Early feeding choices do not influence neurodevelopment in extremely preterm infants

Neurodevelopmental outcomes among extremely preterm neonates are not different between those fed donor milk and those fed preterm formula, according to a study.

The study included 483 infants (median gestational age 26 weeks, median birth weight was 840 g, 52 percent girls) who received minimal maternal milk. These infants were randomly assigned to groups fed preterm formula (n=244) or donor human milk (n=239) through 120 days of age, death, or hospital discharge.

The primary outcome of Bayley Scales of Infant and Toddler Development (BSID) cognitive score (score range, 54–155; a score of ≥85 indicates no neurodevelopmental delay) was measured at 22 to 26 months’ corrected age, with a score of 54 being assigned to infants who died between randomization and 22 to 26 months’ corrected age. Secondary outcomes included BSID language and motor scores, in-hospital growth, necrotizing enterocolitis, and death.

Of the infants, 54 died prior to follow-up, leaving 376 (88 percent) in the study. The adjusted mean BSID cognitive score did not significantly differ between the donor milk group and the preterm formula group (80.7 vs 81.1; adjusted mean difference, −0.77, 95 percent confidence interval [CI], −3.93 to 2.39). Likewise, there was no significant between-group difference in the adjusted mean BSID language and motor scores.

Death prior to follow-up was documented in 13 percent of infants in the donor milk group and in 11 percent of those in the preterm formula group (adjusted risk difference, −1 percent, 95 percent CI, −4 to 2). Necrotizing enterocolitis occurred in 4.2 percent and 9.0 percent of infants in the respective groups (adjusted risk difference, −5 percent, 95 percent CI, −9 to −2).

Infants in the donor milk group had a slower weight gain compared with those in the preterm formula group (22.3 vs 24.6 g/kg/d).