Human milk feeding and retinopathy of prematurity | LATCH

Article Review: Human Milk Feeding Protects Very-Low-Birth-Weight Infants from Retinopathy of Prematurity: A Pre-Post Cohort Analysis

Author: Kim Carmignani, MSN, RN-NIC In fetal development, the retinal blood vessels begin to form during the fourth month of gestation and are completely formed at term gestation. When babies are born prematurely, the development of these vessels is often interrupted. This interruption and the subsequent abnormality of retinal blood vessel development are the known risk factors associated with retinopathy of prematurity (ROP).

In fetal development, the retinal blood vessels begin to form during the fourth month of gestation and are completely formed at term gestation. When babies are born prematurely, the development of these vessels is often interrupted. This interruption and the subsequent abnormality of retinal blood vessel development are the known risk factors associated with retinopathy of prematurity (ROP). A single-center observational pre-post cohort study published in The Journal of Maternal-Fetal & Neonatal Medicine examined the influence of the infants’ diet (human milk versus formula) on the incidence of ROP.

The authors concurred that infants that are fed human milk, either mother’s own milk (MOM) or donor milk (DM), experienced a 13.1% decrease in the incidence of ROP, compared with infants fed formula. The infants were fed either human milk (HM), defined as MOM or DM or MOM plus DM (with a bovine fortifier) until reaching 150 cc/kg/day of enteral feeding, or any formula (PF), defined as preterm formula or MOM plus preterm formula before reaching 150 cc/kg/day. ROP was defined as any stage 2-4 ROP, as identified by a retinal exam. This study showed statistically significant differences between the two diet populations.

A total of 186 infants, born at < 1500 grams or less than 32 weeks gestation, were included. Of these infants, 114 were HM fed, and 72 were PF fed. The two groups were compared to determine the incidence of major morbidities associated with prematurity.

Only 5.7% of the infants on the HM diet developed ROP, compared to 29% of the PF-fed infants. The question that seems to be unanswered is “why?” Is this result because of the faster advancement of feeding-related to better feeding tolerance? Are the HM-fed infants presenting with less oxygen toxicity because they have fewer symptoms associated with feeding intolerance, such as desaturation episodes and apnea? Are the antioxidant components in human milk protecting the infants from developing ROP? Studies such as this one may influence a mother’s decision to provide her own milk, accept the use of donor milk for her own infant, or support the need for donor milk in lieu of preterm formula in the NICU.

Reference:

Ginovart G, Gich I, Verd S. Human milk feeding protects very low-birth-weight infants from retinopathy of prematurity: a pre–post cohort analysis. J Matern Fetal Neonatal Med. 2016; 29(23):3790-3795. doi:10.3109/14767058.2016.1145648