title: Visual development of human milk-fed preterm infants provided with extra energy and nutrients after hospital discharge.
abstract: BACKGROUND
  Human milk (HM) is the optimal way to nourish preterm low birth weight (LBW) infants after hospital discharge. However, there are few data on which to assess whether HM alone is sufficient to address hospital-acquired nutrition deficits, and no adequately powered studies have examined this question using neurodevelopment as an outcome. The purpose of this work was to determine whether adding extra energy and nutrients to the feedings of predominantly HM-fed LBW infants early after discharge improves their visual development. Visual development was used in this study as a surrogate marker for neurodevelopment.
  
  
  METHODS
  At discharge, 39 predominantly HM-fed LBW infants (750-1800 g, 1288 ± 288 g) were randomized to receive human milk alone (control) or around half of the HM received daily mixed with a multinutrient fortifier (intervention) for 12 weeks. Grating acuity (ie, visual acuity) and contrast sensitivity were assessed using sweep visual-evoked potential tests at 4 and 6 months corrected age.
  
  
  RESULTS
  At 4 and 6 months corrected age, intervention infants demonstrated higher grating acuity compared to those in the control group (intervention: 7.8 ± 1.3 and 9.7 ± 1.2 [cycles/degree] vs control 6.9 ± 1.2 and 8.2 ± 1.3, P = .02). Differences in contrast sensitivity did not reach statistical significance (P = .11).
  
  
  CONCLUSIONS
  Adding a multinutrient fortifier to a portion of the expressed breast milk provided to predominantly HM-fed LBW infants early after discharge improves their early visual development. Whether these subtle differences in visual development apply to other aspects of development or longer term neurodevelopment are worthy of future investigation.
authors.affiliation: Physiology and Experimental Medicine Program, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: O'Connor
authors.forename: Karen
authors.initials: K
authors.lastname: Weishuhn
authors.forename: Joanne
authors.initials: J
authors.lastname: Rovet
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mirabella
authors.forename: Ann
authors.initials: A
authors.lastname: Jefferies
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Campbell
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Asztalos
authors.forename: Mark
authors.initials: M
authors.lastname: Feldman
authors.forename: Hilary
authors.initials: H
authors.lastname: Whyte
authors.forename: Carol
authors.initials: C
authors.lastname: Westall
mesh_terms: D015350:Contrast Sensitivity / Q000502:physiology; D002149:Energy Intake; D005260:Female; D005527:Food, Fortified; D005865:Gestational Age; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development* / Q000502:physiology; D008297:Male; D008895:Milk, Human; D009420:Nervous System / Q000254:growth & development*; D010351:Patient Discharge; D014792:Visual Acuity / Q000502:physiology*