Related Experiment Video
Updated: Apr 23, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Human milk and neurodevelopment in children with very low birth weight: a systematic review
Winston Koo1, Surinder Tank, Sandra Martin
1Department of Pediatrics, Louisiana State University Health Sciences, 1501 Kings Hwy, Shreveport, LA, USA. wkoo@lsuhsc.edu.
Insights
Human milk (HM) feeding may support neurodevelopment in very low birth weight (VLBW) preterm infants. However, high-quality studies are needed to confirm HM
Area of Science:
- Neonatal Nutrition and Neurodevelopment
- Pediatric Neurology
- Evidence-Based Medicine
Background:
- Human milk (HM) provides essential nutrients and neurotrophic factors crucial for the developing brains of preterm infants, especially those with very low birth weight (VLBW).
- The independent effect of HM on neurodevelopmental outcomes in VLBW infants remains incompletely understood due to methodological limitations in existing research.
Purpose of the Study:
- To systematically review original studies evaluating the reproducible, independent effect of HM feeding on neurodevelopmental outcomes in preterm VLBW infants.
- To assess the methodological quality of studies examining HM's impact on VLBW infant neurodevelopment.
Main Methods:
- A systematic search of seven major databases identified 24 original studies.
- Studies were independently evaluated by two authors based on 13 non-nutritive and nutritive methodological parameters and outcome measure consistency.
- Seven studies focusing exclusively on VLBW infants, with adequate data and methodology, were included in the final review.
Main Results:
- VLBW infants without neurological impairment who received HM demonstrated normal or low-normal neurodevelopmental test scores.
- Formula feeding, particularly with older formulations, was associated with lower subtest scores in four studies.
- No randomized clinical trials specifically comparing HM versus formula feeding in exclusively VLBW infants were identified.
Conclusions:
- Existing evidence suggests a potential benefit of HM for neurodevelopment in VLBW infants, but methodological limitations and lack of high-quality RCTs hinder definitive conclusions.
- Further high-quality research is essential to reassess the role of HM in VLBW infant neurodevelopment, considering current HM fortifier and preterm formula advancements.
Abstract:
Human milk (HM) contains critical nutrients and possibly other neurotrophic factors that could benefit the less developed brain of preterm infants, particularly those with very low birth weight (VLBW). This study aims to systematically review the original studies to determine whether there is a reproducible independent effect of HM feeding on neurodevelopment outcome in preterm VLBW infants. Search of seven databases (PubMed, Cochrane, CINAHL, Embase, Proquest Research Library, Google Scholar, and Web of Science) identified 24 original studies. Each study was evaluated by two authors independently for 8 non-nutritive (study design, target population, a priori power calculation, adjustment for baseline growth status, postnatal complication, other confounders, observer blinding to feeding status, effect size) and 5 nutritive (definition and duration of HM intake, use of HM fortifier, source of HM data, infant formula used) methodology parameters, and consistency and directness of outcome measures. Thirteen reports of preterm infants with wide ranges of birth weights were excluded as none provided sufficient data to delineate the effects of HM feeding on developmental outcome of subjects with VLBW. Eleven reports included only VLBW children and 7 studies were reviewed after elimination of preliminary data from same cohort or lack of appropriate standardized testing or control group. These 7 studies (n = 18 to 704, median 219) were performed at <3 years (3 studies) and at 5 to 11 years (4 studies). Six studies were secondary analysis of data from other studies. Each study met or only partially met 4 to 10 methodological parameters. VLBW children with no neurological impairment fed HM achieved normal or low normal range of test scores. Formula feeding using older formulations was associated with a lower subtest score in 4 studies. There is no randomized clinical trial comparing the neurodevelopment outcome of HM versus formula or minimal HM feeding that included only children with VLBW. The role of HM in the neurodevelopment and cognitive function of VLBW children needs reassessment with high quality studies in the context of current formulations of HM fortifier and preterm formula.
