Abstract
Purpose
To review and synthesize the literature on human milk and structural brain development
and injury in preterm infants, focusing on the application of quantitative brain magnetic
resonance imaging (MRI) in this field.
Methods
For this narrative review, we searched PubMed for articles published from 1990 to
2021 that reported observational or interventional studies of maternal milk or donor
milk in relation to brain development and/or injury in preterm infants assessed with
quantitative MRI at term equivalent age. Studies were characterized with respect to
key aspects of study design, milk exposure definition, and MRI outcomes.
Findings
We identified 7 relevant studies, all of which were observational in design and published
between 2013 and 2021. Included preterm infants were born at or below 33 weeks’ gestation.
Sample sizes ranged from 22 to 377 infants. Exposure to human milk included both maternal
and donor milk. No study included a full-term comparison group. Main MRI outcome domains
were white matter integrity (assessed with diffusion tensor imaging, resting state
functional connectivity, or semiautomated segmentation of white matter abnormality)
and total and regional brain volumes. Studies revealed that greater exposure to human
milk versus formula was associated with favorable outcomes, including more mature
and connected cerebral white matter with less injury and larger regional brain volumes,
notably in the deep nuclear gray matter, amygdala-hippocampus, and cerebellum. No
consistent signature effect of human milk exposure was found; instead, the beneficial
associations were regional and tissue-specific neuroprotective effects on the areas
of known vulnerability in the preterm infant.
Implications
Evidence to date suggests that human milk may protect the preterm infant from the
white matter injury and dysmaturation to which this population is vulnerable. Brain
MRI at term equivalent age is emerging as a useful tool to investigate the effects
of human milk on the preterm brain. When grounded in neurobiological knowledge about
preterm brain injury and development, this approach holds promise for allowing further
insight into the mechanisms and pathways underlying beneficial associations of human
milk with neurodevelopmental outcomes in this population and in the investigation
of specific milk bioactive components with neuroprotective or neurorestorative potential.
Keywords
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Article info
Publication history
Published online: March 17, 2022
Accepted:
February 23,
2022
Identification
Copyright
© 2022 Elsevier Inc.
