Donor human milk and structural brain development in very preterm infants.

Area of Science:

• Neonatal neuroscience
• Neuroimaging
• Developmental pediatrics

Background:

• Maternal milk feeding is linked to improved ex-utero brain development in very preterm infants.
• The impact of donor milk on structural brain development in this population remains unclear.

Purpose of the Study:

• To compare structural brain development at term-equivalent age (TEA) in very preterm infants fed primarily maternal milk (MOM), donor human milk (DHM), or preterm formula (PTF).
• To assess brain volumes and white matter microstructure using magnetic resonance imaging (MRI).

Main Methods:

• Observational study of very preterm infants (≤32 weeks' gestation).
• Categorization into MOM, DHM, or PTF groups based on cumulative feed volume.
• TEA brain MRI (coronal T2 for volumes, diffusion tensor imaging for white matter).

Main Results:

• No significant differences in brain volumes between MOM and DHM groups (n=152).
• PTF group showed reduced deep gray matter, brainstem, and total brain volumes compared to MOM.
• DHM group had altered white matter microstructure (pons diffusivity) compared to MOM; PTF group showed more widespread white matter alterations (corpus callosum, internal capsule).

Conclusions:

• Infants fed DHM exhibited brain volumes and white matter development comparable to those fed MOM.
• Formula feeding was associated with lower brain volumes and greater white matter microstructural abnormalities.
• Donor milk may offer a neurodevelopmental advantage for very preterm infants when maternal milk is not available.