Dataset Information

Human milk feeding and wheeze in Black infants born preterm.

ABSTRACT:

Objectives

To determine the association between human milk exposure at 3 months corrected gestational age and recurrent wheeze in preterm Black infants.

Methods

This is a secondary analysis of data from the D-Wheeze trial (ClinicalTrials.gov identifier NCT01601847). Associations between human milk feeding at 3 months corrected age and wheezing outcomes were examined by generalized linear models.

Results

Exclusively human milk fed infants (n = 13) had significantly fewer wheezing episodes than formula fed infants (n = 230) (IRR (95% CI) = 0.25 (0.07, 0.89), p = 0.03). There were no hospitalizations in infants receiving exclusive human milk. Receiving any human milk was associated with decreased odds of hospitalization by 12 months corrected age (OR (95% CI) = 0.12 (0.02, 0.79), p = 0.03).

Conclusions

Exclusive human milk feeding at three months corrected gestational age is associated with decreased number of wheezing episodes in the first year of life in preterm Black infants.

SUBMITTER: Benson AC

PROVIDER: S-EPMC9617763 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Publications

Human milk feeding and wheeze in Black infants born preterm.

Benson Anna Crist AC Chen Zhengyi Z Minich Nori Mercuri NM Tatsuoka Curtis C Furman Lydia L Ross Kristie K Hibbs Anna Maria AM

Journal of perinatology : official journal of the California Perinatal Association 20220804 11

<h4>Objectives</h4>To determine the association between human milk exposure at 3 months corrected gestational age and recurrent wheeze in preterm Black infants.<h4>Methods</h4>This is a secondary analysis of data from the D-Wheeze trial (ClinicalTrials.gov identifier NCT01601847). Associations between human milk feeding at 3 months corrected age and wheezing outcomes were examined by generalized linear models.<h4>Results</h4>Exclusively human milk fed infants (n = 13) had significantly fewer whe ...[more]

PMID: 35927485

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Project description:ImportanceBlack infants born preterm face high rates of recurrent wheezing throughout infancy. Vitamin D supplementation has the potential to positively or negatively affect wheezing through modulation of the pulmonary and immune systems.ObjectiveTo assess the effectiveness of 2 vitamin D dosing strategies in preventing recurrent wheezing.Design, setting, and participantsA randomized clinical trial enrolled 300 black infants born at 28 to 36 weeks' gestation between January 2013 and January 2016 at 4 sites in the United States, and followed them up through March 2017. Randomization was stratified by site and maternal milk exposure.InterventionsPatients were enrolled prior to discharge from the neonatal intensive care unit or newborn nursery and received open-label multivitamin until they were consuming 200 IU/d of cholecalciferol from formula or fortifier added to human milk, after which they received either 400 IU/d of cholecalciferol until 6 months of age adjusted for prematurity (sustained supplementation) or placebo (diet-limited supplementation). One-hundred fifty three infants were randomized to the sustained group, and 147 were randomized to the diet-limited group.Main outcomes and measuresRecurrent wheezing by 12 months' adjusted age was the primary outcome.ResultsAmong 300 patients who were randomized (mean gestational age, 33 weeks; median birth weight, 1.9 kg), 277 (92.3%) completed the trial. Recurrent wheezing was experienced by 31.1% of infants in the sustained supplementation group and 41.8% of infants in the diet-limited supplementation group (difference, -10.7% [95% CI, -27.4% to -2.9%]; relative risk, 0.66 [95% CI, 0.47 to 0.94]). Upper and lower respiratory tract infections were among the most commonly reported adverse events. Upper respiratory infections were experienced by 84 of 153 infants (54.9%) in the sustained group and 83 of 147 infants (56.5%) in the diet-limited group (difference, -1.6% [95% CI, -17.1% to 7.0%]). Lower respiratory infections were experienced by 33 of 153 infants (21.6%) in the sustained group and 37 of 147 infants (25.2%) in the diet-limited group (difference, -3.6% [95% CI, -16.4% to 4.4%]).Conclusions and relevanceAmong black infants born preterm, sustained supplementation with vitamin D, compared with diet-limited supplementation, resulted in a reduced risk of recurrent wheezing by 12 months' adjusted age. Future research is needed to better understand the mechanisms and longer-term effects of vitamin D supplementation on wheezing in children born preterm.Trial registrationClinicalTrials.gov Identifier: NCT01601847.

Project description:BackgroundIn spite of high rates of initiating breast milk feeding (BMF) among preterm infants, a significant rate of discontinuation occurs shortly after discharge.AimTo investigate the effect of mode (direct feeding at the breast vs. expressing) and exclusivity (breast milk combined with formula vs. breast milk only) as well as maternal perceptions on the duration of BMF among preterm infants.MethodsThe study included mothers whose infants were born before 32 weeks gestation, between January 2012 and August 2015 at Sheba Medical Center (SMC). Perinatal data were collected retrospectively from infants' computerized charts. Mothers were approached >12 months postpartum and were asked to complete a questionnaire. Those who agreed to participate were asked (during their visit to the follow-up clinic or by phone or mail) to complete a questionnaire regarding mode and duration of BMF as well as reasons for its discontinuation. Mothers were also asked about their pre-partum intentions to feed directly at the breast.ResultsOut of 162 eligible mothers, 131 (80.8%) initiated BMF during their intensive care unit (ICU) hospitalization. Of these, 66 (50.3%) discontinued BMF earlier than six months postpartum. BMF ≥ 6 months was significantly associated with direct feeding at the breast, duration of exclusive BMF, and singleton birth. Regression analysis revealed that direct feeding at the breast (any or only) and duration of BMF exclusivity were the only significant variables associated with BMF duration (Odds ratio (OR) 5.5 and 95% confidence interval (CI) 2.00-15.37; OR 1.5 and 95% CI 1.25-1.88, respectively). Milk supply (inadequate or nonexistent) was the most commonly reported cause for BMF discontinuation <6 months. Direct feeding at the breast was significantly associated with BMF duration and was more common among singletons.ConclusionsDirect feeding at the breast and duration of exclusive BMF are associated with duration of BMF among infants born <32 weeks of gestational age (GA). These findings suggest that targeting these two factors may play a key role in prolonging BMF duration among preterm infants.

Dataset Information

Human milk feeding and wheeze in Black infants born preterm.

Objectives

Methods

Results

Conclusions

Publications

Human milk feeding and wheeze in Black infants born preterm.

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