Evolución durante el ingreso de recién nacidos de muy bajo peso alimentados al inicio exclusivamente con leche humana

Abstract

INTRODUCTION: The feeding of human milk (HM) conveys substantial benefits to very low birth weight (VLBW) infants. Nevertheless, previous research reports slow growth among preterm infants fed unfortified human donor milk (DM). Postnatal growth predicts health outcomes of VLBW infants, therefore promoting growth is an important aspect of the management of preterm infants in the neonatal intensive care unit (NICU). The aim of our study was to compare hospital outcomes of any formula-fed (PF) infants with those of only human milk-fed (HM) infants. We have examined growth and breastfeeding rate at discharge before and after gaining access to banked donor human milk. PATIENTS AND METHOD: Non-randomized historically controlled study. Banked donor milk was available from April the 1st, 2009. 186 VLBW infants admitted to our NICU were enrolled. We compared outcomes of 72 VLBW infants who received any formula (pre DM policy) with those of 114 VLBW infants who received only human milk (post DM policy). RESULTS: HM and PF infants had similar baseline characteristics. Receipt of an exclusive diet of human milk was associated with significantly higher weight by 36 weeks postmenstrual age and at discharge (168 and 231 grams, respectively). Weight z-score reached its nadir by 36 weeks postmenstrual age, and it was lower among formula-fed infants (-2. 13 versus -1. 67, p=0. 018). Loss of weight z-score was significantly lower among HM-fed infants than among those formula-fed by day 28 of life and by 36 weeks postmenstrual age (-0. 74 versus -1. 00, p 0. 001; -1. 07 versus -1. 38, p=0. 027, respectively). Change in length or head circumference from birth to discharge did not differ significantly by feeding type. A non-significant difference of any breastfeeding and exclusive breastfeeding rates at discharge in favor of HM-fed infants was discharge in favor of HM-fed infants was observed (77. 8% versus 69. 1% and 49. 1% versus 39. 7%, respectively). Our multivariate analysis confirmed that proportions of retinopathy of prematurity grades 2 and 3 (aOR=0. 174, IC 95%=0. 056-0. 537, p=0. 002) and acute kidney injury were significantly higher among formula infants (aOR=0. 312, IC 95%=0. 060-0. 752, p=0. 016). CONCLUSIONS: Early exclusive human milk feeding of the VLBW infant has decreased rates of acute kidney injury and severe retinopathy of prematurity. Human milk was shown to enhance the growth of VLBW infants, compared with formula. Presence of a human milk bank does not decrease breastfeeding rates at discharge. VLBW infants have the right to be fed only human milk.

Date of Award	11 Dec 2015
Original language	Spanish
Awarding Institution	Vall d'Hebron University Hospital (HUVH)
Supervisor	Sergio Verd Vallespir (Director) & Isabel Badell Serra (Director)