10.

1177/089033402237909
Bier et alJ Hum Lact 18(4), 2002 J Hum Lact 18(4), 2002Human Milk and Cognitive and Motor Development

Human Milk Improves Cognitive and Motor Development of Premature

Infants During Infancy
Jo-Ann Blaymore Bier, MD, Tanya Oliver, MSOTR, Anne E. Ferguson, MSOTR, and Betty R. Vohr, MD

Abstract
Thirty-nine premature infants, 29 of whom received human milk (HMG) and 10 of whom re-
ceived formula only (FG), were enrolled in a study examining the effect of human milk on cog-
nitive and motor development. Infants were assessed at 3, 7, and 12 months corrected ages; the
Peabody Picture Vocabulary Test was administered to their mothers. HMG infants had higher
motor scores than FG infants at 3 months (48 ± 20 vs 35 ± 12, P = .05) and 12 months (63 ± 20
vs 46 ± 15, P < .05) and higher cognitive scores at 12 months corrected age (101 ± 11 vs 90 ± 9,
P < .05). HMG infants had higher scores (motor R2 = 0.2, cognitive R2 = 0.3; P < .05) adjusting
for oxygen requirement and maternal vocabulary score. Human milk is associated with im-
proved development of premature infants at 3 and 12 months corrected age in this sample.
J Hum Lact. 18(4):361-367.
Keywords: premature infants, human milk, formula, neurodevelopment

Premature infants are surviving in increasing numbers for infants who received human milk after adjusting for
in the United States, and increased knowledge with differences in education and social class. The advantage
regard to feeding approaches that may improve was dose related, associated with the quantity of human
neurodevelopmental outcome is of clinical impor- milk provided by tube feeding, not with actual breast-
tance. 1-4 Morley et al 5 examined the relationship feeding.6 Lucas et al7 also conducted a randomized
between mother’s choice to provide milk for her prema- multicenter study evaluating term formula versus
ture infant and developmental outcome at 18 months of preterm formula with and without human milk and later
age in 771 infants with birth weights less than 1850 g. development in preterm infants. Two trials were con-
Results showed an 8-point cognitive advantage on the ducted in the Lucas study: the first trial randomized
Bayley Scales of Infant Development for infants who infants into term formula versus preterm formula
received human milk. A 4.3-point advantage remained groups, and the second randomized infants into term
after controlling for demographic and perinatal factors formula and preterm formula used as supplements to
in this nonrandomized study. Follow-up of this cohort at human milk. Both preterm formula groups demon-
7.5 to 8 years of age showed an 8.3-point IQ advantage strated a developmental advantage at 18 months over
those fed term formula. Follow-up at 7.5 to 8 years of
Received for review, May 25, 2001; revised manuscript accepted for publica- age showed a cognitive disadvantage for boys who had
tion, March 13, 2002.
been fed term formula compared to those fed premature
Jo-Ann Blaymore Bier is an associate professor of pediatrics at the Brown infant formula. More of the children fed term formula as
University School of Medicine and a developmental pediatrician at the Child
Development Center of Rhode Island Hospital, Providence. Tanya Oliver is
infants had a verbal IQ less than 85 (greater than 1 SD
an occupational therapist at Bayview Rehabilitation Medical Center, Johns below the mean) compared to those fed preterm formula
Hopkins Medical Center, Baltimore, Maryland. Anne E. Ferguson is an oc- (P = .02).8 A second randomized prospective study
cupational therapist and a certified lactation counselor at St. Luke’s Hospital,
compared preterm infants who received mature donor
New Bedford, Massachusetts. Betty R. Vohr is a professor of pediatrics at
the Brown University School of Medicine and director of the Neonatal human milk versus a preterm formula as their only
Follow-Up Program at Women and Infants Hospital, Providence, Rhode Is- enteral feedings or as supplements to expressed mater-
land. Address correspondence to Jo-Ann Blaymore Bier, Child Development nal milk. Although mature human milk was known to be
Center, APC-6, Rhode Island Hospital, 593 Eddy Street, Providence, RI
02903, USA.
nutritionally deficient for premature infants, there was
J Hum Lact 18(4), 2002
no difference in developmental outcome at 18 months of
DOI: 10.1177/089033402237909 age. In addition, when these investigators compared the
 Copyright 2002 International Lactation Consultant Association

