The Impact of Enteral Nutrition Type, Volume, and Time of Introduction on the Risk of Growth Failure and Bronchopulmonary Dysplasia in Preterm Infants

TL;DR

This study shows that giving preterm infants their mother's own milk early and in larger volumes can improve growth and reduce the risk of a serious lung condition.

Contribution

The study identifies specific timing and volume thresholds for enteral nutrition that influence growth and BPD outcomes in preterm infants.

Findings

Early introduction of mothers' own milk (within 3 days of life) is linked to better linear growth in preterm infants.

Higher volumes of mothers' own milk reduce the severity of bronchopulmonary dysplasia.

Growth failure and BPD severity are closely related, suggesting shared risk factors.

Abstract

Background/Objectives: Greater than 50% of surviving very preterm infants are affected by postnatal growth failure and are at high risk of associated development of bronchopulmonary dysplasia (BPD). Given the influence of enteral feeding on growth failure, we aimed to determine the impact of type, volume, and time of introduction of enteral feeds on mitigating the risk of postnatal growth failure and BPD risk. Methods: This was a retrospective chart review of mothers’ own milk (MOM), pooled pasteurized donor human milk (PDHM) feeding, postnatal growth, and BPD severity in preterm infants <33 weeks of gestation admitted to the Children’s Hospital of Richmond at VCU neonatal intensive care unit between 2021 and 2024. Statistical analysis included linear regression with moderation analysis using the Hayes Process model, chi-square tests, linear and multinomial logistic regression, with p-value < 0.05 considered significant. Results: After controlling for the percentage of MOM received at 34 weeks corrected gestational age (cGA), greater severity of BPD was associated with lower infant weight and growth failure, p < 0.001. Early introduction of MOM (3 days of life) and greater volume of MOM showed better linear growth and decreased risk of severe BPD, respectively (p < 0.001). Conclusions: Provision of MOM to preterm infants within 3 days of life was associated with a moderation of the relationship between gestational age and growth velocity, with improved growth velocity trajectory. Preterm infants who received a greater volume of MOM through 34 weeks cGA experienced less severe BPD compared to those fed higher volumes of PDHM. As the incidence of growth failure paralleled the incidence of BPD severity, identification of key MOM components becomes important to address and augment the value of PDHM in the management of preterm infants.

Figures