Mother's Own Milk and Retinopathy of Prematurity

Abstract

Purpose : Mothers’ own milk (MOM) feedings reduce the risk of multiple potentially preventable morbidities of prematurity in very low birthweight (VLBW: 1500 g birthweight) infants, including necrotizing enterocolitis, late onset sepsis, bronchopulmonary dysplasia and neurodevelopmental problems. Although bioactive components in MOM suggest a favorable impact on retinopathy of prematurity (ROP), this relationship remains undetermined. This study compared dose of MOM received by VLBW infants who did and did not require treatment for severe ROP.

Methods : This case-control study compared subjects with severe ROP (defined as patients requiring treatment) matched to controls without severe ROP cared for in the study neonatal intensive care unit (NICU) from 2005 and 2015. Matching characteristics included: gender, race/ethnicity, gestational age, birth weight, antenatal steroid use, oxygen duration and birth year. Exposure to MOM during the first 28 days of life (DOL) used a weight-adjusted dose (mL/kg/d) and cumulative percentage of all enteral feedings. Other predictors of ROP such as days on mechanical ventilation and the presence of other NICU morbidities were compared for the two groups using Chi square or Mann Whitney U test.

Results : The sample included 31 subjects with severe ROP matched to 62 controls without severe ROP. Table 1 displays demographics, predictors of ROP and NICU morbidities evaluated for subjects and controls. Table 2 shows comparison of exposure to MOM during the first 28 DOL and days on TPN. Of the variables examined, subjects treated for severe ROP had statistically significantly more days of TPN (36 days vs. 25 days p-value 0.016) and more days on mechanical ventilation (55 days vs. 46 days, p-value 0.035). Exposure to MOM and some of the other variables trended to favor higher rates in either subjects or controls but were not statistically significant.

Conclusions : Lower birth weight, more days on mechanical ventilation, and greater number of TPN days in infants treated for ROP suggest greater medical acuity than infants who did not require treatment for ROP, which likely resulted in the lower weight-adjusted dose of MOM received by ROP infants during the first 28 DOL. Additional data modeling and inclusion of MOM dose through to NICU discharge are required to determine the impact of MOM on ROP in this population.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Table 1. Demographics, Predictors of ROP and NICU Morbidities

 

Table 2. Exposure to Mother's Own Milk (MOM) and TPN