361
362
infants fed mature milk with a cohort of premature
infants from a previous study who had been fed term
formula, the infants in the study fed mature human milk
had higher scores at 18 months, again supporting human
milk’s positive effect on development.9
The effect of human milk on improved cognitive
functioning has been thought to be related to the long
chain fatty acids, arachidonic and docosahexaenoic
acid, which are present in human milk but not in bovine
10
milk and formulas. These fatty acids are found in both
brain and red cell membranes, and exposure to these
fatty acids during critical periods of neurodevelopment
10-13
has been related to cognitive development.
Results of these previous studies suggest that human
milk has a beneficial effect on cognitive development,
but effect on motor development has rarely been investi-
gated. The purpose of our study was to prospectively
compare cognitive and motor development of infants
with birth weights less than 2000 g who have received
human milk with those who have received only infant
formula. We hypothesized that premature infants who
receive their mothers’ milk would show improved
motor and cognitive outcomes during infancy com-
pared to formula-fed infants.
Patients and Methods
Thirty-nine infants with birth weights less than
2000 g were enrolled between January 1996 and June
1999. Exclusion criteria included a positive history of
maternal illicit drug use, maternal mental illness, HIV
infection, positive toxicology screen for illicit drugs,
infants with signs of drug withdrawal, and infants
whose mothers were taking medications known to be a
contraindication for breastfeeding. Approval was
obtained from the investigational review boards of
Rhode Island Hospital and Women and Infants Hospital
in Providence, Rhode Island, and St. Luke’s Hospital in
New Bedford, Massachusetts, and informed consent
was obtained from the mothers of all infants.
Mothers were approached during their infant’s first 2
weeks of life in the special care nursery of Women and
Infants Hospital. Mothers at this hospital are routinely
asked whether they are planning to breastfeed their
infants shortly after birth; the nursing staff and lactation
counselors provide lactation support and breast-pumping
information. This was a convenience sample of infants.
The actual number of mothers approached for participa-
tion in this study was not accounted for. Mothers who
planned to breastfeed their infants and were therefore
Bier et al J Hum Lact 18(4), 2002
pumping breast milk were placed in the human milk
group (n = 29); mothers who planned to feed their infant
only formula and were therefore not pumping were
placed in the formula group (n = 10). Family and neona-
tal data were collected. Family data included maternal
and paternal education and occupation, maternal age
and parity, previous breastfeeding experience, and
parental smoking. Socioeconomic status (SES) was
calculated using the Hollingshead 4-factor scoring
system, which is calculated based on maternal and
14
paternal education and occupation. Neonatal data
included birth weight, gestation, multiple birth, and
number of days of oxygen requirement.
During the hospitalization, daily dietary information
was obtained, which included the amount of human
milk and/or formula taken by gavage and/or bottle and
number of breastfeedings. Infant weight was recorded
by the infant’s nurse. The standard premature infant for-
mula used in our special care nursery is initially 24 calo-
ries per ounce; it is iron fortified and 11% whey. At 32
weeks gestation, the infant’s formula was changed to
one that is iron-fortified and 22 calories per ounce.
Human milk fortifier (one 4-kcal packet) is added to
each 25 cc of human milk. Weight was obtained using a
Deteco infant scale. A research assistant or the primary
investigator of the study measured infant length and
head circumference once a week. Length was obtained
using a flexible tape measure. The subjects were in a
supine position with the crown of the head held by either
a nurse or a member of the study team. Shoulders and
buttocks were flat, and the legs were extended at the hips
and knees, touching the infant’s bed, with arms flat
against the bed. With one hand gently upon the knees
ensuring they were flat, the measurer applied gentle
pressure with the tape stretched until it reached the
heels. Length was recorded to the nearest 0.1 cm. Head
circumference was measured with a flexible tape held
superior to the eyebrows to obtain the largest fronto-
occipital circumference.
During the infants’ hospitalizations, members of the
study staff were available 8 hours per day, 5 days per
week, to help with breastfeeding and/or bottle-feeding
questions or concerns of mothers whose infants were
enrolled in the study.
