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Breastfeeding boosts key metabolites for brain growth in VLBW babies

Pearl Toh
01 May 2019

Preterm infants with very low birth weight (VLBW) who were breastfed have significantly higher levels of metabolites important for brain growth and development in their brain tissue compared with formula-fed infants, suggesting that breastfed infants have improved cerebral metabolism at term-equivalent age, according to a study presented at the PAS 2019 Meeting.   

“Our previous research established that vulnerable preterm infants who are fed breast milk early in life have improved brain growth and neurodevelopmental outcomes. It was unclear what makes breastfeeding so beneficial for newborns’ developing brains,” said study principal investigator Dr Catherine Limperopoulos, director of MRI Research of the Developing Brain at Children's National Medical Center in Washington, DC, US.

Among the 27 VLBW infants with imaging spectral data from proton magnetic resonance spectroscopy available for the frontal white matter, infants who were breastfed showed significantly higher levels of inositol in this area of the brain compared with formula-fed infants (11.8 vs 9.2; p=0.04). [PAS 2019, abstract 3685.1]   

Breastfed infants also had higher levels of creatinine in the cerebellar tissue (n=34) compared with formula-fed infants (10.1 vs 7.1; p=0.01).

The other key metabolites studied, including inositol, N-acetyl-aspartate, and choline similarly showed a trend towards higher concentration in the cerebellar structure of the breastfed vs the formula-fed infants, although the difference between the two groups was not significant.

“Key metabolite levels ramp up during the times babies’ brains experience exponential growth,” observed Dr Katherine Ottolini, also from the Children's National Medical Center, who presented the study during PAS 2019 Meeting.

“Creatine facilitates recycling of ATP, the cell’s energy currency. Seeing greater quantities of this metabolite denotes more rapid changes and higher cellular maturation. Choline is a marker of cell membrane turnover; when new cells are generated, we see choline levels rise,” she explained.

In addition, the more often the VLBW infants were breastfed (as indicated by the percentage of breast milk days), the greater the levels of creatinine and choline in the cerebellar tissue.

The prospective study included 42 infants born at VLBW (<1,500 g) and ≤32 weeks gestational age (GA) admitted to a NICU* within the first 7 days of life. The infants underwent brain imaging with proton magnetic resonance spectroscopy, an MRI technique which allows noninvasive imaging of metabolites in specific areas of the brain. Among the infants studied, 27 were breastfed (mean GA at birth 27.1 weeks, 33 percent male) and 15 were formula-fed (mean GA at birth 28.1 weeks).

“[Proton magnetic resonance spectroscopy] enables us to measure metabolites essential for growth and answer that lingering question [on the mechanism behind the benefits of breast milk on brain development,” said Limperopoulos.

According to the investigators, imaging technology helps identify abnormal brain development during infancy and thus allows early intervention when necessary. “Proton magnetic resonance spectroscopy may serve as an important additional tool to advance our understanding of how breastfeeding boosts neurodevelopment for preterm infants,” said Limperopoulos.

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Joyce Lam Ching Mei, 28 Mar 2019
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