[Hot Science] Breastmilk exposure and its association with brain development and connectivity in preterm infants

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General Nutrition Obstetrics / Gynaecology Paediatrics Nutrition & Disease Management
[Hot Science] Breastmilk exposure and its association with brain development and connectivity in preterm infants

Uncertainties remain about the optimal nutritional regimen for preterm infants who are peculiarly vulnerable to altered brain structure and connectivity as well as subsequent neurocognitive impairment.


  • Preterm infants delivered at ≤ 33.0 gestational weeks (n = 47), were stratified into two groups:
    • Group 1: Exclusively breastfed for < 75% days of neonatal inpatient care (n = 20)
    • Group 2: Exclusively breastfed for ≥ 75% days of inpatient care (n = 27)


  • Managed nutritional regimen with the following principles:
    • Immediately after delivery, breastmilk expression was encouraged, and colostrum was fed once available
    • If breastmilk expression was insufficient/declined by 48 hours of age, donor milk was given as supplementation/replacement accordingly
    • If birth weight < 1500 g, parenteral nutrition was started upon admission to neonatal care
    • All infants received multivitamins from day 7 and iron supplementation from day 42 post-birth
  • Collected daily nutritional intake data from birth until discharge to home
  • Obtained and compared brain magnetic resonance imaging (MRI) between group 1 and 2

Key Findings

  • As compared to Group 1 infants, Group 2 infants (exclusively breastfed for ≥ 75% days of inpatient care) had:
    • Higher fractional anisotropy (FA)-weighted connectome connectivity (p = 0.04)
    • Greater FA in major white matter fasciculi within various areas, such as the corpus callosum, centrum semiovale, corticospinal tracts, etc (p < 0.05)
  • Noticeable increase in structural connectivity and tract water diffusion parameters were found in those with ≥ 90% breastmilk exposure, suggesting a potential dose-dependent association
  • No significant differences in brain volumes between groups


An increased breastmilk exposure in preterm infants is associated with improved cerebral structural connectivity as well as the microstructural properties of white matter tracts

Link to the article



Blesa M, et al. Early breast milk exposure modifies brain connectivity in preterm infants. NeuroImage. 2019;184:431-439.

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