title: Breast milk is better than formula milk in preventing parenteral nutrition-associated liver disease in infants receiving prolonged parenteral nutrition.
abstract: OBJECTIVE
  Breast milk has been shown to be associated with greater success with regard to weaning children with intestinal failure off parenteral nutrition (PN). There are only a few studies investigating the role of breast milk in decreasing PN-associated liver disease (PNALD). The aim of our study was to determine whether breast milk is better than formula milk in preventing PNALD in infants receiving PN for >4 weeks.
  
  
  METHODS
  We conducted a retrospective analysis of newborns requiring prolonged parenteral nutrition. We divided the sample into 3 different groups (exclusive breast-feeding, exclusive formula-feeding, and mixed feeding. We compared baseline characteristics, feeding profiles and liver function tests, and liver enzymes among the 3 groups.
  
  
  RESULTS
  Among infants receiving PN for >4 weeks, we found that infants who were fed only breast milk were significantly less likely to develop PNALD (34.6%) compared with those who were fed only formula milk (72.7%; P = 0.008). The mean maximum conjugated bilirubin (P = 0.03) and the mean maximum aspartate aminotransferase were significantly lower in the breast-fed group (P = 0.04) compared with the formula-fed group. Among the mixed-feeding group, infants who received a higher percentage of breast milk showed a significant negative correlation with the mean maximum conjugated bilirubin. (Pearson correlation -0.517, P = 0.027). The mean number of days receiving PN and the average daily lipid intake in the 2 groups was not significantly different.
  
  
  CONCLUSIONS
  As a modality for early enteral nutrition, breast milk is protective against the development of PNALD in infants receiving PN for >4 weeks.
authors.affiliation: Department of Medical Education, Miami Children's Hospital, Miami, FL 33155, USA. Sakil.Kulkarni@mch.com
authors.forename: Sakil
authors.initials: S
authors.lastname: Kulkarni
authors.forename: Velma
authors.initials: V
authors.lastname: Mercado
authors.forename: Mirta
authors.initials: M
authors.lastname: Rios
authors.forename: Richard
authors.initials: R
authors.lastname: Arboleda
authors.forename: Roberto
authors.initials: R
authors.lastname: Gomara
authors.forename: William
authors.initials: W
authors.lastname: Muinos
authors.forename: Jesse
authors.initials: J
authors.lastname: Reeves-Garcia
authors.forename: Erick
authors.initials: E
authors.lastname: Hernandez
mesh_terms: D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001903:Bottle Feeding; D001942:Breast Feeding; D004041:Dietary Fats / Q000008:administration & dosage; D005260:Female; D006801:Humans; D041943:Infant Formula / Q000737:chemistry*; D007231:Infant, Newborn; D008099:Liver / Q000201:enzymology / Q000378:metabolism; D008107:Liver Diseases / Q000097:blood / Q000201:enzymology / Q000209:etiology / Q000517:prevention & control*; D008111:Liver Function Tests; D008297:Male; D008892:Milk; D008895:Milk, Human; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D004041:Dietary Fats; D001219:Aspartate Aminotransferases; D001663:Bilirubin