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Cardiac Performance in the First Year of Age Among Preterm Infants Fed Maternal Breast Milk
Afif El-Khuffash1, Adam J Lewandowski2, Amish Jain3
1Department of Neonatology, The Rotunda Hospital and School of Medicine (Pediatrics), Royal College of Surgeons in Ireland, Dublin, Ireland.
Insights
Higher consumption of mother's own milk in preterm infants is linked to improved cardiac function by age 1 year. This suggests breast milk plays a key role in normalizing cardiac development in premature infants.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Nutritional Science
Background:
- Neonatal exposure to human milk is associated with improved cardiac mechanics in adults born preterm.
- The impact of mother's own milk on cardiac performance in preterm infants within the first year of life remains unclear.
Purpose of the Study:
- To investigate the association between mother's own milk consumption and cardiac performance in preterm infants during their first year of age.
- To determine if higher intake of mother's own milk enhances cardiac function and morphology in this population.
Main Methods:
- A cross-sectional study involving 80 preterm infants and 100 full-term controls.
- Echocardiograms were performed at multiple time points to assess cardiac function (strain), morphology (mass, areas), and pulmonary hemodynamics.
- Statistical analysis was conducted to correlate mother's own milk consumption with cardiac indices at 1 year of corrected age.
Main Results:
- Each week of mother's own milk exposure in preterm infants was associated with improved right and left ventricular longitudinal strain, larger right ventricle areas, increased left ventricle mass index, and decreased pulmonary vascular resistance at 1 year.
- Cardiac measures in preterm infants approached those of full-term controls with increased mother's own milk intake.
- Improvements in right ventricle function and pulmonary hemodynamics were observed even at earlier postmenstrual ages with increased milk exposure.
Conclusions:
- Higher consumption of mother's own milk is associated with enhanced cardiac performance in preterm infants by 1 year of age.
- Mother's own milk may act as a modulator of cardiac mechanics, aiding in the normalization of the cardiac phenotype in preterm infants.
- These findings underscore the importance of promoting mother's own milk intake for optimizing cardiovascular outcomes in premature infants.
Importance:
There is a beneficial association between human breast milk exposure in the neonatal period and cardiac mechanics in adults who were born preterm. It is unknown whether this benefit is apparent in infants in the first year of age.
Objective:
To test the hypothesis that higher consumption of mother's own milk in preterm infants is associated with enhanced cardiac performance during the first year of age.
Design, Setting, And Participants:
This cross-sectional study of cardiac and nutritional data at an academic medical center included 80 individuals born preterm and 100 individuals in the control group born full-term. All births were between 2011 and 2013. Two-dimensional echocardiograms were performed at 32 weeks' and 36 weeks' postmenstrual age and at 1 year's corrected age in individuals born preterm and at 1 month and 1 year of age in individuals born full-term. Statistical analysis was performed from January to May 2021.
Exposures:
Consumption of mother's own milk.
Main Outcomes And Measures:
Main study outcomes included echocardiography measures of right and left ventricle longitudinal strain (function), left ventricle mass index and right ventricular areas (morphology), and pulmonary vascular resistance (pulmonary hemodynamics) at age 1 year.
Results:
Of 180 infants included in the study, 97 (54%) were Black infants and 89 (49%) were female infants. Among the 80 infants born in the preterm cohort, 43 (54%) were female infants and 43 (54%) were Black infants. The median gestational age at birth of the preterm infants was 27.0 weeks (interquartile range, 26.0-28.0 weeks) and the median birth weight was 960 g (interquartile range, 800-1138). For each week of exposure to mother's own milk, preterm infants had greater magnitudes of right ventricular strain (eg, right longitudinal strain: β, 0.021; 95% CI, 0.002-0.041; P < .001) and left ventricular strain (eg, left longitudinal strain: β, 0.065; 95% CI, 0.049-0.080; P = .01), larger right ventricle areas (eg, systolic area: β, 0.026; 95% CI, 0.011-0.042; P = .009), larger left ventricle mass index (β, 0.045; 95% CI, 0.024-0.073; P = .003), and decreased pulmonary vascular resistance (eg, pulmonary artery acceleration time: β, 0.041; 95% CI, 0.018-0.063; P < .001) at 1 year's corrected age, even after accounting for gestational age and common neonatal morbidities. Cardiac values approached those seen in controls born full-term with increased mother's own milk exposure. There were no differences in any of the cardiac indices at 32 weeks' postmenstrual age, but with each week of exposure, right ventricle function (eg, right longitudinal strain: β, 0.016; 95% CI, 0.002-0.031; P < .001) was greater and pulmonary pressured (eg, pulmonary artery acceleration time: β, 0.0032; 95% CI, 0.0013-0.0062; P < .001).
Conclusions And Relevance:
This study found that preterm infants with higher consumption of mother's own milk had enhanced cardiac performance at age 1 year, suggesting that mother's own milk consumption may play a dynamic modulator role on cardiac mechanics in preterm-born infants and help in normalization of the preterm cardiac phenotype.