At the time of discharge, mothers in both groups were
given a calendar on which to record study data through
12 months corrected age. Weekly recordings by moth-
ers on their calendars included the amount of formula
taken, number of breastfeedings, amount of maternal
J Hum Lact 18(4), 2002 Human Milk and Cognitive and Motor Development
Table 1. Evaluation Measurements
Feeding
Time Point Information Weight
1 month after discharge X X
3 months corrected age X X
7 months corrected age X X
12 months corrected age X X
milk received by bottle, and the amount and type of solid
food taken per day. The recorded amounts were aver-
aged for each time period: the first month after dis-
charge, 1 month postdischarge through 3 months cor-
rected age, 3 months corrected age through 7 months
corrected age, and 7 months corrected age through 12
months corrected age.
After discharge, the principal investigator was avail-
able to all mothers at all times by beeper to answer ques-
tions related to feeding their infant. A home visit was
made 1 month postdischarge. At that visit, weight,
length, and head circumference were measured by a
research assistant or the principal investigator. Calendar
information was obtained. At 3 and 7 months corrected
age, the infants were evaluated at their regularly sched-
uled visit at the Neonatal Follow-Up Program. The pur-
pose of this program is to follow the medical and devel-
opmental outcome of premature and other high-risk
infants who are discharged from the special care nurs-
ery. Weight, length, and head circumference were mea-
sured, and the infants’ motor development was assessed
15
using the Alberta Infant Motor Scale (AIMS). The
AIMS is a performance-based observational tool for the
motor assessment of developing infants aged 0 to 18
months. A raw score is obtained based on the observa-
tion of the infant in a prone position, a supine position,
sitting, and bearing weight on his or her legs. The raw
score is converted to a percentile score based on the
infant’s corrected age, with 50% being “average.” To
our knowledge, this scale has not been previously used
in this population.
16
The revised Bayley Scales were administered to the
infants at the 7-month visit. These scales are the most
widely used scales for the evaluation of infant and tod-
dler cognitive development. They have been used rou-
tinely in studies examining cognitive outcomes of pre-
mature infants using corrected ages. Results are
reported as a Mental Developmental Index (MDI), stan-
dardized with a mean of 100 ± 15. The final evaluation
took place at the infants’ homes at 12 months corrected
age. Growth parameters were measured, and the AIMS
363
Head Alberta Infant Bayley Scales of
Length Circumference Motor Scale Infant Development
X X
X X X
X X X X
X X X X
and Bayley Scales were administered at this visit. One
study staff member administered the Bayley Scales, and
this individual was blind to the infants’ groups. Calen-
dar information was collected at all visits. The Peabody
Picture Vocabulary Test (PPVT) was administered to
the mothers at the infants’ 7- or 12-month visit. The
PPVT is a 1-word receptive vocabulary test. This test
was to be used as a “proxy variable” for maternal cogni-
tion. Table 1 summarizes the measurements and tests
done at each evaluation.
Unpaired t tests were used to compare continuous
variables, and chi-square analysis was used to compare
discreet variables. At each time period, the original 2
groups (human milk group vs formula) were compared.
Independent variables included maternal and infant
characteristics, growth parameters, cognitive scores on
the Bayley Scales, and motor score on the AIMS. Anal-
ysis of covariance was used to compare scores with
main effects (human milk vs formula) and covarying for
confounding variables, which differed significantly
between the 2 groups in bivariate comparisons. Regres-
sion analysis was used to examine the association
between amount of human milk intake in the special
care nursery and subsequent cognitive and motor
scores. Statistical significance was set at P < .05.
Results
Maternal and infant background data are shown in
Table 2. Infants were of similar gestation (28.6 ± 2.9
weeks vs 29.9 ± 2.2 weeks) and birth weight (1174 ±
305 g vs 1198 ± 170 g) in the human milk and formula
groups, respectively. Infants in the human milk group
had a longer oxygen requirement during their hospital-
ization (16.1 ± 17.6 days vs 5.5 ± 10.1 days; P < .05).
There were no significant differences in maternal age
(29.7 ± 6.9 years vs 26.5 ± 7.9 years) or Hollingshead
SES score (41.0 ± 12.8 vs 32.0 ± 15.9) between the
groups. Mothers of infants in the human milk group had
a higher PPVT score compared to mothers of infants in
the formula group (91.6 ± 15.1 vs 82.7 ± 5.2; P < .05).
364 Bier et al J Hum Lact 18(4), 2002

