Breast-feeding the preterm

In order to catch up a little with the last month’s publications, I will post a few things with grouped studies that seem to me to be related.

Alves E, Rodrigues C, Fraga S, Barros H, Silva S: Parents’ views on factors that help or hinder breast milk supply in neonatal care units: Systematic review. Archives of Disease in Childhood – Fetal and Neonatal Edition 2013. In a very small number of studies, parents (almost exclusively mothers) felt that knowledge regarding breast-feeding, and reinforcement of the mother’s motivation, as well as flexibility in NICU routines that impact on breast-feeding were important.

Menon G, Williams TC: Human milk for preterm infants: Why, what, when and how? Archives of Disease in Childhood – Fetal and Neonatal Edition 2013. A quick overview of some of the issues regarding breast milk and the preterm. Overstates I think, the proven benefits (there is almost no good evidence that late onset sepsis is reduced, for example, it may well be true, but the evidence is very weak). I think that is important because the better supported benefits (reduced NEC and improved long-term outcomes) are enough to drive a much more active approach to improving breast-feeding rates, without stretching the evidence. They list some of the unknowns regarding maternal and donor breast milk in the preterm. For maternal breast milk the major concerns I think are 1. How important is CMV transmission, and what is the best way to reduce it; and 2. How to individualize fortification of breast milk to achieve optimal outcomes. For donor breast milk the questions are 1. how to assure nutritional quality control, and 2. how to minimize the adverse effects of pasteurization.

Cooper AR, Barnett D, Gentles E, Cairns L, Simpson JH: Macronutrient content of donor human breast milk. Archives of Disease in Childhood – Fetal and Neonatal Edition 2013. I guess in some ways this was predictable: donor breast milk varies a lot. This study uses a set of analyses of donor breast milk to calculate how that variability would affect the nutritional requirements of preterm infants. The answer is, a lot. Even with fortification nearly half of the breast milk samples fail to give enough protein.

Rochow N, Fusch G, Choi A, Chessell L, Elliott L, McDonald K, Kuiper E, Purcha M, Turner S, Chan E et al: Target fortification of breast milk with fat, protein, and carbohydrates for preterm infants. The Journal of pediatrics 2013 This is an initial study showing that individualized fortification of breast milk is indeed possible in a clinical routine fashion. Without too much fuss, using an automated analyzer, they could adjust the fortification of the breast milk in 23 pilot babies, and then give a more optimal nutrition. They compared some nutritional and growth outcomes with 20 matched, routinely fortified controls, and found some apparent growth improvements. This seems to be the way forward for the future.
Finally, and not in preterms:

Welle-Strand GK, Skurtveit S, Jansson LM, Bakstad B, Bjarkø L, Ravndal E: Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants. Acta Paediatrica 2013. Is it safe for mothers in a methadone program to breast feed? This study suggests that there may be benefits for the baby that were hypothesized previously, the babies have less withdrawal.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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