In Canada, the primary cause of mortality in infancy and long-term disability in children is being born at very low birth weight (<1500g or <3.3lbs; Saigal & Doyle, 2008). If these infants are fed their mother’s milk in the neonatal intensive care unit (NICU) they experience fewer severe infections (Hylander, Strobino, & Dhanireddy, 1998; Patel et al., 2013), improved feeding tolerance (Schanler, Shulman, & Lau, 1999; Sisk, Lovelady, Gruber, Dillard, & O’Shea, 2008), lower colonization of pathogenic bacteria (Yoshioka, Iseki, & Fujita, 1983), and increased neurocognitive development (Anderson, Johnstone, & Remley, 1999). However, due to many reasons related to preterm birth, as many as 70% of mothers cannot provide a sufficient amount of breastmilk to meet the demands of these infants, therefore, a supplement is necessary (Callen & Pinelli, 2005). Currently in Canada, either pasteurized donor breastmilk (donor milk) or preterm formula is used as a supplement to mother’s milk.
It is well known that the rate of weight gain of very low birth weight infants during initial hospitalization is influenced by both the type (mother’s milk, donor, or formula) and nutrient composition of their enteral feeds (Aimone et al., 2009; Poindexter, Langer, Dusick, & Ehrenkranz, 2006). In addition, it has been shown that the postnatal growth rate positively influences neurodevelopment (Ehrenkranz et al., 2006; Latal-Hajnal, von Siebenthal, Kovari, Bucher, & Largo, 2003; Sammallahti et al., 2014). However, rapid weight gain or catch-up growth is also associated with greater fat mass in childhood (Singhal et al., 2010) and higher blood pressure in adolescence (Singhal et al., 2007). In general, infants born prematurely have more fat mass and less fat-free mass than term babies in early life (Johnson, Wootton, Leaf, & Jackson, 2012), in childhood (Giannì et al., 2015), and in adulthood (Sipola-Leppanen et al., 2015). Moreover, preterm infants, particularly those born small-for-gestational age, are more likely to be obese and develop metabolic syndrome later in life (de Jong, Cranendonk, & van Weissenbruch, 2015; Sipola-Leppanen et al., 2015; Uthaya et al., 2005). Given the known positive association between rate of weight gain of very low birth weight infants during initial hospitalization and later neurodevelopment, a better understanding of the combination of feeding type and nutrient composition that maximizes brain development, but reduces the risk of obesity and chronic disease in adulthood, is urgently required.
Feeding donor milk to very low birth weight infants in the NICU may improve quality of growth and health outcomes later in life. Unlike preterm formula, pasteurized donor milk contains immunoglobulin, growth factors, and cytokines, which are important for gastrointestinal development and inflammation reduction (O’Connor, Ewaschuk, & Unger, 2015). Moreover, preterm infants fed human milk appear to develop less fat mass than those fed infant formula (Huang et al., 2016). However, infants fed fortified donor milk are known to experience slower postnatal growth rates than formula-fed infants (Schanler et al., 1999). Nevertheless, it is understood that the benefits of improved health outcomes greatly outweigh the slower growth rate associated with breastmilk consumption (Quigley & McGuire, 2014; O’Connor et al., 2016). Finally, it is unknown if donor milk compared to preterm formula is the ideal supplement to mother’s milk in very low birth weight infants.
Accumulating evidence emphasizes the potential for infant nutrition as a dominant and modifiable predictor of childhood obesity risk (Brands, Demmelmair, & Koletzko, 2014). However, no studies have examined the long-term impact of donor milk in comparison to preterm formula on the growth and body composition of very low birth weight infants. Understanding the role of donor milk and preterm formula in the programming of body composition of very low birth weight infants will provide important insights into potential nutritional strategies to support the growth and development of this population.
Aimone, A., Rovet, J., Ward, W., Jefferies, A., Campbell, D. M., Asztalos, E., … OʼConnor, D. L. (2009). Growth and Body Composition of Human Milk–fed Premature Infants Provided With Extra Energy and Nutrients Early After Hospital Discharge: 1-year Follow-up: Journal of Pediatric Gastroenterology and Nutrition, 49(4), 456–466. https://doi.org/10.1097/MPG.0b013e31819bc94b
Anderson, J. W., Johnstone, B. M., & Remley, D. T. (1999). Breast-feeding and cognitive development: a meta-analysis. American Journal of Clinical Nutrition, 70.
Brands, B., Demmelmair, H., & Koletzko, B. (2014). How growth due to infant nutrition influences obesity and later disease risk. Acta Paediatrica, 103(6), 578–585. https://doi.org/10.1111/apa.12593
Callen, J., & Pinelli, J. (2005). A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants. Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses, 5(2), 72–88; quiz 89–92.
