P.A., and D.T.]); (237117 [to L.D.]); (491209 [to P.A.]); Senior Research Fellowship (1081288 [to P.A.]); Early Career Fellowships (1012236 [to D.T.] and 1053787 [to J.C.]); Career Development Fellowships (1085754 [to D.T.] and 1053609 [to K.L.]); National Institutes of Health (HD058056); United Cerebral Palsy Foundation (US); Leila Y. Mathers Charitable Foundation (US); the Brown Foundation (US); the Victorian Government's Operational Infrastructure Support Program; and The Royal Children's Hospital Foundation. V.N. was supported by the Cambridge Commonwealth Travelling Bursary (St John's College, Cambridge); Mary Euphrasia Mosley and Sir Bartle Frere Fund; Lord Mayor's 800th Anniversary Awards Trust; Nichol Young Foundation; and the Worts Travelling Scholars' Award. T.I. served on the Editorial Board of The Journal of Pediatrics (2007-2015). The other authors declare no conflicts of interest.

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