1. Longer and more maternal milk intake was associated with better academic performance and reduced symptoms of attention-deficit/hyperactivity disorder (ADHD) in premature infants.

2. Benefits of maternal milk were greater in infants born at lowest gestational ages.

 Evidence Rating Level: 2 (Good)

 Infants born pre-term have increased mortality and morbidity and are at risk for long-term neurodevelopmental sequelae. Although maternal milk has been shown to positively affect neurodevelopment in full-term infants, this same benefit is less clear for pre-term infants.

This prospective cohort study included 586 preterm infants (53.6% male) to evaluate the association between maternal milk feeding on cognitive and behavioral outcomes.  Infants born less than 33-week gestation across 5 different Australian hospitals were included from January 2001 to December 2005. The primary exposure was mean volume of maternal milk ingested during hospitalization and duration of maternal milk feeding determined at follow-up visits at 4, 12, and 18 months. Neurodevelopment outcomes including 1) IQ, 2) academic achievement, 3) symptoms of attention-deficit/hyperactivity disorder (ADHD), 4) executive function, and 5) behavior were measured when infants reached 7 years of age. The association was adjusted for potential confounding covariates such as income, education level, occupation, race, alcohol use, and number of people living in the home.

Both higher maternal milk intake and longer duration of maternal milk intake during hospitalization were independently associated with higher cognitive performance, better academic achievements, and fewer symptoms of ADHD. Maternal milk exposure was not associated with executive function or behavior. Despite this, the study was limited due to the exclusion of donor human milk as a potential substitute for maternal milk. As a result, whether breast milk in general could provide similar benefits in preterm infants with no access to maternal milk remains to be determined. However, this large cohort study offers preliminary evidence that maternal milk could provide long-term benefits for pre-term infants.

Click to read study in: JAMA Network Open 

Image: PD

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