Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e953-e959 (doi:10.1542/peds.2006-3227)

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ARTICLE

Persistent Beneficial Effects of Breast Milk Ingested in the Neonatal Intensive Care Unit on Outcomes of Extremely Low Birth Weight Infants at 30 Months of Age

Betty R. Vohr, MD^a, Brenda B. Poindexter, MD, MS^b, Anna M. Dusick, MD^b, Leslie T. McKinley, MS, RD^a, Rosemary D. Higgins, MD^c, John C. Langer, MSc^d, W. Kenneth Poole, PhD^d for the National Institute of Child Health and Human Development National Research Network

^a Department of Pediatrics, Brown Medical School, Providence, Rhode Island
^b Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
^c Center for Developmental Biology and Perinatal Medicine, National Institute of Child Health and Human Development, Rockville, Maryland
^d Research Triangle Institute, Research Triangle Park, North Carolina

BACKGROUND. We previously reported beneficial effects of breast milk ingestion by infants with extremely low birth weight in the NICU on developmental outcomes at 18 months’ corrected age. The objective of this study was to determine whether these effects of breast milk in infants with extremely low birth weight persisted at 30 months’ corrected age.

METHODS. Nutrition data, including enteral and parenteral feeds, were prospectively collected, and 30 months’ corrected age follow-up assessments were completed on 773 infants with extremely low birth weight who participated in the National Institute of Child Health and Human Development Neonatal Research Network Glutamine Trial. A total of 593 ingested some breast milk during the neonatal hospitalization, and 180 ingested none. Neonatal feeding characteristics and morbidities and 30-month interim history, neurodevelopmental outcomes, and growth parameters were analyzed. Children were divided into quintiles of breast milk volume to evaluate the effects of volume of human milk ingested during the NICU hospitalization.

RESULTS. At 30 months, increased ingestion of breast milk was associated with higher Bayley Mental Developmental Index scores, higher Bayley behavior score percentiles for emotional regulation, and fewer rehospitalizations between discharge and 30 months. There were no differences in growth parameters or cerebral palsy. For every 10 mL/kg per day increase in breast milk, the Mental Developmental Index increased by 0.59 points, the Psychomotor Developmental Index by 0.56 points, and the total behavior percentile score by 0.99 points, and the risk of rehospitalization between discharge and 30 months decreased by 5%.

CONCLUSIONS. Beneficial effects of ingestion of breast milk in the NICU persist at 30 months’ corrected age in this vulnerable extremely low birth weight population. Continued efforts must be made to offer breast milk to all extremely low birth weight infants both in the NICU and after discharge.

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Key Words: breast milk • extremely low birth weight • Bayley • outcomes

Abbreviations: ELBW—extremely low birth weight • BM—breast milk • CA—corrected age • BSID-II—Bayley Scales of Infant Development II • MDI—Mental Developmental Index • PDI—Psychomotor Developmental Index

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Accepted Mar 14, 2007.

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