Table 2. Participant Characteristics

Human Milk Formula
(n = 29) (n = 10)
Mean SD Range Mean SD Range

Infant characteristics
Birth weight, g 1174 305 600-1965 1198 170 960-1460
Gestation, wk 28.6 2.9 23-34 29.9 2.2 27-34
Days received O2* 16.1 17.6 0-56** 5.5 10.1 0-34

n % n %

Female 16 55 8 80
Complications
Sepsis 3 10 0
Gr. 3-4 intraventricular hemorrhage 1 3 0
Necrotizing enterocolitis 0 1 10

Mean SD Range Mean SD Range

Maternal characteristics
Hollingshead socioeconomic status 41.0 12.8 15-66 32.0 15.9 17-55
Maternal Peabody Picture Vocabulary Test 91.6 15.1 62-133** 82.7 5.2 75-89
Age, y 29.7 6.9 17-43 26.5 7.9 16-37

n % n %

Previous live birth 11 38 2 20

Multiple gestation 9 31 3 30
Parental smoking 6 21 2 20

*Human milk group median = 8 days, formula group median = 3 days.

**Significant difference between groups, P < .05.

Mean weight and gestational age at discharge did not
differ between groups. Mean weight was 2071 ± 210 g
(range = 1685 to 2615 g) in the human milk group and
2131 ± 328 g (range = 1785 to 2717 g) in the formula
group at mean gestational ages of 37.3 ± 1.9 weeks
(range = 34 to 43 weeks) and 36.1 ± 1.3 weeks (range =
34 to 38 weeks), respectively. Mean gestational age at
the time of the 1-month visit did not differ between
groups and was 41.3 ± 2.0 weeks (range = 38 to 47
weeks) in the human milk group and 40.2 ± 1.4 weeks
(range = 38 to 42.5 weeks) in the formula group.
Infants in the human milk group received a mean of
170 ± 258 mL (median = 43 mL/wk, range = 0 to 1051
mL) of premature infant formula per week during their
stay in the special care nursery. Infants in this group
received 852 ± 429 mL (median = 878 mL/wk, range =
77 to 1754 mL) of human milk per week by gavage or
bottle. They were fed at the breast a mean of only 14.1 ±
9.3 times during their entire hospitalization in the spe-
cial care nursery; most feedings of maternal milk were
given by bottle.
Five infants in the human milk group were not fed
human milk after discharge. The 24 infants who contin-
ued to receive human milk after discharge were breast-
fed a mean of 5.7 ± 2.6 times per day and received a
mean of 224 ± 255 mL/d (median = 180 mL) of human
milk from bottles and 185 ± 211 mL/d (median = 115
mL) of formula during their first month after discharge
from the hospital. Two infants in the human milk group
were fed some pureed solid foods prior to 1 month.
Seven additional infants stopped receiving human
milk after 1-month postdischarge. The 17 infants who
continued to receive human milk between the 1- and 3-
month visits were breastfed a mean of 3.7 ± 3.4 times
per day (range = 0 to 10 times per day) and were bottle-
fed a mean of 59 ± 79 mL (median = 21 mL, range = 0 to
180 mL) of human milk per day and 296 ± 301 mL
(median = 255 mL, range = 0 to 750 mL) of formula per
day. These infants received a mean of 2.8 ± 5.9 oz
(median = 0 oz, range = 0 to 20 oz) of pureed foods per day.
Nine of the original 29 infants in the human milk
group continued breastfeeding between 3 and 7 months
J Hum Lact 18(4), 2002 Human Milk and Cognitive and Motor Development
Percent Partially Fed Human Milk
Percent Receiving Only Human Milk
100
Percent Exclusively Fed at Breast
80
% of Infants
60
40
20
0
SCN 1 Month 3 Months 7 Months 12 Months
Figure 1. Percentage of infants in the human milk group (n = 29)
receiving any human milk in the special care nursery
(SCN), receiving only human milk, and exclusively fed
at the breast during each assessment period.
corrected age. These infants were breastfed 4.5 ± 4.1
times per day (range = 1 to 10 times) and received 38 ±
106 mL (median = 0, range = 0 to 300 mL) of human
milk by bottle and 306 ± 373 mL (median = 485 mL,
range = 0 to 840 mL) of formula per day. They also were
fed a mean of 12.4 ± 6.4 oz (range = 4 to 22 oz) of pureed
baby food per day.
