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Christine Simon1 BS, Laura Bashir2 MS, RD, Amanda Froling2 MPT, Nicole Rickard2 OTRL, Jacob Keeley1 MS, Michelle Jankowski1 MAS, Rawad Obeid2 MD

1Oakland University William Beaumont School of Medicine, Rochester, MI

2Pediatric Neurology Department, Corewell Health Children’s Hospital, Royal Oak, MI

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The Impact of Post-Discharge Diet on Growth and Neurodevelopmental Outcomes in

Preterm Infants

Premature infants are surviving at increased rates but continue to face an elevated risk of adverse neurodevelopment outcomes.1 Human milk has demonstrated notable benefits for growth in the NICU. A 2019 study found that infants fed human milk supplemented with formula or fortifiers in the NICU exhibited better weight gain than those receiving unfortified human milk.2

The aim of this study is to investigate the dietary practices of premature infants after discharge from the NICU and its effect on growth and neurodevelopmental outcome.

Introduction

A retrospective study of premature infants who were followed in the Neurodevelopment Clinic at Corewell Health Children’s Hospital in Royal Oak, MI between February 2020 and February 2024.

Inclusion Criteria:

  • Discharged from Corewell Health Children’s Hospital NICU
  • Presentation to the clinic for an initial assessment between two- and six-months corrected age

Exclusion Criteria:

  • Genetic syndromes
  • Discharged with a nasogastric tube, or gastrostomy tube
  • Birth at ≥ 37 weeks gestational age

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We identified the type of milk they received after discharge from NICU up until the first follow up visit (Human milk only vs. Synthetic Formula only, vs. Human Milk + Synesthetic Formula fortification vs. Human Milk + human milk Fortification).

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We evaluated their growth parameters (weight, length, and head circumference) and Developmental scores (Alberta Infant Motor Scale and Peabody Score) at 8 – 10.99 months corrected age.

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We evaluated the Bayley III Infant Development Scores at 24 months corrected age.

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Results

References

  1. Brown JV, Lin L, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev. 2020;6(6):CD000343. doi:10.1002/14651858.CD000343.pub4
  2. Belfort MB, Edwards EM, Greenberg LT, Parker MG, Ehret DY, Horbar JD. Diet, weight gain, and head growth in hospitalized US very preterm infants: a 10-year observational study. Am J Clin Nutr. 2019;109(5):1373-1379. doi:10.1093/ajcn/nqz008
  3. Gehl B, Brownell E, Power K, et al. Comparison of Types of Breast Milk Fortification at Discharge from the Neonatal Intensive Care Unit and Breast Milk Feeding Rates and Growth at 4 Months Corrected Age. Breastfeed Med Off J Acad Breastfeed Med. 2020;15(10):655-661. doi:10.1089/bfm.2020.0022

Acknowledgements

Thank you to:

  • Dr. Rawad Obeid (Embark Mentor)
  • Laura Bashir, Amanda Froling, Nicole Rickard (Data Collection)
  • Jacob Keeley & Michelle Jankowski (Statistician)
  • Dr. Kara Sawarynski & Dr. Dwayne Baxa (Embark Team)

Despite the importance of human milk on long term neurodevelopment, half of premature infants discharged form our NICU switched to synthetic formula for feeding. This trend deserves further study to address the reasons behind it to improve neurodevelopmental outcome in this population.

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Conclusions

Methods

Results

  • 135 infants (70%) were discharged from NICU on human milk (with either synthetic formula fortification, or with human milk fortification, or human milk only). While 70 infants (36%) continued to receive some form of human milk on their first follow up visit.

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  • 49 infants (25%) were discharged with human milk with a human milk fortifier. By the 2-6 month corrected age visit, no infant was taking human milk fortifiers anymore.

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  • Head circumference trended larger in the human milk only group at 8 – 10.99 months corrected age, and this trend was present despite adjusting for significant variables (Table-1).

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  • The human milk only group also tended to do better on the Bayley III Developmental Assessment, mainly the language and cognitive assessments, and this trend was present despite adjusting for significant demographic variables (Table-3).

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Figure 1: Inclusion and Exclusion Criteria