Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula

Deborah L. O'Connor, Joan Jacobs, Robert Hall, David Adamkin, Nancy Auestad, Marcella Castillo, William E. Connor, Sonja L. Connor, Kathleen Fitzgerald, Sharon Groh-Wargo, E. Eugenie Hartmann, Jeri Janowsky, Alan Lucas, Dean Margeson, Patricia Mena, Martha Neuringer, Gail Ross, Lynn Singer, Terence Stephenson, Joanne Szabo & 1 others Vance Zemon

    Research output: Contribution to journalArticle

    121 Citations (Scopus)

    Abstract

    Background: In a recent meta-analysis, human milk feeding of low birth-weight (LBW) infants was associated with a 5.2 point improvement in IQ tests. However, in the studies in this meta-analysis, feeding regimens were used (unfortified human milk, term formula) that no longer represent recommended practice. Objective: To compare the growth, in-hospital feeding tolerance, morbidity, and development (cognitive, motor, visual, and language) of LBW infants fed different amounts of human milk until term chronologic age (CA) with those of LBW infants fed nutrient-enriched formulas from first enteral feeding. Methods: The data in this study were collected in a previous randomized controlled trial assessing the benefit of supplementing nutrient-enriched formulas for LBW infants with arachidonic acid and docosahexaenoic acid. Infants (n = 463, birth weight, 750-1,800 g) were enrolled from nurseries located in Chile, the United Kingdom, and the United States. If human milk was fed before hospital discharge, it was fortified (3,050-3,300 kJ/L, 22-24 kcal/oz). As infants were weaned from human milk, they were fed nutrient-enriched formula with or without arachidonic and docosahexaenoic acids (3,300 kJ/L before term, 3,050 kJ/L thereafter) until 12 months CA. Formula fed infants were given nutrient-enriched formula with or without added arachidonic and docosahexaenoic acids (3,300 kJ/L to term, 3,050 kJ/L thereafter) until 12 months CA. For the purposes of this evaluation, infants were categorized into four mutually exclusive feeding groups: 1) predominantly human milk fed until term CA (PHM-T, n = 43); 2) ≥ 50% energy from human milk before hospital discharge (≥ 50% HM, n = 98); 3) <50% of energy from human milk before hospital discharge (<50% HM, n = 203); or 4) predominantly formula fed until term CA (PFF-T, n = 119). Results: PFF-T infants weighed approximately 500 g more at term CA than did PHM-T infants. This absolute difference persisted until 6 months CA. PFF-T infants were also longer (1.0-1.5 cm) and had larger head circumferences (0.3-1.1 cm) than both PHM-T and ≥ 50% HM infants at term CA. There was a positive association between duration of human milk feeding and the Bayley Mental Index at 12 months CA (P = 0.032 full and P = 0.073 reduced, statistical models) after controlling for the confounding variables of home environment and maternal intelligence. Infants with chronic lung disease fed ≥ 50% HM until term CA (n = 22) had a mean Bayley Motor Index about 11 points higher at 12 months CA compared with infants PFF-T (n = 24, P = 0.033 full model). Conclusion: Our data suggest that, despite a slower early growth rate, human milk fed LBW infants have development at least comparable to that of infants fed nutrient-enriched formula. Exploratory analysis suggests that some subgroups of human milk fed LBW infants may have enhanced development, although this needs to be confirmed in future studies.

    Original languageEnglish (US)
    Pages (from-to)437-446
    Number of pages10
    JournalJournal of Pediatric Gastroenterology and Nutrition
    Volume37
    Issue number4
    DOIs
    StatePublished - Oct 2003

    Fingerprint

    Infant Formula
    infant formulas
    Human Milk
    breast milk
    Growth and Development
    Premature Infants
    growth and development
    low birth weight
    Low Birth Weight Infant
    Food
    docosahexaenoic acid
    arachidonic acid
    Arachidonic Acids
    nutrients
    meta-analysis
    Meta-Analysis
    infant development
    cognitive development
    head circumference
    feed formulation

    Keywords

    • Development
    • Formula feeding
    • Growth
    • Human milk
    • Infant nutrition
    • Low birth weight

