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Does Human Milk Prevent ROP?
Heller C, O'Shea M, Yao Q. et al. Human Milk Intake and Retinopathy of Prematurity in ELBW Infants. PEDIATRICS (July 2007); 120:1-9. [Full text] [PDF]
Patients and Methods. This study is a secondary analysis of data collected for a trial of glutamine supplementation in extremely low birth weight infants (birth weight <1000 g). Using logistic regression, we estimated odds ratios and 95% confidence intervals for any human milk intake and, among infants who received human milk, for each 10 mL/kg per day and each 10% increase in volume.
Results. Of the 1057 infants included in this cohort, 788 infants (75%) received at least some human milk. Among these milk-fed infants, the median volume of human milk intake was 30 mL/kg per day (interquartile range: 6–83 mL/kg per day), and the median proportional volume of human milk intake was 0.18 (interquartile range: 0.03–0.66). One hundred sixty-three infants (15%) developed severe retinopathy of prematurity.
Conclusions. In extremely low birth weight infants, human milk intake was not associated with a decreased risk of severe retinopathy of prematurity.
Comments. This is a
negative study and it was not designed to test their hypothesis because data
were derived from the 1433 infants enrolled in a multicenter, randomized
clinical trial of parenteral glutamine supplementation. An imbalance between
oxidant generating systems and antioxidants in VLBWI is implicated in the
pathogenesis of ROP. Human milk has many enzymatic and non-enzymatic
antioxidant constituents which may protect against the
development of ROP. In this study authors chose surgical therapy for ROP as a
surrogate for severe or threshold ROP although this decision varies from one
ophthalmologist to another. It would have been more informative if the
authors could have graded the ROP as “threshold,” “prethreshold,” or “less
than prethreshold”. Furthermore, it is not known what is the required
amount and volume of milk that could help in preventing ROP as well as the
composition of human milk e.g LCPUFAs level and its serum level after
absorption. Although the association of human milk and ROP risk has been
examined previously, with conflicting results, I believe we need more studies
to explore the effect of human milk in decreasing the prevalence of ROP. SAA
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