title: The apparent breastfeeding paradox in very preterm infants: relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT.
abstract: BACKGROUND
  Supplementation of breast milk is difficult once infants suckle the breast and is often discontinued at end of hospitalisation and after discharge. Thus, breastfed preterm infants are exposed to an increased risk of nutritional deficit with a possible consequence on neurodevelopmental outcome.
  
  
  OBJECTIVE
  To assess the relationship between breast feeding at time of discharge, weight gain during hospitalisation and neurodevelopmental outcome.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Two large, independent population-based cohorts of very preterm infants: the Loire Infant Follow-up Team (LIFT) and the EPIPAGE cohorts.
  
  
  METHODS
  2925 very preterm infants alive at discharge.
  
  
  METHODS
  Suboptimal neurodevelopmental outcome, defined as a score in the lower tercile, using Age and Stages Questionnaire at 2 years in LIFT and Kaufman Assessment Battery for Children Test at 5 years in EPIPAGE. Two propensity scores for breast feeding at discharge, one for each cohort, were used to reduce bias.
  
  
  RESULTS
  Breast feeding at time of discharge concerned only 278/1733 (16%) infants in LIFT and 409/2163 (19%) infants in EPIPAGE cohort. Breast feeding is significantly associated with an increased risk of losing one weight Z-score during hospitalisation (LIFT: n=1463, adjusted odd ratio (aOR)=2.51 (95% CI 1.87 to 3.36); EPIPAGE: n=1417, aOR=1.55 (95% CI 1.14 to 2.12)) and with a decreased risk for a suboptimal neurodevelopmental assessment (LIFT: n=1463, aOR=0.63 (95% CI 0.45 to 0.87); EPIPAGE: n=1441, aOR=0.65 (95% CI 0.47 to 0.89) and an increased chance of having a head circumference Z-score higher than 0.5 at 2 years in LIFT cohort (n=1276, aOR=1.43 (95% CI 1.02 to 2.02)) and at 5 years in EPIPAGE cohort (n=1412, aOR=1.47 (95% CI 1.10 to 1.95)).
  
  
  CONCLUSIONS
  The observed better neurodevelopment in spite of suboptimal initial weight gain could be termed the 'apparent breastfeeding paradox' in very preterm infants. Regardless of the mechanisms involved, the current data provide encouragement for the use of breast feeding in preterm infants.
authors.affiliation: Department of Neonatal Medicine, Nantes University, CHU of Nantes, Nantes, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Rozé
authors.forename: Dominique
authors.initials: D
authors.lastname: Darmaun
authors.forename: Clair-Yves
authors.initials: CY
authors.lastname: Boquien
authors.forename: Cyril
authors.initials: C
authors.lastname: Flamant
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Picaud
authors.forename: Christophe
authors.initials: C
authors.lastname: Savagner
authors.forename: Olivier
authors.initials: O
authors.lastname: Claris
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lapillonne
authors.forename: Delphine
authors.initials: D
authors.lastname: Mitanchez
authors.forename: Bernard
authors.initials: B
authors.lastname: Branger
authors.forename: Umberto
authors.initials: U
authors.lastname: Simeoni
authors.forename: Monique
authors.initials: M
authors.lastname: Kaminski
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Ancel