de Jong, M., Cranendonk, A., & van Weissenbruch, M. M. (2015). Components of the metabolic syndrome in early childhood in very-low-birth-weight infants and term small and appropriate for gestational age infants. Pediatric Research, 78(4), 457–461. https://doi.org/10.1038/pr.2015.118
Ehrenkranz, R. A., Dusick, A. M., Vohr, B. R., Wright, L. L., Wrage, L. A., & Poole, W. K. (2006). Growth in the Neonatal Intensive Care Unit Influences Neurodevelopmental and Growth Outcomes of Extremely Low Birth Weight Infants. Pediatrics, 117(4), 1253–1261. https://doi.org/10.1542/peds.2005-1368
EMBRACEHER INNOVATIONS, INC. (2016). How to Pump and Store Breastmilk? [digital image]. Retrieved from http://www.embracefamilyhealth.com/how-to-pump-and-storage-breastmilk/
Giannì, M. L., Roggero, P., Piemontese, P., Morlacchi, L., Bracco, B., Taroni, F., … Mosca, F. (2015). Boys who are born preterm show a relative lack of fat-free mass at 5 years of age compared to their peers. Acta Paediatrica, 104(3), e119–e123. https://doi.org/10.1111/apa.12856
Huang, P., Zhou, J., Yin, Y., Jing, W., Luo, B., & Wang, J. (2016). Effects of breast-feeding compared with formula-feeding on preterm infant body composition: a systematic review and meta-analysis. British Journal of Nutrition, 116(1), 132–141. https://doi.org/10.1017/S0007114516001720
Hylander, M. A., Strobino, D. M., & Dhanireddy, R. (1998). Human milk feedings and infection among very low birth weight infants. Pediatrics, 102. https://doi.org/10.1542/peds.102.3.e38
Johnson, M. J., Wootton, S. A., Leaf, A. A., & Jackson, A. A. (2012). Preterm Birth and Body Composition at Term Equivalent Age: A Systematic Review and Meta-analysis. Pediatrics, 130(3), e640–e649. https://doi.org/10.1542/peds.2011-3379
Latal-Hajnal, B., von Siebenthal, K., Kovari, H., Bucher, H. U., & Largo, R. H. (2003). Postnatal growth in VLBW infants: significant association with neurodevelopmental outcome. The Journal of Pediatrics, 143(2), 163–170. https://doi.org/10.1067/S0022-3476(03)00243-9
O’Connor, D. L., Ewaschuk, J. B., & Unger, S. (2015). Human milk pasteurization: benefits and risks. Current Opinion in Clinical Nutrition and Metabolic Care, 18(3), 269–275. https://doi.org/10.1097/MCO.0000000000000160
O’Connor, D. L., Gibbins, S., Kiss, A., Bando, N., Brennan-Donnan, J., Ng, E., … Unger, S. (2016). Effect of Supplemental Donor Human Milk Compared With Preterm Formula on Neurodevelopment of Very Low-Birth-Weight Infants at 18 Months: A Randomized Clinical Trial. JAMA, 316(18), 1897–1905. https://doi.org/10.1001/jama.2016.16144
Patel, A. L., Johnson, T. J., Engstrom, J. L., Fogg, L. F., Jegier, B. J., Bigger, H. R., & Meier, P. P. (2013). Impact of early human milk on sepsis and health-care costs in very low birth weight infants. Journal of Perinatology, 33(7), 514–519. https://doi.org/10.1038/jp.2013.2
Poindexter, B. B., Langer, J. C., Dusick, A. M., & Ehrenkranz, R. A. (2006). Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. The Journal of Pediatrics, 148(3), 300–305. https://doi.org/10.1016/j.jpeds.2005.10.038
Quigley, M., & McGuire, W. (2014). Formula versus donor breast milk for feeding preterm or low birth weight infants. In Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. Retrieved from http://onlinelibrary.wiley.com.myaccess.library.utoronto.ca/doi/10.1002/14651858.CD002971.pub3/abstract
Saigal, S., & Doyle, L. W. (2008). An overview of mortality and sequelae of preterm birth from infancy to adulthood. The Lancet, 371(9608), 261–269. https://doi.org/10.1016/S0140-6736(08)60136-1
Sammallahti, S., Pyhälä, R., Lahti, M., Lahti, J., Pesonen, A.-K., Heinonen, K., … Räikkönen, K. (2014). Infant growth after preterm birth and neurocognitive abilities in young adulthood. The Journal of Pediatrics, 165(6), 1109–1115.e3. https://doi.org/10.1016/j.jpeds.2014.08.028
Schanler, R. J., Shulman, R. J., & Lau, C. (1999). Feeding strategies for premature infants: Beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics, 103. https://doi.org/10.1542/peds.103.6.1150
Singhal, A., Cole, T. J., Fewtrell, M., Kennedy, K., Stephenson, T., Elias-Jones, A., & Lucas, A. (2007). Promotion of Faster Weight Gain in Infants Born Small for Gestational Age. Circulation, 115(2), 213–220. https://doi.org/10.1161/CIRCULATIONAHA.106.617811
Singhal, A., Kennedy, K., Lanigan, J., Fewtrell, M., Cole, T. J., Stephenson, T., … Lucas, A. (2010). Nutrition in infancy and long-term risk of obesity: evidence from 2 randomized controlled trials. The American Journal of Clinical Nutrition, 92(5), 1133–1144. https://doi.org/10.3945/ajcn.2010.29302
Sipola-Leppanen, M., Vaarasmaki, M., Tikanmaki, M., Matinolli, H.-M., Miettola, S., Hovi, P., … Kajantie, E. (2015). Cardiometabolic Risk Factors in Young Adults Who Were Born Preterm. American Journal of Epidemiology, 181(11), 861–873. https://doi.org/10.1093/aje/kwu443
Sisk, P. M., Lovelady, C. A., Gruber, K. J., Dillard, R. G., & O’Shea, T. M. (2008). Human milk consumption and full enteral feeding among infants who weight < = 1250 grams. Pediatrics, 121. https://doi.org/10.1542/peds.2007-2110
Uthaya, S., Thomas, E. L., Hamilton, G., Doré, C. J., Bell, J., & Modi, N. (2005). Altered Adiposity after Extremely Preterm Birth. Pediatric Research, 57(2), 211–215. https://doi.org/10.1203/01.PDR.0000148284.58934.1C
Yoshioka, H., Iseki, K., & Fujita, K. (1983). Development and differences of intestinal flora in the neonatal period in breast-fed and bottle-fed infants. Pediatrics, 72.
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