    ASJC Scopus subject areas

    • Gastroenterology
    • Histology
    • Medicine (miscellaneous)
    • Food Science
    • Pediatrics, Perinatology, and Child Health

    Cite this

    Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula. / O'Connor, Deborah L.; Jacobs, Joan; Hall, Robert; Adamkin, David; Auestad, Nancy; Castillo, Marcella; Connor, William E.; Connor, Sonja L.; Fitzgerald, Kathleen; Groh-Wargo, Sharon; Hartmann, E. Eugenie; Janowsky, Jeri; Lucas, Alan; Margeson, Dean; Mena, Patricia; Neuringer, Martha; Ross, Gail; Singer, Lynn; Stephenson, Terence; Szabo, Joanne; Zemon, Vance.

    In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 37, No. 4, 10.2003, p. 437-446.

    Research output: Contribution to journalArticle

    O'Connor, DL, Jacobs, J, Hall, R, Adamkin, D, Auestad, N, Castillo, M, Connor, WE, Connor, SL, Fitzgerald, K, Groh-Wargo, S, Hartmann, EE, Janowsky, J, Lucas, A, Margeson, D, Mena, P, Neuringer, M, Ross, G, Singer, L, Stephenson, T, Szabo, J & Zemon, V 2003, 'Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula', Journal of Pediatric Gastroenterology and Nutrition, vol. 37, no. 4, pp. 437-446. https://doi.org/10.1097/00005176-200310000-00008
    O'Connor, Deborah L. ; Jacobs, Joan ; Hall, Robert ; Adamkin, David ; Auestad, Nancy ; Castillo, Marcella ; Connor, William E. ; Connor, Sonja L. ; Fitzgerald, Kathleen ; Groh-Wargo, Sharon ; Hartmann, E. Eugenie ; Janowsky, Jeri ; Lucas, Alan ; Margeson, Dean ; Mena, Patricia ; Neuringer, Martha ; Ross, Gail ; Singer, Lynn ; Stephenson, Terence ; Szabo, Joanne ; Zemon, Vance. / Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula. In: Journal of Pediatric Gastroenterology and Nutrition. 2003 ; Vol. 37, No. 4. pp. 437-446.
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    title = "Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula",
    abstract = "Background: In a recent meta-analysis, human milk feeding of low birth-weight (LBW) infants was associated with a 5.2 point improvement in IQ tests. However, in the studies in this meta-analysis, feeding regimens were used (unfortified human milk, term formula) that no longer represent recommended practice. Objective: To compare the growth, in-hospital feeding tolerance, morbidity, and development (cognitive, motor, visual, and language) of LBW infants fed different amounts of human milk until term chronologic age (CA) with those of LBW infants fed nutrient-enriched formulas from first enteral feeding. Methods: The data in this study were collected in a previous randomized controlled trial assessing the benefit of supplementing nutrient-enriched formulas for LBW infants with arachidonic acid and docosahexaenoic acid. Infants (n = 463, birth weight, 750-1,800 g) were enrolled from nurseries located in Chile, the United Kingdom, and the United States. If human milk was fed before hospital discharge, it was fortified (3,050-3,300 kJ/L, 22-24 kcal/oz). As infants were weaned from human milk, they were fed nutrient-enriched formula with or without arachidonic and docosahexaenoic acids (3,300 kJ/L before term, 3,050 kJ/L thereafter) until 12 months CA. Formula fed infants were given nutrient-enriched formula with or without added arachidonic and docosahexaenoic acids (3,300 kJ/L to term, 3,050 kJ/L thereafter) until 12 months CA. For the purposes of this evaluation, infants were categorized into four mutually exclusive feeding groups: 1) predominantly human milk fed until term CA (PHM-T, n = 43); 2) ≥ 50{\%} energy from human milk before hospital discharge (≥ 50{\%} HM, n = 98); 3) <50{\%} of energy from human milk before hospital discharge (<50{\%} HM, n = 203); or 4) predominantly formula fed until term CA (PFF-T, n = 119). Results: PFF-T infants weighed approximately 500 g more at term CA than did PHM-T infants. This absolute difference persisted until 6 months CA. PFF-T infants were also longer (1.0-1.5 cm) and had larger head circumferences (0.3-1.1 cm) than both PHM-T and ≥ 50{\%} HM infants at term CA. There was a positive association between duration of human milk feeding and the Bayley Mental Index at 12 months CA (P = 0.032 full and P = 0.073 reduced, statistical models) after controlling for the confounding variables of home environment and maternal intelligence. Infants with chronic lung disease fed ≥ 50{\%} HM until term CA (n = 22) had a mean Bayley Motor Index about 11 points higher at 12 months CA compared with infants PFF-T (n = 24, P = 0.033 full model). Conclusion: Our data suggest that, despite a slower early growth rate, human milk fed LBW infants have development at least comparable to that of infants fed nutrient-enriched formula. Exploratory analysis suggests that some subgroups of human milk fed LBW infants may have enhanced development, although this needs to be confirmed in future studies.",
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    author = "O'Connor, {Deborah L.} and Joan Jacobs and Robert Hall and David Adamkin and Nancy Auestad and Marcella Castillo and Connor, {William E.} and Connor, {Sonja L.} and Kathleen Fitzgerald and Sharon Groh-Wargo and Hartmann, {E. Eugenie} and Jeri Janowsky and Alan Lucas and Dean Margeson and Patricia Mena and Martha Neuringer and Gail Ross and Lynn Singer and Terence Stephenson and Joanne Szabo and Vance Zemon",
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    TY - JOUR

