Dose-dependent effect of human milk on Bronchopulmonary dysplasia in very low birth weight infants

Abstract

Background and aim Human milk has potential protective effects against bronchopulmonary dysplasia (BPD). However, studies on the association between the dose of human milk and BPD in China are limited. This study aimed to evaluate the dose-dependent effects of human milk on BPD and other neonatal morbidities in very low birth weight (VLBW) infants. Methods This retrospective cohort study of preterm infants was conducted on preterm infants of gestational age ≤ 34 weeks and birth weight < 1500 g admitted to the multicenter clinical research database for breastfeeding quality improvement in Jiangsu province. The multivariate analysis was performed to compare the effect outcomes of daily graded doses [1–24 mL/(kg · day), 25–49 mL/(kg · day), and ≥ 50 mL/(kg · day) of body weight] of human milk on neonatal outcomes throughout the first 4 weeks of life versus a reference group receiving no human milk. The models were adjusted for potential confounding variables. Results Of 964 included infants, 279 (28.9%) received exclusive preterm formula, 128 (13.3%) received 1–24 ml/(kg · day), 139 (14.4%) received 25–49 ml/(kg · day), and 418 (43.4%) received ≥50 ml/(kg · day) human milk for the first 4 weeks of life. Compared with infants receiving exclusive formula, those receiving the highest volume of human milk daily [≥50 mL/(kg · day)] had lower incidences of BPD [27.5% in ≥50 mL/(kg · day) vs 40.1% in 0 mL/(kg · day) human milk, P = 0.001)], moderate and severe BPD [8.9% in ≥50 mL/(kg · day) vs 16.1% in 0 mL/(kg · day), P = 0.004], necrotizing enterocolitis [NEC; 3.8% in ≥50 mL/(kg · day) vs 10.8% in 0 mL/(kg · day), P = 0.001], late-onset sepsis [LOS; 9.3% in ≥50 mL/(kg · day) vs 19.7% in 0 mL/(kg · day), P <0.01], and extrauterine growth retardation [EUGR; 38.5% in ≥50 mL/(kg · day) vs 57.6% in 0 mL/(kg · day), P <0.01)]. The logistic regression indicated that those receiving ≥50 ml/kg · day human milk had lower odds of BPD [adjusted odds ratio (AOR) 0.453; 95% confidence interval (CI): 0.309, 0.666], moderate and severe BPD (AOR 0.430; 95% CI: 0.249, 0.742), NEC (AOR 0.314; 95% CI: 0.162, 0. 607), LOS (AOR 0.420; 95% CI: 0.263, 0.673), and EUGR (AOR 0.685; 95% CI: 0.479, 0.979). Conclusions A daily threshold amount of ≥50 ml/(kg · day) human milk in the first 4 weeks of life was associated with lower incidence of BPD as well as NEC, LOS, and EUGR in VLBW infants. Trial registration ClinicalTrials.gov Identifier: NCT03453502. Registration date: March 5, 2018. This study was retrospectively registered.

Human breast milk‐derived exosomes through inhibiting AT II cell apoptosis to prevent bronchopulmonary dysplasia in rat lung

“…A previous study indicated that HBM feeding can reduce the incidence of BPD 14,15,30 . HBM has antioxidant components, to reduce oxidative stress in premature infants and reduce the occurrence of BPD 31 .…”

“…29 A previous study indicated that HBM feeding can reduce the incidence of BPD. 14,15,30 HBM has antioxidant components, to reduce oxidative stress in premature infants and reduce the occurrence of BPD. 31 The HBM-Exo can contain large amounts of antioxidants that are protected from digestion and absorption by the gastrointestinal tract, thus entering the epithelial cells of the lung to against lung damage.…”

Quality Improvement to Increase Breastfeeding in Preterm Infants: Systematic Review and Meta-Analysis

“…A prospective cohort study (41) found that a considerable proportion (60.7%) of very-low-birth-weight infants without breastfeeding at discharge received high-dose breastfeeding within 14 and 28 days after birth; some had received higher amounts of MOM than infants who received exclusive and partial MOM at discharge. Early high-dose breastfeeding can significantly reduce the risk of a variety of morbidities in very-low-birth-weight patients, including LOS, NEC, and BPD, and reduce the associated costs (42)(43)(44). This emphasizes the need to collect the dose of BM (in mL/kg/d or as a proportion of total enteral feeding).…”

T Lymphocytes, Multi-Omic Interactions and Bronchopulmonary Dysplasia

“…Therefore, besides its nutritional benefits, breastfeeding may have a positive impact on the incidence of BPD exploiting this and possibly other, yet undiscovered mechanisms. Indeed, Xu et al have recently reported that a daily threshold amount of 50 ml/kg/day or more of human milk in the first 4 weeks of life was associated with lower incidence of BPD ( 63 ).…”