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Neurodevelopmental outcomes of extremely preterm infants fed an exclusive human milk-based diet versus a mixed human
Amy B Hair1, Aloka L Patel2, Ursula Kiechl-Kohlendorfer3
1Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. abhair@texaschildrens.org.
Insights
Infants fed exclusive human milk-based fortifier showed better cognitive development than those fed bovine milk-based fortifier. This highlights the potential benefits of human milk for preterm infant neurodevelopment.
Area of Science:
- Neonatal nutrition
- Neurodevelopmental pediatrics
- Infant health outcomes
Background:
- Preterm infants, especially those with low birth weight (BW) ≤1250g, are at risk for neurodevelopmental impairments.
- Nutritional strategies during the neonatal period may influence long-term cognitive and motor outcomes.
- The role of exclusive human milk-based (HUM) fortifiers versus bovine milk-based (BOV) alternatives in optimizing neurodevelopment requires further investigation.
Purpose of the Study:
- To compare neurodevelopmental outcomes at 18-22 months of corrected age (CA) in preterm infants exposed to HUM versus BOV fortifiers.
- To assess differences in cognitive, language, and motor scores based on infant feeding protocols.
Main Methods:
- Retrospective multi-center cohort study involving 252 infants from 6 centers.
- Neurodevelopmental assessment at 18-22 months CA using the Bayley Scales of Infant Development III (BSID-III).
- BSID-III scores were adjusted for BW, sex, study site, and history of necrotizing enterocolitis.
Main Results:
- Infants receiving HUM fortifier demonstrated significantly higher cognitive scores (96.5 ± 15.1) compared to the BOV group (89.6 ± 14.1, adjusted p=0.0001).
- Language scores showed a trend towards higher means in the HUM group (85.5 ± 15.0) versus BOV (82.2 ± 14.1, adjusted p=0.09), but did not reach statistical significance.
- Motor scores were comparable between the HUM (92.9 ± 11.7) and BOV (91.4 ± 14.6) groups (adjusted p=0.32).
Conclusions:
- Preterm infants fed an exclusive human milk-based diet exhibited superior cognitive outcomes at 18-22 months CA.
- These findings suggest a potential neuroprotective benefit of HUM fortifiers on cognitive development in this vulnerable population.
- Further research is warranted to elucidate the mechanisms underlying the positive impact of human milk-based nutrition on infant neurodevelopment.
Objective:
The objective of this multi-center study was to compare, in infants ≤1250 g birth weight (BW) with neurodevelopmental assessment at 18-22 months of corrected age (CA), whether their neurodevelopmental outcomes differed based on exposure to an exclusive human milk-based (HUM) or to a bovine milk-based fortifier and/or preterm formula (BOV).
Study Design:
Retrospective multi-center cohort study of infants undergoing neurodevelopmental assessment as to whether HUM or BOV exposure related to differences in outcomes of infants at 18-22 months CA, using the Bayley Scales of Infant Development III (BSID-III). BSID-III cognitive, language, and motor scores were adjusted for BW, sex, study site, and necrotizing enterocolitis.
Results:
252 infants from 6 centers were included. BSID-III cognitive scores were higher in the HUM group (96.5 ± 15.1 vs 89.6 ± 14.1, adjusted p = 0.0001). Mean BSID-III language scores were 85.5 ± 15.0 in HUM and 82.2 ± 14.1 in BOV (adjusted p = 0.09). Mean BSID-III motor scores were 92.9 ± 11.7 in HUM and 91.4 ± 14.6 in BOV (adjusted p = 0.32).
Conclusion:
In this cohort of infants undergoing neurodevelopmental assessment, infants receiving HUM diet had significantly higher cognitive BSID-III scores at 18-22 months CA. Further investigation is needed of this potential for HUM to positively influence infant cognitive outcomes.
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