In the realm of neonatal medicine, the impact of early nutrition on brain development continues to be a critical focus, especially for infants born prematurely. A groundbreaking study recently published in Pediatric Research provides compelling evidence on how donor human milk influences the structural brain development of very preterm infants, shedding light on potential pathways to improve neurodevelopmental outcomes in this vulnerable population.
Preterm birth, defined as birth before 37 weeks of gestation, poses significant risks for neurological impairments due to the interruption of critical brain growth phases that typically occur in the third trimester. Infants born very preterm, usually before 32 weeks, face heightened risks of cognitive, motor, and behavioral disorders later in life. The brain’s rapid development during this period makes it exceptionally sensitive to external influences, including nutritional intake.
This new investigation aimed to assess the differential effects of donor human milk versus formula feeding on the brain structure of very preterm infants, employing advanced neuroimaging techniques to provide detailed insights. Donor human milk, obtained from screened lactating individuals and pasteurized to ensure safety, has been known to supply essential nutrients and bioactive factors absent in formula yet widely utilized in neonatal intensive care units (NICUs) worldwide when the infant’s own mother’s milk is unavailable.
Utilizing quantitative magnetic resonance imaging (MRI) methods, the research team observed significant differences in brain volumes and white matter integrity among infants fed with donor human milk compared to those fed formula. These neuroimaging biomarkers serve as proxies for neurological health and maturation, reflecting the extent and quality of brain development. The methodology included precise volumetric analyses of cortical and subcortical structures, as well as diffusion tensor imaging (DTI) to assess microstructural development.
Remarkably, infants receiving donor human milk exhibited greater total brain volume and enhanced microstructural integrity of white matter tracts vital for cognitive and motor functions, compared to their formula-fed counterparts. These findings suggest that donor milk confers neuroprotective benefits that may translate into improved developmental trajectories, potentially mitigating some adverse effects associated with prematurity.
The study’s design carefully controlled for confounding variables such as gestational age at birth, birth weight, and exposure to neonatal morbidities, ensuring that observed differences were attributable primarily to nutritional intake. This rigorous approach lends robustness to the conclusions, emphasizing the intrinsic value of human milk components beyond mere caloric content.
Exploring the underlying biological mechanisms, donor human milk contains numerous bioactive elements such as growth factors, immunoglobulins, enzymes, and anti-inflammatory agents. These molecules promote neurogenesis, synaptogenesis, and myelination, processes critical to brain maturation during the neonatal period. Pasteurization, while necessary for safety, may reduce some of these factors, yet donor milk still retains substantial activity compared to formula.
The implications of this research extend beyond immediate neonatal care. Long-term neurodevelopmental outcomes are significantly influenced by early brain structure integrity, affecting cognitive functions including memory, attention, and executive functions. Enhancing brain development through optimal nutrition opens avenues for reducing the burden of neurodevelopmental disabilities commonly observed in preterm populations.
Moreover, this study underscores the importance of expanding donor milk programs in NICUs, advocating for policy shifts to prioritize human milk availability when maternal lactation is insufficient. Current barriers, including logistic challenges, cost, and supply limitations, must be addressed to maximize the benefit for preterm infants globally.
Future research directions highlighted by the authors include longitudinal studies tracking neurodevelopmental progress into childhood and adolescence, exploring whether the structural advantages observed translate into measurable cognitive and behavioral improvements. Additionally, investigating optimization of donor milk processing to preserve bioactive components may further augment its neuroprotective capacity.
Advanced neuroimaging serves as an indispensable tool in neonatal research, bridging clinical observations with mechanistic understanding. By elucidating the nuanced influence of nutrition on brain architecture, studies like this guide interventions targeting the earliest windows of neuroplasticity, when therapeutic efforts are most impactful.
In conclusion, this pivotal research confirms that donor human milk is not merely a nutritional alternative but a critical contributor to enhanced brain development in very preterm infants. Its use correlates with measurable improvements in brain structure, setting a precedent for refining neonatal nutritional protocols to support optimal brain health outcomes.
As the landscape of neonatal care evolves, integrating such evidence-driven approaches ensures that vulnerable preterm infants receive the best foundation for neurodevelopment. The study serves as a clarion call to clinicians, researchers, and policymakers alike, emphasizing the profound significance of early-life nutritional interventions in shaping lifelong neurological trajectories.
The findings resonate deeply amidst ongoing efforts to mitigate the lifelong challenges faced by preterm infants. With more widespread implementation, donor human milk feeding protocols could fundamentally alter the developmental prospects for millions of infants worldwide, heralding a new era in neonatal neuroprotection rooted in the power of human milk.
Subject of Research: The impact of donor human milk on structural brain development in very preterm infants.
Article Title: Donor human milk and structural brain development in very preterm infants.
Article References:
Ottolini, K.M., Basu, S.K., Ngwa, J. et al. Donor human milk and structural brain development in very preterm infants. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04539-3
DOI: https://doi.org/10.1038/s41390-025-04539-3
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