Feeding donor human milk versus preterm formula during birth hospitalization, which is better for preterm infants? Study sheds light

"In the randomized clinical trial, the Bayley Scales of Infant and Toddler Development (BSID) adjusted mean cognitive score for infants fed donor human milk was 80.7 (measured at 22-26 months corrected age) versus 81.1 for infants fed preterm formula (adjusted between-group mean difference, −0.77), which was not a significant difference," the researchers reported. Also, there was no difference in the adjusted mean language and motor scores.

Maternal milk feeding of extremely preterm infants during birth hospitalization has been linked with better neurodevelopmental outcomes compared to the preterm formula. For infants receiving no or minimal maternal milk, there is no information on whether donor human milk conveys similar neurodevelopmental advantages versus preterm formula.

To fill this knowledge gap, Tarah T. Colaizy, University of Iowa, Iowa City, and colleagues aimed to determine if among extremely preterm infants who received minimal maternal milk, nutrient-fortified, pasteurized donor human milk improves neurodevelopmental outcomes at 22 to 26 months corrected age compared with preterm infant formula.

For this purpose, the research team conducted a double-blind, randomized clinical trial at 15 US academic medical centres within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study enrolled infants younger than 29 weeks 0 days gestation or with a birth weight of less than 1000 g between 2012 and 2019.

Exposures were preterm formula or donor human milk feeding from randomization to 120 days of age, death, or hospital discharge. • Of 1965 eligible infants, 483 were randomized (239 in the donor milk group and 244 in the preterm formula group); the median gestational age was 26 weeks, the median birth weight was 840 g, and 52% were female.

The study's primary outcome was the BSID cognitive score measured at 22 to 26 months corrected age; a score of 54 (score range, 54-155; a score of ≥85 indicates no neurodevelopmental delay) was assigned to infants who died between randomization and 22 to 26 months corrected age. The 24 secondary outcomes included BSID language and motor scores, necrotizing enterocolitis, in-hospital growth, and death.

Key findings of the study include:

• Fifty-four infants died before follow-up; 88% of survivors were assessed at 22 to 26 months of corrected age.
• The adjusted mean BSID cognitive score was 80.7 for the donor milk group vs 81.1 for the preterm formula group (adjusted mean difference, −0.77, which was not significant); the adjusted mean BSID language and motor scores also did not differ.
• Mortality (death before follow-up) was 13% in the donor milk group vs 11% in the preterm formula group (adjusted risk difference, −1%).
• Necrotizing enterocolitis occurred in 4.2% of infants in the donor milk group vs 9.0% of infants in the preterm formula group (adjusted risk difference, −5%).
• Weight gain was slower in the donor milk group (22.3 g/kg/d) compared with the preterm formula group (24.6 g/kg/d).

"Neurodevelopmental outcomes at 22 to 26 months’ corrected age did not differ between infants fed donor milk or preterm formula, among extremely preterm neonates fed minimal maternal milk," the researchers concluded.

Reference:

Colaizy TT, Poindexter BB, McDonald SA, et al. Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula: A Randomized Clinical Trial. JAMA. Published online January 30, 2024. doi:10.1001/jama.2023.27693