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Effect of Supplemental Donor Human Milk Compared With Preterm Formula on Neurodevelopment of Very Low-Birth-Weight Infants at 18 Months: A Randomized Clinical Trial.
JAMA. 2016 11 08; 316(18):1897-1905.JAMA

Abstract

Importance

For many very low-birth-weight (VLBW) infants, there is insufficient mother's milk, and a supplement of pasteurized donor human milk or preterm formula is required. Awareness of the benefits of mother's milk has led to an increase in use of donor milk, despite limited data evaluating its efficacy.

Objective

To determine if nutrient-enriched donor milk compared with formula, as a supplement to mother's milk, reduces neonatal morbidity, supports growth, and improves neurodevelopment in VLBW infants.

Design, Setting, and Participants

In this pragmatic, double-blind, randomized trial, VLBW infants were recruited from 4 neonatal units in Ontario, Canada, within 96 hours of birth between October 2010 and December 2012. Follow-up was completed in July 2015.

Interventions

Infants were fed either donor milk or formula for 90 days or to discharge when mother's milk was unavailable.

Main Outcomes and Measures

The primary outcome was the cognitive composite score on the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 18 months' corrected age (standardized mean, 100 [SD, 15]; minimal clinically important difference, 5 points). Secondary outcomes included Bayley-III language and motor composite scores, growth, and a dichotomous mortality and morbidity index.

Results

Of 840 eligible infants, 363 (43.2%) were randomized (181 to donor milk and 182 to preterm formula); of survivors, 299 (92%) had neurodevelopment assessed. Mean birth weight and gestational age of infants was 996 (SD, 272) g and 27.7 (2.6) weeks, respectively, and 195 (53.7%) were male. No statistically significant differences in mean Bayley-III cognitive composite score (adjusted scores, 92.9 in donor milk group vs 94.5 in formula group; fully adjusted mean difference, -2.0 [95% CI, -5.8 to 1.8]), language composite score (adjusted scores, 87.3 in donor milk group vs 90.3 in formula group; fully adjusted mean difference, -3.1 [95% CI, -7.5 to 1.3]), or motor composite score (adjusted scores, 91.8 in donor milk group vs 94.0 in formula group; fully adjusted mean difference, -3.7 [95% CI, -7.4 to 0.09]) were observed between groups. There was no statistically significant difference in infants positive for the mortality and morbidity index (43% in donor milk group, 40% in formula group) or changes in growth z scores.

Conclusions and Relevance

Among VLBW infants, use of supplemental donor milk compared with formula did not improve neurodevelopment at 18 months' corrected age. If donor milk is used in settings with high provision of mother's milk, this outcome should not be considered a treatment goal.

Trial Registration

isrctn.org Identifier: ISRCTN35317141.

Authors+Show Affiliations

Physiology and Experimental Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada2Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.Trillium Health Partners, Mississauga, Ontario, Canada.Evaluative and Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada5Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.Physiology and Experimental Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.Physiology and Experimental Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada2Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada6Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Ontario, Canada.Department of Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada8Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada9St. Michael's Hospital and Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada10Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.Department of Pediatrics, William Osler Health System, Brampton, Ontario, Canada.Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada.Department of Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada8Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.Department of Pediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada8Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada13Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada10Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada15Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada10Department of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada13Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Comment

