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Human milk feeding prevents retinopathy of prematurity (ROP) in preterm VLBW neonates
Paolo Manzoni1, Ilaria Stolfi, Roberto Pedicino
1Neonatal Intensive Care Unit, S. Anna Hospital, Torino, Italy. paolomanzoni@hotmail.com
Insights
Exclusive human milk feeding significantly reduces the risk of retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants. This finding highlights the protective role of maternal milk in preventing ROP in the NICU setting.
Area of Science:
- Neonatology
- Ophthalmology
- Nutritional Science
Background:
- Retinopathy of prematurity (ROP) is a complex condition influenced by various factors, with limited understanding of its link to neonatal nutrition policies.
- Human maternal milk is recognized as the optimal nutrition for premature infants, including those susceptible to severe complications like ROP.
Purpose of the Study:
- To investigate the hypothesis that exclusive feeding with fresh maternal milk can prevent any stage of ROP in very low birth weight (VLBW) neonates.
- To compare the incidence of ROP in VLBW infants fed exclusively maternal milk versus those fed preterm formula.
Main Methods:
- Secondary analysis of data from two consecutive multicenter randomized controlled trials (RCTs) conducted in Italian tertiary neonatal intensive care units (NICUs).
- Systematic screening for ROP detection was performed according to the ETROP study definition.
- Univariate and multivariate logistic regression analyses were used to identify factors associated with ROP, including type of milk feeding.
Main Results:
- A total of 314 infants received exclusive maternal milk, and 184 received preterm formula; groups were comparable in clinical and demographic characteristics.
- ROP incidence (any stage) was significantly lower in the maternal milk group (3.5%) compared to the formula group (15.8%) (RR 0.14; p=0.004).
- Threshold ROP was also significantly reduced in infants fed maternal milk (1.3% vs. 12.3%; p=0.009), and exclusive human milk feeding remained a significant protective factor in multivariate analysis.
Conclusions:
- Exclusive human maternal milk feeding from birth is associated with the prevention of ROP in VLBW infants.
- This study underscores the critical role of maternal milk in mitigating ROP risk within the NICU environment.
- Neonatal nutritional policies favoring human milk are essential for improving outcomes in premature infants.
Background:
Retinopathy of prematurity (ROP) is a multifactorial disease, but little is known about its relationships with neonatal nutritional policies. Human, maternal milk is the best possible nutritional option for all premature infants, including those at high risk for severe complications of prematurity, such as ROP.
Objective:
This is a secondary analysis of data collected during two multicenter RCTs performed consecutively (years 2004 through 2008) by a network of eleven tertiary NICUs in Italy. The two trials aimed at assessing effectiveness of fluconazole prophylaxis (Manzoni et al., N Engl J Med 2007 Jun 14;356(24):2483-95), and of bovine lactoferrin supplementation (Manzoni et al., JAMA 2009 Oct 7;302(13):1421-8), in prevention of invasive fungal infection, and of late-onset sepsis in VLBW infants, respectively. We tested the hypothesis that exclusive feeding with fresh maternal milk may prevent ROP of any stage - as defined by the ETROP study - in VLBW neonates, compared to formula feeding.
Methods:
We analyzed the database from both trials. Systematic screening for detection of ROP was part of the protocol of both studies. The definition of threshold ROP was as defined by the ETROP study. Univariate analysis was performed to look for significant associations between ROP and several possible associated factors, and among them, the type of milk feeding (maternal milk or formula for preterms). When an association was indicated by p < 0.05, multiple logistic regression was used to determine the factors significantly associated with ROP.
Results:
In both trials combined, 314 infants received exclusively human maternal milk (group A), and 184 a preterm formula because their mothers were not expected to breastfeed. The clinical, demographical and management characteristics of the neonates did not differ between the two groups, particularly related to the presence of the known risk factors for ROP. Overall, ROP incidence (any stage) was significantly lower in infants fed maternal milk (11 of 314; 3.5%) as compared to formula-fed neonates (29 of 184; 15.8%) (RR 0.14; 95% CI 0.12-0.62; p = 0.004). The same occurred for threshold ROP (1.3% vs. 12.3%, respectively; RR 0.19; 95% CI 0.05-0.69; p = 0.009). At multivariate logistic regression controlling for potentially confounding factors that were significantly associated to ROP (any stage) at univariate analysis (birth weight, gestational age, days on supplemental oxygen, systemic fungal infection, outborn, hyperglycaemia), type of milk feeding retained significance, human maternal milk being protective with p = 0.01.
Conclusions:
Exclusive human, maternal milk feeding since birth may prevent ROP of any stage in VLBW infants in the NICU.
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