Only 5 of the original 29 infants continued breast-
feeding through 1 year corrected age. These infants
were breastfed a mean of 4.3 ± 1.4 times per day and
received 156 ± 223 mL of formula per day (median = 0
mL, range = 0 to 480 mL). None of the 5 infants who
were breastfed through 1 year of age received maternal
milk by bottle.
The percentage of infants in the human milk group
who continued to receive human milk after discharge is
shown graphically in Figure 1. Of the 29 infants who
received human milk in the special care nursery, 6
(21%) received no formula supplementation, only
breastfeedings and bottle-feedings of human milk with
human milk fortifier (one 4-kcal packet added to each
25 cc of human milk). Twenty-four (83%) of the 29
infants continued to receive maternal milk after dis-
charge; 5 (17%) were breastfed and received maternal
milk by bottle, but no formula, and 4 (14%) of the origi-
nal 29 were fed exclusively at the breast. The same 4
infants who were exclusively breastfed after discharge
continued exclusively breastfeeding through 7 months.
Of the 5 infants who continued to receive human milk
after 7 months, 3 were exclusively breastfed beginning
postdischarge through 1 year corrected age. The 29
infants in the human milk group received maternal milk
for a mean of 24 ± 20 weeks (range = 2 to 66 weeks).
365
Mean weight at 1 month was 3.4 ± 0.4 kg (range = 2.7
to 4.8 kg) in the human milk group and 3.4 ± 0.2 kg
(range = 3.0 to 3.8 kg) in the formula group. Length was
49.9 ± 2.7 cm (range = 44 to 54 cm) and 49.0 ± 2.7 cm
(range = 33 to 37 cm) and mean head circumference was
35.6 ± 2.0 cm (range = 31 to 39 cm) and 35.1 ± 1.3 cm
(range = 33 to 37 cm) at 1-month postdischarge in the
human milk and formula groups, respectively. There
were also no significant differences in growth parame-
ters between the groups at 3, 7, and 12 months cor-
rected age.
Infants in the human milk group had a higher mean
score on the AIMS, 48 ± 20%, compared to infants in the
formula group, 35 ± 12% (P = .05) at 3 months.
Although the human milk group’s AIMS score was 11
points higher at 7 months corrected age (58 ± 26% vs 47
± 26%), the difference did not reach statistical signifi-
cance. The mean Bayley MDI at 7 months did not differ
between groups and was 94 ± 7 in the human milk group
and 90 ± 9 in the formula group. At 12 months, infants in
the human milk group had a higher mean AIMS score,
63 ± 20% vs 46 ± 15% (P < .05) and a higher mean
Bayley MDI, 101 ± 11 vs 90 ± 9 (P < .05) compared to
infants in the formula group.
Analysis of covariance was used to compare 12-
month AIMS score and Bayley MDI with main group
effects (human milk vs formula), covarying for number
of days of oxygen and maternal PPVT score. The results
show that human milk was associated with a higher 12-
month AIMS score after controlling for days of oxygen
and maternal PPVT score, R2 = 0.2, P < .05. Twelve-
month MDI also remained significantly higher for the
human milk group after controlling for days of oxygen
and maternal PPVT (R2 = 0.3, P < .025), with adjusted
mean scores for human milk vs formula as follows:
AIMS, 62 ± 20% vs 47 ± 15%, and Bayley MDI, 100 ±
12 vs 91 ± 10 (Table 3).
Regression analysis was used to examine associa-
tions between the amount of human milk infants
received in the special care nursery (mL/wk) by gavage
and/or bottle, number of days of oxygen use and mater-
nal PPVT score (for all 39 infants enrolled), and the
Bayley MDI and AIMS scores. Results show an associ-
ation between human milk intake during hospitalization
and the 7- and 12-month MDI scores (r = 0.4, R2 = 0.1,
β = .4, coefficient for intercept = 90.4, P < .05, and r =
0.4, R2 = 0.2, β = .4, coefficient for intercept = 92.3, P <
.025, at 7 and 12 months, respectively). There was no
association between either number of days of oxygen
366 Bier et al J Hum Lact 18(4), 2002