    T1 - Growth and development of premature infants fed predominantly human milk, predominantly premature infant formula, or a combination of human milk and premature formula

    AU - O'Connor, Deborah L.

    AU - Jacobs, Joan

    AU - Hall, Robert

    AU - Adamkin, David

    AU - Auestad, Nancy

    AU - Castillo, Marcella

    AU - Connor, William E.

    AU - Connor, Sonja L.

    AU - Fitzgerald, Kathleen

    AU - Groh-Wargo, Sharon

    AU - Hartmann, E. Eugenie

    AU - Janowsky, Jeri

    AU - Lucas, Alan

    AU - Margeson, Dean

    AU - Mena, Patricia

    AU - Neuringer, Martha

    AU - Ross, Gail

    AU - Singer, Lynn

    AU - Stephenson, Terence

    AU - Szabo, Joanne

    AU - Zemon, Vance

    PY - 2003/10

    Y1 - 2003/10

    N2 - Background: In a recent meta-analysis, human milk feeding of low birth-weight (LBW) infants was associated with a 5.2 point improvement in IQ tests. However, in the studies in this meta-analysis, feeding regimens were used (unfortified human milk, term formula) that no longer represent recommended practice. Objective: To compare the growth, in-hospital feeding tolerance, morbidity, and development (cognitive, motor, visual, and language) of LBW infants fed different amounts of human milk until term chronologic age (CA) with those of LBW infants fed nutrient-enriched formulas from first enteral feeding. Methods: The data in this study were collected in a previous randomized controlled trial assessing the benefit of supplementing nutrient-enriched formulas for LBW infants with arachidonic acid and docosahexaenoic acid. Infants (n = 463, birth weight, 750-1,800 g) were enrolled from nurseries located in Chile, the United Kingdom, and the United States. If human milk was fed before hospital discharge, it was fortified (3,050-3,300 kJ/L, 22-24 kcal/oz). As infants were weaned from human milk, they were fed nutrient-enriched formula with or without arachidonic and docosahexaenoic acids (3,300 kJ/L before term, 3,050 kJ/L thereafter) until 12 months CA. Formula fed infants were given nutrient-enriched formula with or without added arachidonic and docosahexaenoic acids (3,300 kJ/L to term, 3,050 kJ/L thereafter) until 12 months CA. For the purposes of this evaluation, infants were categorized into four mutually exclusive feeding groups: 1) predominantly human milk fed until term CA (PHM-T, n = 43); 2) ≥ 50% energy from human milk before hospital discharge (≥ 50% HM, n = 98); 3) <50% of energy from human milk before hospital discharge (<50% HM, n = 203); or 4) predominantly formula fed until term CA (PFF-T, n = 119). Results: PFF-T infants weighed approximately 500 g more at term CA than did PHM-T infants. This absolute difference persisted until 6 months CA. PFF-T infants were also longer (1.0-1.5 cm) and had larger head circumferences (0.3-1.1 cm) than both PHM-T and ≥ 50% HM infants at term CA. There was a positive association between duration of human milk feeding and the Bayley Mental Index at 12 months CA (P = 0.032 full and P = 0.073 reduced, statistical models) after controlling for the confounding variables of home environment and maternal intelligence. Infants with chronic lung disease fed ≥ 50% HM until term CA (n = 22) had a mean Bayley Motor Index about 11 points higher at 12 months CA compared with infants PFF-T (n = 24, P = 0.033 full model). Conclusion: Our data suggest that, despite a slower early growth rate, human milk fed LBW infants have development at least comparable to that of infants fed nutrient-enriched formula. Exploratory analysis suggests that some subgroups of human milk fed LBW infants may have enhanced development, although this needs to be confirmed in future studies.

