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Growth Efficiency of Donor Human Milk Compared With Maternal Milk and Formula in Preterm Infants
Insights
Pasteurized donor human milk (PDHM) supports less weight gain in preterm infants compared to mother's own milk (MM). Formula feeding resulted in greater weight gain than either human milk option, highlighting the need for close monitoring.
Area of Science:
- Neonatal Nutrition
- Pediatric Growth Studies
- Clinical Effectiveness Research
Background:
- Human milk is crucial for preterm infants, with pasteurized donor human milk (PDHM) used when mother's own milk (MM) is insufficient.
- PDHM has been linked to suboptimal growth outcomes in vulnerable neonates.
Purpose of the Study:
- To compare the clinical effectiveness of PDHM, MM, and formula in supporting daily weight gain and growth in preterm infants during hospitalization.
- To quantify growth differences between infants receiving PDHM, MM, and formula.
Main Methods:
- Retrospective cohort study of over 2,600 preterm infants (born before 34 weeks' gestation) across five newborn nurseries.
- Analysis of daily weight gain and weight Z-score changes from birth to discharge, comparing infants based on milk source (PDHM, MM, formula).
Main Results:
- Infants receiving PDHM had 74% of the daily weight gain compared to MM (p < 0.0001).
- Formula-fed infants showed 115% of the weight gain seen with MM (p < 0.0001).
- Highest PDHM exposure correlated with a significant decline in weight-for-age Z-score compared to no PDHM exposure (p = 0.005).
Conclusions:
- Growth outcomes differ significantly based on milk source, with higher PDHM exposure linked to poorer growth metrics.
- Formula supports greater weight gain than both PDHM and MM in preterm infants.
- Close growth monitoring and nutritional adjustments are essential for preterm infants, especially those on PDHM.
Importance:
Human milk is beneficial for preterm newborns, and pasteurized donor human milk (PDHM) is increasingly used when mother's own milk (MM) is insufficient. However, PDHM has been associated with suboptimal growth outcomes.
Objective:
To quantify the comparative clinical effectiveness of PDHM, MM, and formula in supporting daily weight gain and growth outcomes during the birth hospitalization.
Design:
Retrospective cohort study of infants born before 34 weeks' gestation between 2016 and 2024.
Setting:
Five newborn nurseries across the Mass General Brigham healthcare system (Boston, MA), including one Level IV, one Level III, and three Level II newborn units.
Participants:
A total of 2,635 preterm infants born before 34 weeks' gestation between 2016 and late 2024 were included in the daily weight gain analysis, contributing 40,007 days of eligible enteral intake data for evaluation of in-hospital growth outcomes. For the analysis examining the association between PDHM use and discharge weight, 2,719 infants met eligibility criteria.
Exposures:
PDHM, MM, formula.
Main Outcomes And Measures:
The primary outcome was daily weight gain (g/kg/day). The secondary outcome was the change in weight Z-score from birth to discharge.
Results:
In adjusted analyses, an equal volume of PDHM was associated with 74% of the daily weight gain achieved with MM (p < 0.0001, 95% CI 70%-77%), and formula with 115% of MM (p < 0.0001, 95% CI 111%-119%). During the birth hospitalization, infants in the highest quartile of PDHM exposure had a significantly greater decline in weight-for-age Z-score compared with those with no exposure (-0.09, p = 0.005), while no differences were observed in the lower quartiles.
Conclusions And Relevance:
Growth outcomes varied by PDHM exposure, with a significant decline observed only in the highest quartile, while lower exposure levels showed no significant effect. Formula-fed infants were observed to have greater weight gain than either PDHM or MM. These results highlight the need for close growth monitoring and timely nutritional adjustments in preterm infants, particularly when PDHM is the primary source of enteral nutrition.
Question:
How does pasteurized donor human milk (PDHM) compare with mother's own milk (MM) and formula in supporting in-hospital growth among preterm infants born at or before 34 weeks' gestation?
Findings:
In this multicenter retrospective cohort study involving > 2500 preterm infants contributing over 40,000 infant-days of enteral data, PDHM correlated with significantly reduced daily weight gain compared with MM, whereas formula supported greater weight gain than either human milk source. At discharge, infants with the highest quartile of PDHM exposure showed a greater reduction in weight-for-age Z-score than infants with no PDHM exposure. No association was observed in the lower quartiles.
Meaning:
Our findings underscore the need for close growth monitoring and potentially greater nutritional supplementation in relation to PDHM exposure.
