The importance of breast milk in preventing Bronchopulmonary Dysplasia in preterm infants

/ Allgemein

Nurse preparing breast milk for newborn infant

© Quirin Leppert

Bronchopulmonary dysplasia (BPD), is a chronic lung disease that affects premature infants who required ventilation and oxygen therapy after birth, resulting from lung injury and impaired lung development. It is a leading cause of morbidity in preterm infants. Understanding modifiable factors, such as the quality of nutrition, can offer strategies to decrease the incidence and severity of BPD, reducing its impact on preterm health. Mother’s own milk (MOM) has an antioxidant effect and is effective in preventing severe forms of BPD. When MOM is unavailable, preterm donor milk (PDM) has shown to achieve similar protective effects in prevention. 

Comparable outcomes through MOM and PDM  

The study, conducted in the Department of Neonatology at Hospital General Universitario Gregorio Marañón in Madrid from January 2020 to December 2022, aimed to compare the incidence of BPD in preterm infants fed predominantly MOM versus those who received mostly PDM. Additionally, it analysed differences in nutritional components of PDM in patients with or without BPD. The study included 199 newborns, classified by the type of milk received (>50% MOM or >50% PDM) and by BPD diagnosis (noBPD/1 or BPD 2-3). Results showed no significant difference in BPD incidence between those receiving mainly MOM or PDM (19% vs. 20%). Of the total participants, 86% received PDM at some point, with 54% predominantly fed PDM and 46% predominantly MOM. The incidence of BPD was similar regardless of milk type, compared to overall lower rates of BPD for infants receiving human milk compared to those that did not. The study concludes that non-pooled PDM matched by gestational age and time of lactation can be a viable alternative to MOM, with a comparable protective effect against severe BPD. 

Differences between noBPD/1 and BPD2-3 patients regarding nutrition and growth 

When analysing nutritional variables related to BPD, the researchers found that for patients with moderate to severe BPD (BPD 2-3), fortification of feeds started later compared to others (16.62 days vs. 10.96 days).  Exclusive enteral nutrition was also achieved later in the BPD 2-3 patient group versus the rest of the preterm infants studied. (17.28 days vs. 10.34 days). However, these differences were not significant when adjusted for gestational age in a multivariate model. At discharge, 30% of BPD 2-3 patients and 36% of noBPD/1 patients were exclusively breastfed. Despite receiving adequate nutritional intake as per ESPGHAN recommendations, patients with BPD 2–3 exhibited lower growth compared to the noBPD/1 group, particularly in length. Breastfeeding not only offers protection against BPD but also decreases the risk of subsequent hospital admissions within the first 6 months of life, with exclusive breastfeeding showing the most significant effects.  

PDM as practicable and effective alternative to MOM 

The donor milk in this study was sourced from mothers of preterm infants with similar gestational ages and days of life. The absence of significant differences in BPD diagnosis between patients predominantly receiving MOM and those predominantly receiving donor milk suggests that PDM is a viable and effective alternative when MOM is not available. It potentially offers advantages over pooled mature milk from term mothers typically used in standard milk banks, as mature milk has a different composition regarding nutrients. 

In summary, a comprehensive approach to BPD is necessary, considering its multifactorial nature and emphasising preventive strategies to reduce its severity and incidence in preterm infants. This study found no differences in BPD diagnosis between patients predominantly receiving MOM and those receiving PDM. However, further research is needed to evaluate the protective effect of diet on BPD development and severity. 

Paper available at: 

Full list of authors: Amaia Merino-Hernández, Andrea Palacios-Bermejo, Cristina Ramos-Navarro, Silvia Caballero-Martín, Noelia González-Pacheco, Elena Rodríguez-Corrales, María Carmen Sánchez-Gómez de Orgaz and Manuel Sánchez-Luna