Elsevier

The Journal of Pediatrics

Volume 169, February 2016, Pages 76-80.e4
The Journal of Pediatrics

Original Article
Does Breastmilk Influence the Development of Bronchopulmonary Dysplasia?

https://doi.org/10.1016/j.jpeds.2015.10.080Get rights and content

Objective

To assess whether breastmilk feeding is associated with a reduced risk of bronchopulmonary dysplasia (BPD). Secondary outcome measures analyzed were retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC).

Study design

In an ongoing multicenter cohort study, the data of 1433 very low birth weight infants born before 32 weeks of gestation and discharged in 2013 were analyzed. We compared growth and neonatal complications of infants who received breastmilk exclusively (N = 223) with those who received formula feedings exclusively (N = 239). Logistic regression models were estimated for BPD, ROP, and NEC using nutrition as an independent variable. The Firth logistic regression model and Lasso were used for sensitivity analyses.

Results

Exclusively breastmilk-fed infants gained less weight compared with formula-fed infants. SDS for weight decreased between birth and discharge (median (Q1-Q3): formula −0.9 (−1.4 to [−0.5]) vs breastmilk −1.1 (−1.7 to [−0.6])). Exclusive formula feeding of very low birth weight infants was associated with increased risks of BPD (OR 2.6) as well as NEC (OR 12.6) and ROP (OR 1.80) after controlling for known risk factors.

Conclusions

Exclusive breastmilk feeding was associated with lower growth rates and a reduced risk of BPD as well as NEC and ROP.

Section snippets

Methods

The German Neonatal Network studies the long-term effects of genetic, clinical, and social risk factors as well as center specific treatment strategies. In 2013, 48 centers in Germany (Appendix; available at www.jpeds.com) prospectively collected clinical data for this study. Data quality was maintained by yearly on-site monitoring. We restricted our analysis to infants from 22+0 to 31+6 weeks of gestation who were discharged alive.

Our study was not designed to evaluate the influence of

Results

A total of 1433 VLBW infants with a gestational age of less than 32 weeks were discharged in 2013. The number of infants included in each center varied from 4-113. Only 2 centers contributed less than 10 infants, most centers between 30 and 60 infants, and 5 centers contributed more than 80 infants. Rates of exclusively formula-fed infants varied from 0%-49%, and rates of exclusively breastmilk-fed infants from 0%-75% within the participating centers. Furthermore, 239/1433 (17%) received no

Discussion

Exclusive breastmilk feeding was associated with a lower risk of BPD as well as NEC and ROP after controlling for known risk factors. Results for BPD, NEC, and ROP remained significant after adjusting for multiple testing. Like Schanler et al,5 we found a reduced rate of BPD in the group of exclusively breastmilk-fed infants. Schanler et al5 and O'Connor et al8 used the same definition for BPD as we used. However, Schanler et al5 included only infants whose mothers intended to breastfeed. They

References (29)

  • R.J. Schanler et al.

    Randomized trial of donor human milk versus preterm formula as substitutes for mothers' own milk in the feeding of extremely premature infants

    Pediatrics

    (2005)
  • A. Maayan-Metzger et al.

    Human milk versus formula feeding among preterm infants: short term outcomes

    Am J Perinatol

    (2012)
  • A. Sullivan et al.

    An exclusively human milk based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products

    J Pediatr

    (2010)
  • D.L. O'Connor et al.

    Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula

    J Pediatr Gastroenterol Nutr

    (2003)
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    GNN is funded by the German Ministry for Education and Research (01ER0805 and 01ER1501). The authors declare no conflicts of interest.

    List of GNN study group members is available at www.jpeds.com (Appendix).

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