Table 3. Adjusted Alberta Infant Motor Scale (AIMS) and Bayley Scales of Infant Development Scores
Human Milk Formula
(n = 29) (n = 10)
Infant Corrected
Scale Age, mo Adjusted Mean SD Range Adjusted Mean SD Range

AIMS* 3 48 20 17-75** 35 12 20-50

7 58 26 7-95 47 26 10-90
12 62 20 25-95† 47 15 25-75
Bayley MDI ‡ 7 94 7 84-111 90 9 76-102
12 100 12 82-117† 91 10 80-106

Results of analysis of covariance, main effect: human milk versus formula groups, covarying for maternal Peabody Picture Vocabulary Test score, number of
2 2
days of oxygen; dependent variable: 12 months AIMS score; R = 0.2; dependent variable: 12 months Bayley Mental Developmental Index (MDI); R = 0.3.
*Mean = 100 ± 15.
**P = .05.
†P < .05.
‡Mean = 50% ± 10%.

(r = 0.1, R = 0.02, β = .118, coefficient for intercept =

2
99.5) or PPVT score (r = 0.04, R = 0.04, β = .035, coef-
2
ficient for intercept = 90.4) and MDI.
Post hoc analysis of the study data for the AIMS
revealed a 68% power to detect differences at 3 months,
30% at 7 months, and 82% at 12 months. Power analysis
for the Bayley MDI score revealed a power of 37% at 7
months and 90% at 12 months.
Discussion
Our data add to the previous literature supporting the
benefits of human milk for the neurodevelopment of the
5-8 6
premature infant. Lucas et al followed preterm
infants through childhood and, after controlling for
socioeconomic status, found an IQ advantage in infants
who had received human milk during their initial hospi-
talization. Our study was unique in that mothers in the 2
groups were of similar ages and socioeconomic back-
grounds, and we identified both a motor advantage with
the AIMS and a mental developmental advantage with
the Bayley Scales at 12 months in premature infants.
The results are of interest, since one would expect motor
development during early infancy to be less influenced
by social and environmental factors than cognitive
development.
Because our study design was nonrandomized, there
may be unidentified confounding variables. The differ-
ences in developmental scores did remain, however,
after controlling for maternal PPVT scores. Although
the post hoc power analysis supports the differences
found at 12 months, caution must be used in generaliz-
ing our results given our small sample size and observa-
tional design.
Although infants were enrolled with birth weights
less than 2000 g, only 2 infants in this study had a birth
weight greater than 1500 g. Moreover, 11 infants had
birth weights less than 1000 g and, therefore, were at
highest risk for adverse developmental sequelae.17-20 In
addition, infants in the human milk group had a longer
oxygen requirement compared to infants in the formula
group. A prolonged oxygen requirement is a marker for
development of bronchopulmonary dysplasia (BPD),
and infants with BPD are at an increased risk for adverse
21-23
developmental sequelae. Despite these disadvan-
tages, infants in the human milk group demonstrated
higher cognitive and motor scores than those in the for-
mula group.
Both study groups had similar growth parameters
through 12 months corrected age. In our study, most
infants in the human milk group also received
