Finding Potential in Another Mother’s Breastmilk

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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.

References

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