Does breastfeeding in the neonatal period influence the cognitive function of very-low-birth-weight infants at 5 years of age?

doi:10.1016/j.braindev.2008.05.011

Brain and Development

Volume 31, Issue 4, April 2009, Pages 288-293

https://doi.org/10.1016/j.braindev.2008.05.011 Get rights and content

Abstract

Aim: Breast milk is rich in docosahexaenoic acid (DHA), which is selectively concentrated in neuronal membranes and is thought to be necessary for optimal neurodevelopment. This study evaluated the relationship between breastfeeding, especially the resultant DHA level in the red blood cell (RBC) membranes of infants, and the cognitive function of very-low-birth-weight infants at 5 years of age. Methods: Eighteen patients were classified into groups that were breastfed or formula-fed or both. We measured the DHA concentration in the RBC membranes of 18 preterm infants at 4 weeks of age. To evaluate cognitive function at the age of 5 years, we asked the children to perform five tests: the Kaufman Assessment Battery for Children, Day–Night Test, Kansas Reflection Impulsivity Scale for Preschoolers (KRISP), Motor Planning Test, and Strengths and Difficulties Questionnaire. Results: The DHA level at 4 weeks after birth was significantly higher in the breastfed infants than in the formula-fed infants. The scores for the Day–Night Test, KRISP, and Motor Planning Test were significantly higher in the breastfed group. There were significant correlations between the scores for the Day–Night Test and for the KRISP and the level of DHA at 4 weeks of age. Conclusion: Breastfeeding in the neonatal periods increases the DHA level in preterm infants and may have an important influence on brain development not only during early infancy but also during the preschool years, especially in terms of cognitive function.

Introduction

Numerous behavioral and biomedical studies conducted over the past 40 years have established a link between pediatric nutrition and cognitive development, especially intellectual competence. Several studies have shown a positive correlation between breastfeeding and cognitive development in children. A meta-analysis by Anderson et al. concluded that breastfeeding was associated with better cognitive performance, compared with formula-feeding [1], [2], [3], [4], [5], [6]. Their findings were adjusted for potential confounding variables such as parental education, socioeconomic status, gestational week, and birth-weight. These findings suggest that breast milk provides nutrients required for the development of the brain and that polyunsaturated fatty acids (PUFAs) are especially beneficial. Many studies suggest a relationship between PUFA and intellectual development. Others have found that giving pregnant women docosahexaenoic acid (DHA) supplements influences their children’s development [7], [8], [9], [10].

The long-term effects of breastfeeding and DHA on cognitive function have not been investigated adequately, especially in terms of the executive function of preterm children. Some studies have reported a low level of executive function in preterm infants compared with term infants, and this has been linked to low levels of DHA, an essential nutrient for infant development.

This study evaluates the relationship between breastfeeding, with a focus on the resultant DHA level in red blood cell (RBC) membranes in early infancy, and the cognitive function of very-low-birth-weight infants at 5 years of age.

Section snippets

Subjects

Thirty-eight infants were enrolled between 1999 and 2000 at Juntendo University Hospital in Tokyo, Japan. We measured the DHA concentration in the RBC membranes of 30 preterm infants at 4 weeks of age. We identified 38 premature infants using our enrollment criteria. Of these, 26 subjects were invited to participate in development tests. Twelve subjects were excluded: 4 had moderate or severe cerebral palsy, 4 were missing DHA data for the neonatal period, 2 had very severe chronic lung

Study population

Table 1 presents the birth data and other characteristics of the study population. The 18 patients were classified into either the breastfed group (BM; n = 10) or the group fed formula with or without breast milk (formula; n = 8). The breastfeeding group was defined as the group fed milk consisting of more than 80% breast milk during the first month of life. The infants fed less than 80% breast milk were classified as the control group. Based on your comments, we added this to the text. And the

Discussion

This is the first study to examine the relationship between breastfeeding in the neonatal periods and cognitive function of preterm children at 5 years of age in Japan. Our findings indicate that breastfeeding in neonatal periods improves cognitive function, especially executive function, at 5 years of age. In addition, breastfeeding increased the DHA level in preterm infants at 1 month of age. Our findings indicate that the DHA supplied by breastfeeding has a positive effect on the development

Acknowledgement

We thank Dr. Willatts, Peter, Department of Psychology, University of Dundee, UK, for giving advice on this study.

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Original articleDoes breastfeeding in the neonatal period influence the cognitive function of very-low-birth-weight infants at 5 years of age?

Abstract

Introduction

Section snippets

Subjects

Study population

Discussion

Acknowledgement

Soc Sci Med

Early Hum Dev

Am J Clin Nutr

Prostanglandins Leukot Essent Fatty Acids

Cognition

J Am Acad Child Adolesc Psychiatry

Breast feeding and cognitive development at age 1 and 5 years

Arch Dis Child

Breastfeeding effects on intelligence quotient in 4- and 11-year old children

Pediatrics

Breast-feeding and child development at 5 years

Dev Med Child Neurol

Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal development

Acta Paediatr

Original article
Does breastfeeding in the neonatal period influence the cognitive function of very-low-birth-weight infants at 5 years of age?