supplementation with premature infant formula and
human milk fortifier. Twenty-three of the 29 (79%)
infants in the human milk group received at least some
formula while in the special care nursery, and 15 of the
24 (63%) infants who received human milk after dis-
charge received some formula in addition to maternal
milk. Any potential difference in growth patterns
between premature infant formula and human milk may
therefore be minimized by the supplemental formula or
human milk fortifier given to the infants fed human
milk.
Our study was also unique in that it documents inges-
tion of human milk both in the special care nursery and
after discharge. Several findings are evident. There was
a steady decrease in the percentage of infants receiving
human milk after discharge, dropping to 17% of the 29
J Hum Lact 18(4), 2002 Human Milk and Cognitive and Motor Development
infants at 12 months. The mothers most likely to con-
tinue providing human milk were those exclusively
breastfeeding at 1 month after discharge (3 of 5 vs 1 of
24; P < .025). Finally, differences in motor and Bayley
Scale scores were found despite the limited use of
human milk postdischarge, the small sample size, and
observational design.
Our conclusion based on this preliminary study is
that human milk is associated with improved cognitive
and motor development in premature infants at 3 to 12
months corrected age. Although this study needs repli-
cation with a larger cohort, we also conclude that the
provision of human milk and breastfeeding should be
enthusiastically supported in the special care nursery
and after discharge.
References
1. Bier JB, Pezzullo J, Kim E, Garcia-Coll C, Oh W, Vohr BR. Outcome
of extremely low birth weight infants: 1980 to 1990. Acta Paediatr.
1994;83:1244-1248.
2. Stevenson DK, Wright LL, Lemons JA, et al. Very low birth weight
outcomes of the National Institute of Child Health and Human Devel-
opment Neonatal Research Network, January 1993 through December
1994. Am J Obstet Gynecol. 1998;179:1632-1639.
3. Bregman J. Developmental outcome in very low birthweight infants:
current status and future trends. Pediatr Clin North Am. 1998;45:673-
690.
4. Lee KS, Kim BI, Khoshnood B, et al. Outcome of very low birth weight
infants in industrialized countries: 1947-1987. Am J Epidemiol.
1995;141:1188-1195.
5. Morley R, Cole TJ, Powell R, Lucas A. Mother’s choice to provide
breast milk and developmental outcome. Arch Dis Child. 1988;63:
1382-1385.
6. Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breast milk
and subsequent intelligence quotient in children born preterm. Lancet.
1992;339:261-264.
7. Lucas A, Morley R, Cole TJ, et al. Early diet in preterm babies and de-
velopmental status at 18 months. Lancet. 1990;335:1477-1481.
8. Lucas A, Morley R, Cole TJ. Randomised trial of early preterm babies
and later intelligence quotient. Br Med J. 1998;317:1481-1487.
9. Lucas A, Morley RM, Cole TJ, Gore SM. A randomized multicenter
study of human milk versus formula and later development in preterm
infants. Arch Dis Child. 1994;71:288-290.
10. Lucas A, Fewtrell MS, Morley R, et al. Randomized outcome trial of
