The Link Between Breastmilk and School-Age Outcomes for Children Born Preterm


Breast Milk is known to give your baby a healthy start in life. It has everything a child needs to thrive during their early life and the only food and drink your baby needs. The importance and benefits of breastfeeding to a child’s growth and development or even the mother’s well-being are no secret. There is so much more to it than just food for the baby, as it is also a meaningful moment and shared experience for the mother and child, which fosters a close, loving bond between the mom and her baby.

Breastfed babies are also said to be sick less often than babies who are not breastfed since breastmilk helps protect babies from certain illnesses. More so, the benefits of breastfeeding extend beyond the early stages of a baby’s life. Compelling evidence suggests that prolonged and exclusive breastfeeding in infancy is linked with neurodevelopmental outcomes in childhood. It is possible that diverse effects of breast milk may occur at various stages of brain development.

In light of this, researchers from Brigham and Women’s Hospital and associates from the South Australian Health and Medical Research Institute examined the relationship between maternal milk feeding after premature birth and cognitive, academic, and behavioral outcomes at school age. They explored whether connections varied based on gestational age at birth, prenatal status, and infant sex.

Maternal Milk and Neurodevelopmental Outcomes for Former Preterm Infants

Premature delivery, sometimes referred to as preterm birth, occurs when a baby is delivered before the full 37 weeks of pregnancy. The chance of death or severe disability is considered to increase with the time of birth.

The World Health Organization estimates that 15 million babies are born too soon every year. That is greater than one in ten infants. Preterm delivery problems claim the lives of almost 1 million kids every year. Learning difficulties, vision and hearing issues, and other disabilities are common among survivors.

Children born preterm have a higher risk of developing attention-deficit/hyperactivity disorder and inferior scholastic ability in math, reading, and other subjects (ADHD).

WHO has created new guidelines with suggestions for enhancing preterm birth outcomes. The use of safe oxygen therapy, thermal care, feeding assistance, kangaroo mother care, and other methods to facilitate newborns’ easier breathing are among the essential interventions that can increase the likelihood of survival and positive health outcomes for preterm infants.

However, despite the adverse effects of premature birth on infants’ cognitive abilities when they reach school age, there are still limited interventions and studies on enhancing cognitive development for preterm newborns.

In addition, the Brigham and Women’s Hospital researchers noted that very few studies have looked at the relationship between maternal milk feeding during newborn hospitalization and neurodevelopment at school age, despite the well-known advantages of breastfeeding for a child’s brain development. Current studies also have certain limitations, including small sample size, little information on the amount of maternal milk the newborn was exposed to, and examination of a limited range of neurodevelopmental outcomes, which influences the outcomes and conclusion of the study.

Hence, the study published under JAMA Network Open went on to examine neurodevelopmental outcomes for 586 infants born at less than 33 weeks gestation at one of five Australian perinatal centers. Children were evaluated at age 7.

The team analyzed data on the volume of maternal milk infants received each day and how long parents continued breastfeeding predicted several neurodevelopmental outcomes. These outcomes included academic achievement, Verbal and Performance IQ, symptoms of ADHD, executive function, and behavior.

From their analysis, the researchers found that:

  • Higher maternal milk intake was linked with more excellent Performance IQ and higher reading and math scores. 
  • Parents also reported fewer ADHD symptoms for children who consumed more maternal milk during infancy. 
  • The duration of maternal milk intake (up to 18 months corrected age) was also linked with more excellent reading, spelling, and math scores.
  • “children who had greater maternal milk intake both during and after time in the neonatal intensive care unit (NICU) had greater academic achievement, higher IQs, and reduced ADHD symptoms.”

After controlling for confounders, the beneficial associations were higher for infants born at the lowest gestational ages, especially those born below 30 weeks.

In sum, a higher dose of maternal milk during the critical period from very preterm birth to term-equivalent age is linked with improved cognitive and academic outcomes and fewer ADHD symptoms at school age. The findings also suggest that infants who are less mature at birth may derive more significant benefits from maternal milk feeding after birth. 

The study suggests that an intervention in the first weeks and months of a preterm infant’s life may lead to better neurodevelopmental outcomes in later years. It also supports recommendations by national and international organizations such as the American Academy of Pediatrics and the World Health Organization, both of which recommended that fortified maternal milk should be the primary diet for prematurely born infants.

Additionally, the study confirms that recommendations, strategies, and policies supporting lactation for women should be further encouraged as it greatly benefits the children’s future.

Journal Reference

Belfort, M. B., Knight, E., Chandarana, S., Ikem, E., Gould, J. F., Collins, C. T., Makrides, M., Gibson, R. A., Anderson, P. J., Simmer, K., Tiemeier, H., & Rumbold, A. (2022). Associations of maternal milk feeding with neurodevelopmental outcomes at 7 years of age in former preterm infants. JAMA Network Open, 5(7). 

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