DoMINO: Donor milk for improved neurodevelopmental outcomes

Area of Science:

• Neonatal nutrition and neurodevelopment
• Clinical trials in pediatrics
• Infant feeding practices

Background:

• Mother's own milk is optimal for infants, especially very low birth weight (VLBW) infants, for neurocognitive development.
• VLBW infants often require supplementation due to insufficient maternal milk supply.
• Investigating pasteurized donor milk as an alternative to formula is crucial for VLBW infant neurodevelopment.

Purpose of the Study:

• To determine if pasteurized donor milk supplementation improves cognitive outcomes in VLBW infants compared to preterm formula.
• To assess secondary outcomes including morbidity, mortality, growth, and language/motor development.
• To explore feeding tolerance, nutrient intake, and cost-effectiveness of donor milk.

Main Methods:

• A multi-center, double-blind, randomized controlled trial (DoMINO) involving 363 VLBW infants.
• Infants received either pasteurized donor milk or preterm formula as supplementation for 90 days or until hospital discharge.
• Cognitive outcomes were measured at 18 months corrected age using the Bayley Scales of Infant Development, 3rd ed.

Main Results:

• Primary outcome: cognitive development at 18 months corrected age.
• Secondary outcomes: composite of death/morbidity, growth, language, and motor development.
• Exploratory outcomes: feeding tolerance, nutrient intake, and cost-effectiveness.

Conclusions:

• Strategies to mitigate long-term morbidity in preterm infants are essential.
• Pasteurized donor milk may offer neurodevelopmental advantages over formula for VLBW infants.
• Trial results will inform donor milk policy in Canada and globally.