human milk fortification and developmental outcome in preterm in-
fants. Am J Clin Nutr. 1996;64:42-51.
11. Vauy R, Hoffman DR. Essential fatty acid requirements for normal eye
and brain development. Semin Perinatol. 1991;15:449-455.
12. Carlson SE, Werkman SH, Rhodes PG. Visual acuity development in
health preterm infants: effects of marine oil supplementation. Am J
Clin Nutr. 1993;58:35.
13. Jensen RG, Jensen GI. Specialty lipids for infant nutrition: milk and
formulas. J Pediatr Gastroenterol Nutr. 1992;15:232-245.
367
14. Hollingshead AB. Four-factor index of social status. Working paper;
1985; New Haven, CT.
15. Piper MC, Darrah J. Motor Assessment of the Developing Infant. Phila-
delphia, PA: WB Saunders Company; 1994.
16. Bayley Scales of Infant Development. 2nd ed. New York, NY: Psycho-
logical Corporation; 1993.
17. Bergman J, Kimberlin LVS. Developmental outcome in extremely pre-
mature infants: impact of surfactant. Pediatr Clin North Am.
1993;40:937-953.
18. Hack M, Klein NK, Taylor HG. Long-term developmental outcomes
of low birth weight infants: the future of children. Low Birth Weight.
1995;5:176-196.
19. Lorenz JM, Wooliever DE, Jetton JR, Paneth N. A quantitative review
of mortality and developmental disability in extremely premature new-
borns. Arch Pediatr Adolesc Med. 1998;152:425-435.
20. Msall ME, Buck GM, Rogers BT, Duffy LC, Mallen SR, Catanzaro
NL. Predictors of mortality, morbidity, and disability in a cohort of in-
fants < 28 weeks gestation. Clin Pediatr. 1993;32:521-527.
21. Vohr B, Bell EF, Oh W. Infants with bronchopulmonary dysplasia:
growth patterns and neurologic and developmental outcome. Am J Dis
Child. 1982;136:443-447.
22. Vohr BR, Coll CG, Lobato D, Yunis KA, O’Dea C, Oh W.
Neurodevelopmental and medical status of low birth weight (LBW)
survivors with bronchopulmonary dysplasia (BPD) at 10 and 12 years
of age. Dev Med Child Neurol. 1991;33:690-697.
23. Vohr BR, Wright LL, Dusick AD, et al. Neurodevelopmental and func-
tional outcome of extremely low birth weight (ELBW) infants in the
NICHD Neonatal Network 1993-1994. Pediatrics. 2000;106:1216-
1226.
Resumen
La leche materna mejora el desarrollo cognitivo y
motor durante la infancia de los bebés nacidos con bajo
peso. Treinta y nueve bebés prematuros, de los cuales 29
recibieron leche humana (LH) y 10 recibieron formula
(FG), se incorporaron a un estudio para examinar los
efectos de la leche materna en el desarrollo cognitivo y
motor. Los bebés se evaluaron a los 3, 7 y 12 meses de
edad corregida; se administró el Test de “Peabody Pic-
ture Vocabulary” a las madres. Los bebés en el grupo LH
mostraron puntuaciones motoras mayores que los bebés
en el grupo FG a los 3 (48 ± 20 vs 35 ± 12, P = .05) y 12
meses (63 ± 20 vs 46 ± 15, P < .05) y puntajes cognitivos
mayores a los 12 meses de edad corregida (101 ± 11 vs
90 ± 9, P < .05). Los bebés del grupo LH mostraron
2 2
puntuaciones mayores (motor, R = 0.2, cognitivas R =
0.3, P < .05) ajustados al requerimiento de oxígeno y al
puntaje de vocabulario materno. Esta muestra mostro
que la leche materna esta asociada un mejor desarrollo
de los prematuros a los 3 y 12 meses de edad corregida.