Language

eng

PubMed ID

27825008

Citation

O'Connor, Deborah L., et al. "Effect of Supplemental Donor Human Milk Compared With Preterm Formula On Neurodevelopment of Very Low-Birth-Weight Infants at 18 Months: a Randomized Clinical Trial." JAMA, vol. 316, no. 18, 2016, pp. 1897-1905.
O'Connor DL, Gibbins S, Kiss A, et al. Effect of Supplemental Donor Human Milk Compared With Preterm Formula on Neurodevelopment of Very Low-Birth-Weight Infants at 18 Months: A Randomized Clinical Trial. JAMA. 2016;316(18):1897-1905.
O'Connor, D. L., Gibbins, S., Kiss, A., Bando, N., Brennan-Donnan, J., Ng, E., Campbell, D. M., Vaz, S., Fusch, C., Asztalos, E., Church, P., Kelly, E., Ly, L., Daneman, A., & Unger, S. (2016). Effect of Supplemental Donor Human Milk Compared With Preterm Formula on Neurodevelopment of Very Low-Birth-Weight Infants at 18 Months: A Randomized Clinical Trial. JAMA, 316(18), 1897-1905. https://doi.org/10.1001/jama.2016.16144
O'Connor DL, et al. Effect of Supplemental Donor Human Milk Compared With Preterm Formula On Neurodevelopment of Very Low-Birth-Weight Infants at 18 Months: a Randomized Clinical Trial. JAMA. 2016 11 8;316(18):1897-1905. PubMed PMID: 27825008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Supplemental Donor Human Milk Compared With Preterm Formula on Neurodevelopment of Very Low-Birth-Weight Infants at 18 Months: A Randomized Clinical Trial. AU - O'Connor,Deborah L, AU - Gibbins,Sharyn, AU - Kiss,Alex, AU - Bando,Nicole, AU - Brennan-Donnan,Joan, AU - Ng,Eugene, AU - Campbell,Douglas M, AU - Vaz,Simone, AU - Fusch,Christoph, AU - Asztalos,Elizabeth, AU - Church,Paige, AU - Kelly,Edmond, AU - Ly,Linh, AU - Daneman,Alan, AU - Unger,Sharon, AU - ,, PY - 2016/11/9/entrez PY - 2016/11/9/pubmed PY - 2016/12/15/medline SP - 1897 EP - 1905 JF - JAMA JO - JAMA VL - 316 IS - 18 N2 - Importance: For many very low-birth-weight (VLBW) infants, there is insufficient mother's milk, and a supplement of pasteurized donor human milk or preterm formula is required. Awareness of the benefits of mother's milk has led to an increase in use of donor milk, despite limited data evaluating its efficacy. Objective: To determine if nutrient-enriched donor milk compared with formula, as a supplement to mother's milk, reduces neonatal morbidity, supports growth, and improves neurodevelopment in VLBW infants. Design, Setting, and Participants: In this pragmatic, double-blind, randomized trial, VLBW infants were recruited from 4 neonatal units in Ontario, Canada, within 96 hours of birth between October 2010 and December 2012. Follow-up was completed in July 2015. Interventions: Infants were fed either donor milk or formula for 90 days or to discharge when mother's milk was unavailable. Main Outcomes and Measures: The primary outcome was the cognitive composite score on the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 18 months' corrected age (standardized mean, 100 [SD, 15]; minimal clinically important difference, 5 points). Secondary outcomes included Bayley-III language and motor composite scores, growth, and a dichotomous mortality and morbidity index. Results: Of 840 eligible infants, 363 (43.2%) were randomized (181 to donor milk and 182 to preterm formula); of survivors, 299 (92%) had neurodevelopment assessed. Mean birth weight and gestational age of infants was 996 (SD, 272) g and 27.7 (2.6) weeks, respectively, and 195 (53.7%) were male. No statistically significant differences in mean Bayley-III cognitive composite score (adjusted scores, 92.9 in donor milk group vs 94.5 in formula group; fully adjusted mean difference, -2.0 [95% CI, -5.8 to 1.8]), language composite score (adjusted scores, 87.3 in donor milk group vs 90.3 in formula group; fully adjusted mean difference, -3.1 [95% CI, -7.5 to 1.3]), or motor composite score (adjusted scores, 91.8 in donor milk group vs 94.0 in formula group; fully adjusted mean difference, -3.7 [95% CI, -7.4 to 0.09]) were observed between groups. There was no statistically significant difference in infants positive for the mortality and morbidity index (43% in donor milk group, 40% in formula group) or changes in growth z scores. Conclusions and Relevance: Among VLBW infants, use of supplemental donor milk compared with formula did not improve neurodevelopment at 18 months' corrected age. If donor milk is used in settings with high provision of mother's milk, this outcome should not be considered a treatment goal. Trial Registration: isrctn.org Identifier: ISRCTN35317141. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/27825008/Effect_of_Supplemental_Donor_Human_Milk_Compared_With_Preterm_Formula_on_Neurodevelopment_of_Very_Low_Birth_Weight_Infants_at_18_Months:_A_Randomized_Clinical_Trial_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.16144 DB - PRIME DP - Unbound Medicine ER -