NICU Human Milk Dose and 20-Month Neurodevelopmental Outcome in Very Low Birth Weight Infants

Neonatology. 2017;112(4):330-336. doi: 10.1159/000475834. Epub 2017 Aug 3.


Background: The association between human milk (HM) feeding in the NICU and neurodevelopmental (ND) outcome in very low birth weight (VLBW) infants is unclear. Limitations of previous studies include a lack of exact estimates of HM dose and of generalizability to minority populations.

Objective: To determine the impact on ND outcome of an exact dose of HM received in the NICU in a diverse, contemporary cohort of VLBW infants.

Methods: We included 430 VLBW infants born in the period 2008-2012 for whom the mean daily dose (DD) of HM received during the stay in the NICU (NICU HM-DD) was calculated prospectively from the daily nutritional intake from admission to discharge. Outcomes included Bayley-III index scores at 20 months' corrected age (CA) as assessed upon ND follow-up, which were collected retrospectively. Multivariable linear regression analyses controlled for neonatal and social risk factors.

Results: Each 10 mL/kg/day increase in NICU HM-DD was associated with a 0.35 increase in cognitive index score (95% CI [0.03-0.66], p = 0.03), but no significant associations were detected for the language or motor indices.

Conclusions: There is a significant dose-dependent association between NICU HM intake and cognitive scores at 20 months' CA. Further follow-up will determine whether these findings persist at school age, and could help alleviate the special-education and health-care burden in this population.

Keywords: Human milk; Neurodevelopmental outcome; Very low birth weight infants.

MeSH terms

  • Age Factors
  • Birth Weight
  • Child Development*
  • Child Language
  • Cognition
  • Female
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Infant, Very Low Birth Weight*
  • Intensive Care Units, Neonatal*
  • Linear Models
  • Male
  • Milk, Human*
  • Motor Activity
  • Multivariate Analysis
  • Nervous System / growth & development*
  • Nutritional Status
  • Nutritive Value
  • Prospective Studies
  • Retrospective Studies