128 - The Impact of Exclusive Mother’s Own Milk Feeding on Cardiac Performance at 34-36 weeks Postmenstrual Age in Extremely Low Birthweight Infants

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 128
Publication Number: 128.427

Faith Zhu, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Jejelola Ladele, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Ashraf Kharrat, Mount Sinai Hospital, Toronto, ON, Canada; Poorva Deshpande, Mount SInai Hospital, Toronto, ON, Canada; Philip Levy, Boston Children's Hospital, Boston, MA, United States; Afif EL-Khuffash, Royal College of Surgeons in Ireland, Dublin, Dublin, Ireland; Adam J. Lewandowski, University of Oxford, Oxford, England, United Kingdom; Amish Jain, University of Toronto Temerty Faculty of Medicine, toronto, ON, Canada

Presenting Author(s)

Faith Zhu, MBChB

Assistant Professor
University of Toronto Temerty Faculty of Medicine
Toronto, Ontario, Canada

Background: Among preterm neonates, higher exposure to human milk and mother’s own milk (MoM) during neonatal period is associated with enhanced cardiac phenotype during infancy and early adulthood. It is unknown whether MoM benefits exists in the neonatal period and in contemporary practice where formula feeding is infrequent.

Objective: To examine association between higher exclusive MoM days (eMoM) during first 28 days of age and echocardiographic phenotype at 34-36 weeks postmenstrual age (PMA) in extremely low birth weight infants (ELBW, BW < 1000 grams).

Design/Methods: This single-center, nested cohort study included ELBW infants who were prospectively recruited and underwent a comprehensive targeted neonatal echocardiography (TNE) at 34-36 weeks PMA. Daily feeding data (MoM, donor human milk, or a combination) was extracted for the first 28 days and evaluated as primary exposure. There was no formula exposure in the cohort. TNE variables analyzed as outcomes included measures of left (LV) and right (RV) ventricular dimensions, function, and pulmonary hemodynamics. For inter-group comparison, cohort was divided based on < or ≥ median percentage days of eMoM (%eMoM). Linear regression analysis was used to examine associations, adjusting for relevant clinical and anthropometric co-variates and Pearson correlation to examine linear correlations between TNE variables and %eMoM days.

Results: Ninety-seven infants with mean (SD) GA 25.9 were included; median %eMoM was 71.4% with 48 (49%) categorized in lower %eMoM group. Baseline characteristics and clinical outcomes, anthropometric and clinical variables at time of TNE were similar between groups (Table 1). Lower %eMoM group demonstrated smaller RV outflow tract diameter (RVOTd), LV end diastolic volume and fewer PDAs at 36 weeks (Table 2). Apart from slightly higher LV ejection fraction in lower %eMoM group, markers of cardiac function and pulmonary hemodynamics demonstrated no differences (Table 3). On regression analysis, lower %eMoM had smaller RVOTd [mean difference (95% CI) -0.36 (-0.69, -0.03)] and trend towards having smaller LV length [-0.10 (-0.20, 0.0001)]. There were weak but significant correlations between RV and LV dimension and %eMoM (RV length r=0.25, p=0.01; RVOTd r=0.31, p=< 0.01, LV length r=0.26, p=0.01).

Conclusion(s):

This study found an association between higher exposure to eMoM feeding during first month and increased cardiac dimensions at 34-36 weeks PMA in ELBW infants but not with cardiac function. There may be a potential role for eMoM feeding to modulate cardiac structure in preterm-born infants.