    AB - Background: In a recent meta-analysis, human milk feeding of low birth-weight (LBW) infants was associated with a 5.2 point improvement in IQ tests. However, in the studies in this meta-analysis, feeding regimens were used (unfortified human milk, term formula) that no longer represent recommended practice. Objective: To compare the growth, in-hospital feeding tolerance, morbidity, and development (cognitive, motor, visual, and language) of LBW infants fed different amounts of human milk until term chronologic age (CA) with those of LBW infants fed nutrient-enriched formulas from first enteral feeding. Methods: The data in this study were collected in a previous randomized controlled trial assessing the benefit of supplementing nutrient-enriched formulas for LBW infants with arachidonic acid and docosahexaenoic acid. Infants (n = 463, birth weight, 750-1,800 g) were enrolled from nurseries located in Chile, the United Kingdom, and the United States. If human milk was fed before hospital discharge, it was fortified (3,050-3,300 kJ/L, 22-24 kcal/oz). As infants were weaned from human milk, they were fed nutrient-enriched formula with or without arachidonic and docosahexaenoic acids (3,300 kJ/L before term, 3,050 kJ/L thereafter) until 12 months CA. Formula fed infants were given nutrient-enriched formula with or without added arachidonic and docosahexaenoic acids (3,300 kJ/L to term, 3,050 kJ/L thereafter) until 12 months CA. For the purposes of this evaluation, infants were categorized into four mutually exclusive feeding groups: 1) predominantly human milk fed until term CA (PHM-T, n = 43); 2) ≥ 50% energy from human milk before hospital discharge (≥ 50% HM, n = 98); 3) <50% of energy from human milk before hospital discharge (<50% HM, n = 203); or 4) predominantly formula fed until term CA (PFF-T, n = 119). Results: PFF-T infants weighed approximately 500 g more at term CA than did PHM-T infants. This absolute difference persisted until 6 months CA. PFF-T infants were also longer (1.0-1.5 cm) and had larger head circumferences (0.3-1.1 cm) than both PHM-T and ≥ 50% HM infants at term CA. There was a positive association between duration of human milk feeding and the Bayley Mental Index at 12 months CA (P = 0.032 full and P = 0.073 reduced, statistical models) after controlling for the confounding variables of home environment and maternal intelligence. Infants with chronic lung disease fed ≥ 50% HM until term CA (n = 22) had a mean Bayley Motor Index about 11 points higher at 12 months CA compared with infants PFF-T (n = 24, P = 0.033 full model). Conclusion: Our data suggest that, despite a slower early growth rate, human milk fed LBW infants have development at least comparable to that of infants fed nutrient-enriched formula. Exploratory analysis suggests that some subgroups of human milk fed LBW infants may have enhanced development, although this needs to be confirmed in future studies.

    KW - Development

    KW - Formula feeding

    KW - Growth

    KW - Human milk

    KW - Infant nutrition

    KW - Low birth weight

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