350 - Human milk leptin and unique lipid profiles associate with postnatal growth failure and BPD risk in very preterm infants

Publication Number: 3337.350

Karen D.. Hendricks-Muñoz, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Miheret Yitayew, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Nayef Chahin, Children's Hospital of Richmond at VCU, Richmond, VA, United States; Jie Xu, Virginia Commonwealth University, Richmond, VA, United States

Background: Very Preterm (vPT) infants, 22-32 weeks gestation, approximately 1.6% of all US live births, are at risk for postnatal growth failure (PGF) and bronchopulmonary dysplasia (BPD). BPD a multifactorial lung disease with disrupted normal pulmonary development and lung injury is dependent on optimal somatic growth. We identified that mother's own milk (MOM) but not donor human milk (DHM) was independently associated with less PGF and decreased BPD risk in vPT infants. (PMID: 39605248). This study leveraged MOM and DHM samples of a cohort of vPT infants with PGF and BPD to determine the MOM and DHM trophic hormone levels of leptin and ghrelin and lipid composition associated with observed risk of PGF and BPD.

Objective: This study leveraged MOM and DHM samples of a cohort of vPT infants with PGF and BPD with the objective to determine the MOM and DHM trophic hormone levels of leptin and ghrelin and lipid composition associated with observed risk of PGF and BPD.

Design/Methods: This was prospective longitudinal observational study of vPT infants admitted to the Children's Hospital of Richmond at VCU neonatal intensive care unit between 2019-2024 and enrolled in an IRB approved study. Demographic and clinical data including type of enteral feeds (MOM, PDHM) with growth failure defined at < 10th and < 3rd weight percentile at 36 weeks corrected gestational age. Weekly enteral feedings, MOM or DHM, were analyzed for lipid composition via VCU Core Lipidomic facilities with trophic hormones assessed via ELISA. Statistical analysis included linear regression, chi-square tests, linear and multinomial logistic regression; p-value < 0.05 considered significant.

Results: There were 98 infants included in the analysis with 42 (43%) with < 10%tle and 19 (19 %) < 3%tle PGF and 38 (38%) infants with BPD including 20 (53%) with mild BPD and 18 (47%) with moderate/severe BPD. Ghrelin levels were similar among MOM or DHM cohorts. MOM leptin levels were significantly greater as compared to DHM, p< 0.032. Specific lipids dihydroxyl sphingosine-1-phosphate, p< 0.019, as well as unique ceramides and sphingomyelin were significantly higher in MOM compared to DHM, see Figure.

Conclusion(s): In this vPT cohort, MOM was associated with favorable postnatal growth and reduced BPD risk. MOM leptin levels and specific lipid milk sphingomyelin and ceramide compositions were significantly enhanced as compared to DHM. As enteral nutrition is a modifiable treatment in the NICU, identifying human milk components that mitigate PGF and influence BPD risk can assist in supplement strategies to moderate morbidities in this vPT high risk population.

Human Milk Lipid Profiles Associated with MOM compared to DHM
Specific ceramide and sphingomyelin lipid profiles were significantly higher in MOM compared to DHM.