PEDIATRICS Vol. 122 No. 3 September 2008, pp. 687-688 (doi:10.1542/peds.2008-2006)
LETTER TO THE EDITOR |
Human Milk Intake and Retinopathy of Prematurity in Extremely Low Birth Weight Infants: In Reply
T. Michael O'Shea, MD, MPHDepartment of Pediatrics,
Wake Forest University School of Medicine,
Winston-Salem, NC 27157
John Langer, MS
RTI International,
Research Triangle Park, NC 27709-2194
Dale Phelps, MD
Department of Pediatrics,
University of Rochester School of Medicine and Dentistry,
Rochester, NY 14642
We appreciate the writers' interest in our study. We agree with their list of the limitations of our study, which, with 1 exception, were acknowledged in our discussion. Regarding the effect of glutamine supplementation on the risk of retinopathy of prematurity (ROP), we stated that "[t]he group to which infants were randomized in the glutamine supplementation trial (from which the nutritional data for this study were obtained) did not influence either HM [human milk] intake or ROP outcome."1
In response to the authors' assertion that "[a] satisfactory study of potential associations between HM intake and ROP... would not be observational," we can point to the role of observational epidemiology in improving human health (eg, observational studies of prone sleeping and sudden infant death syndrome2–4 and of the benefits of HM for very low birth weight infants5,6).
The referenced quantity of HM feeding (67%–83%) cited by Raghuveer and Belmont is based on data collected between 1 and 8 weeks' postnatal age,7 an interval that differs from that over which HM data were collected in our study. The study cited by Raghuveer and Belmont is notable for its small sample size (7 infants with, and 7 without, retinal detachment) and the lack of adjustment for potential confounders such as sepsis (which occurred 3 times more frequently among cases).
We acknowledge many potential limitations of our study and, therefore, disagree with the writers' assertion that our conclusions "seem to be premature." We do agree (as is always true when one makes inferences on the basis of a sample) that different conclusions might arise from a study of extremely low birth weight (ELBW) infants exposed to different amounts of HM, supplemental iron, or supplemental oxygen.
Although we agree with the authors' statement that additional research of the HM-ROP relationship is needed, we offer the opinion that the study design they describe (ie, randomization to HM or formula) is unlikely to succeed, because mothers who intend to provide HM to their ELBW infants will not accept the risk of their infant being randomly assigned to receive infant formula instead. Trials have been completed among infants whose mothers choose formula feeding by randomly assigning infants to receive either banked HM or formula.8,9 As an alternative, we suggest a randomized trial of an intervention to enhance milk production and expression among mothers who have chosen to provide HM to their ELBW infant. For such a trial we agree with the writers' recommendation of uniform approaches to iron supplementation and oxygen supplementation (ie, uniform oxygen saturation "targets").
REFERENCES
- Heller CD, O'Shea M, Yao Q, et al. Human milk intake and retinopathy of prematurity in extremely low birth weight infants.
Pediatrics. 2007;120
(1):1
–9
[Abstract/Free Full Text] - Taylor JA, Krieger JW, Reay DT, Davis RL, Harruff R, Cheney LK. Prone sleep position and the sudden infant death syndrome in King County, Washington: a case-control study. J Pediatr. 1996;128 (5 pt 1):626 –630[CrossRef][Web of Science][Medline]
- Irgens LM, Markestad T, Baste V, Schreuder P, Skjaerven R, Oyen N. Sleeping position and sudden-infant-death-syndrome in Norway 1967–91.
Arch Dis Child. 1995;72
(6):478
–482
[Abstract/Free Full Text] - American Academy of Pediatrics, Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk.
Pediatrics. 2005;116
(5):1245
–1255
[Abstract/Free Full Text] - Sisk PM, Lovelady CA, Gruber KJ, Dillard RG, O'Shea TM. Human milk consumption and full enteral feeding among infants who weigh
1250 grams.
Pediatrics. 2008;121
(6). Available at: www.pediatrics.org/cgi/content/full/121/6/e1528 - Sisk PM, Lovelady CA, Dillard RG, Gruber KJ, O'Shea TM. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol. 2007;27 (7):428 –433[CrossRef][Web of Science][Medline]
- Okamoto T, Shirai M, Kokubo M, et al. Human milk reduces the risk of retinal detachment in extremely low-birth weight infants. Pediatr Int. 2007;49 (6):894 –897[CrossRef][Web of Science][Medline]
- Schanler RJ, Lau C, Hurst NM, Smith EO. Randomized trial of donor human milk versus preterm formula as substitutes for mothers' own milk in the feeding of extremely premature infants.
Pediatrics. 2005;116
(2):400
–406
[Abstract/Free Full Text] - Lucas A, Gore SM, Cole TJ, et al. Multicentre trial on feeding low birthweight infants: effects of diet on early growth.
Arch Dis Child. 1984;59
(8):722
–730
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics
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