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Neuroimage. 2019 Jan 1;184:431-439. doi: 10.1016/j.neuroimage.2018.09.045. Epub 2018 Sep 18.

Early breast milk exposure modifies brain connectivity in preterm infants.

Author information

1
MRC Centre for Reproductive Health, University of Edinburgh, EH16 4TJ, UK.
2
MRC Centre for Reproductive Health, University of Edinburgh, EH16 4TJ, UK; Centre for Clinical Brain Sciences, Chancellor's Building, 49 Little France Crescent, University of Edinburgh, Edinburgh EH16 4SB, UK.
3
Department of Radiology, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, UK.
4
University / BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, EH16 4TJ, UK.
5
Centre for Clinical Brain Sciences, Chancellor's Building, 49 Little France Crescent, University of Edinburgh, Edinburgh EH16 4SB, UK.
6
MRC Centre for Reproductive Health, University of Edinburgh, EH16 4TJ, UK; Centre for Clinical Brain Sciences, Chancellor's Building, 49 Little France Crescent, University of Edinburgh, Edinburgh EH16 4SB, UK. Electronic address: james.boardman@ed.ac.uk.

Abstract

Preterm infants are at increased risk of alterations in brain structure and connectivity, and subsequent neurocognitive impairment. Breast milk may be more advantageous than formula feed for promoting brain development in infants born at term, but uncertainties remain about its effect on preterm brain development and the optimal nutritional regimen for preterm infants. We test the hypothesis that breast milk exposure is associated with improved markers of brain development and connectivity in preterm infants at term equivalent age. We collected information about neonatal breast milk exposure and brain MRI at term equivalent age from 47 preterm infants (mean postmenstrual age [PMA] 29.43 weeks, range 23.28-33.0). Network-Based Statistics (NBS), Tract-based Spatial Statistics (TBSS) and volumetric analysis were used to investigate the effect of breast milk exposure on white matter water diffusion parameters, tissue volumes, and the structural connectome. Twenty-seven infants received exclusive breast milk feeds for ≥75% of days of in-patient care and this was associated with higher connectivity in the fractional anisotropy (FA)-weighted connectome compared with the group who had < 75% of days receiving exclusive breast milk feeds (NBS, p = 0.04). Within the TBSS white matter skeleton, the group that received ≥75% exclusive breast milk days exhibited higher FA within the corpus callosum, cingulum cingulate gyri, centrum semiovale, corticospinal tracts, arcuate fasciculi and posterior limbs of the internal capsule compared with the low exposure group after adjustment for PMA at birth, PMA at image acquisition, bronchopulmonary dysplasia, and chorioamnionitis (p < 0.05). The effect on structural connectivity and tract water diffusion parameters was greater with ≥90% exposure, suggesting a dose effect. There were no significant groupwise differences in brain volumes. Breast milk feeding in the weeks after preterm birth is associated with improved structural connectivity of developing networks and greater FA in major white matter fasciculi.

KEYWORDS:

Breast milk; Diffusion tensor imaging; Magnetic resonance imaging; Preterm birth

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