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Premature small for gestational age infants fed an exclusive human milk-based diet achieve catch-up growth without metabolic consequences at 2 years of age
  1. Chonnikant Visuthranukul1,2,3,4,
  2. Steven A Abrams5,
  3. Keli M Hawthorne5,
  4. Joseph L Hagan1,
  5. Amy B Hair1
  1. 1Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
  2. 2USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  3. 3Section of Nutrition, Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
  4. 4Pediatric Nutrition STAR, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  5. 5Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
  1. Correspondence to Dr Amy B Hair, Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA; abhair{at}texaschildrenshospital.org

Abstract

Objective To compare postdischarge growth, adiposity and metabolic outcomes of appropriate for gestational age (AGA) versus small for gestational age (SGA) premature infants fed an exclusive human milk (HM)-based diet in the neonatal intensive care unit.

Design Premature infants (birth weight ≤1250 g) fed an exclusive HM-based diet were examined at 12–15 months corrected gestational age (CGA) (visit 1) for anthropometrics, serum glucose and non-fasting insulin, and at 18–22 months CGA (visit 2) for body composition by dual-energy X-ray absorptiometry.

Results Of 51 children, 33 were AGA and 18 were SGA at birth. The SGA group had weight gain (g/day) equal to AGA group during the follow-up period. SGA had a significantly greater body mass index (BMI) z-score gain from visit 1 to visit 2 (0.25±1.10 vs −0.21±0.84, p=0.02) reflecting catch-up growth. There were no significant differences in total fat mass (FM) and trunk FM between groups. SGA had significantly lower insulin level (5.0±3.7vs17.3±15.1 µU/mL, p=0.02) and homeostatic model of assessment-insulin resistance (1.1±0.9vs4.3±4.1, p=0.02). Although regional trunk FM correlated with insulin levels in SGA (r=0.893, p=0.04), they had lower insulin level compared with AGA and no difference in adiposity.

Conclusions SGA premature infants who received an exclusive HM-based diet exhibited greater catch-up growth without increased adiposity or elevated insulin resistance compared with AGA at 2 years of age. An exclusive HM-based diet may improve long-term body composition and metabolic outcomes of premature infants with ≤1250 g birth weight, specifically SGA.

  • premature infants
  • SGA infants
  • human milk
  • adiposity
  • metabolic outcomes

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Footnotes

  • Contributors CV was part of the study design team, assisted in all aspects of the study, performed the statistical analysis of the data and wrote the manuscript. SAA was part of the study design team, assisted in all aspects of the study and preparation of the manuscript. KMH was part of the study design team and assisted in all aspects of the study.JLH was part of statistical analysis. ABH was part of the study design team, assisted in all aspects of the study including recruitment, data analysis, statistical analysis and preparation of the manuscript.

  • Funding The Texas Children’s Hospital Bad Pants Open Fund.

  • Competing interests KMH: receives speaker honoraria from Prolacta Bioscience. ABH receives research support from Prolacta Bioscience for the Human Milk Cream Length of Stay Randomized Trial and the Human Milk Cardiac Study.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval The Institutional Review Board of Baylor College of Medicine and Affiliated Hospitals approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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