A pioneering new study on preemies by researchers from the Children's National Health System has discovered that breast milk optimizes white matter microstructural organization throughout the entire brain—including both hemispheres of the cerebrum and cerebellum—more effectively than formula. This cutting-edge research adds to a growing body of empirical evidence showing that breastfeeding and breast milk improve infants’ overall brain health and functional connectivity.
These findings were presented by Katherine M. Ottolini, Nickie Andescavage, Kushal Kapse, and Catherine Limperopoulos in a lecture, "Impact of Breastmilk on Brain Microstructural Development in VLBW (Very Low Birth Weight) Infants," on May 7 during the 2017 annual meeting (May 6-9) of the Pediatric Academic Societies in San Francisco.
The premature infants examined during this study were born under 1500 grams birth weight prior to 32 weeks and had been admitted to a neonatal intensive care unit (NICU) within the first 48 hours of life. The CDC estimates that approximately one in 10 infants are born prematurely in the United States each year.
Senior author Catherine Limperopoulos and colleagues were able to examine regional cerebellar and cerebral white matter microstructures using state-of-the-art neuroimaging to identify differences between preterm infants at term-equivalent age and healthy term-born control neonates who had consumed breast milk or a manufactured formula specifically designed to meet the nutritional needs of premature infants. (Cerebellar is the sister word to cerebral and means “relating to or located in the cerebellum.")
White matter is composed of bundles of myelinated axons which act as communication lines between various gray matter areas throughout the entire brain. White matter is located beneath cerebral and cerebellar gray matter cortices and makes up about half of the brain's total volume. White matter is a central player in healthy human development as well as many neurological disorders.
Twenty-first-century advances in neuroimaging technology have dramatically improved the ability of neuroscientists to study white matter microstructures using a technique called “diffusion tensor imaging” (DTI) to enhance typical use of MRI brain scans. The researchers were able to leverage advanced DTI methods and 3-D volumetric magnetic resonance imaging (MRI) to calculate brain volumes by region, structure and tissue type. This included gray matter and white matter in the cerebrum and cerebellum.
In a related March 2017 paper, “Cerebellar Microstructural Organization is Altered by Complications of Premature Birth: A Case-Control Study,” Limperopoulos and colleagues concluded, “This DTI study provides evidence that complications of premature birth are associated with altered cerebellar microstructural organization when compared with term-born control infants.”
In many ways, the architectural structure of both hemispheres of the cerebellum mirror that of the left and right hemispheres of the cerebrum. i.e. The cerebellum has an external cerebellar cortex and deep cerebellar white matter called the "arbor vitae" (Latin for “tree of life”).
Robust white matter microstructural organization within the cerebrum and cerebellum is correlated with better neurologic outcomes in both preterm and full-term infants. The scaffolding for critical white matter architecture begins to form in the womb and is augmented for the rest of a person's life when, for instance, he or she attempts to master a new skill.
As an example, in 2009, a landmark study, “Training Induces Changes in White-Matter Architecture” by Jan Scholz and colleagues at Oxford University used DTI to demonstrate changes in white matter microstructures as a result of learning a new fine-tuned motor task (e.g. juggling). This first-of-its-kind study was trailblazing in that it identified a link between motor learning and changes in white matter microstructural brain architecture.
In a statement regarding her recent lecture at the 2017 PAS conference on the brain benefits of feeding preemies a mother's own breast milk, Catherine Limperopoulos said, "There are striking differences in white matter microstructural organization, however, with greater fractional anisotropy in the left posterior limb of internal capsule and middle cerebellar peduncle and lower mean diffusivity in the superior cerebellar peduncle."
As a public health advocate, I keep my antennae up for the latest research on practical ways that people can optimize gray matter volume and white matter functional connectivity between the cerebrum and cerebellum across the human lifespan. After reading about their latest research on breastfeeding and white matter microstructure, I was curious to learn more. So, I reached out to Katherine Ottolini (lead author) and Catherine Limperopoulos (senior author) via email with a few additional questions about their latest findings for my Psychology Today readers.
I asked the researchers, Do you hypothesize that all infants (regardless of VLBW or being preterm) would reap similar cerebral and cerebellar white matter microstructural organization benefits from breastfeeding? Ottolini and Limperopoulos responded in an email:
"The neurodevelopmental benefits of breast milk in term infants have been well established, with both short- and long-term benefits, including improved cognitive and behavioral outcomes and overall child health. MRI studies in term infants also have shown increased brain growth in infants fed breast milk and improved white matter microstructural development in breastmilk-fed term infants at toddler-age. Notably, compared with term infants, preterm infants are at significantly increased risk for white matter injury, and therefore may have the potential to attain even greater benefits from breast milk feeds and protection of the vulnerable preterm brain."
I also asked, Is there anything else about this groundbreaking research on the microstructural benefits of breastfeeding that the research team would like to share with my Psychology Today readers regarding best practices or actionable advice? Ottolini and Limperopoulos responded:
"Infants born prematurely miss out on the significant nutrient transfer from the placenta that normally occurs during the third trimester. Moreover, the brain undergoes a very rapid period of development in the third trimester of pregnancy and postnatally. Specifically, white matter is actively myelinating during this time (i.e., myelinated axons transmit signals from one region of the brain to another) and these data suggest that break milk supports white matter development in infants born prematurely.
We believe this research highlights the importance of nutrition as a modifiable risk factor for supporting brain development in the preterm infant. This research also emphasizes the beneficial effects of feeding mother's own breast milk, and highlights the importance of supporting mothers of preterm infants in breast-feeding during the often stressful time surrounding a preterm birth and a prolonged neonatal intensive care unit stay."
Statistically, preemies experience a high incidence rate of neurocognitive dysfunction even if they don't appear to have structural brain injury. The latest findings suggest that providing them with breast milk early in life holds the potential to lessen these neurodevelopmental risks. Limperopoulos emphasizes that additional studies are needed in a larger group of patients as well as longer term follow-up studies. Stay tuned for more on this topic.
Marie Brossard-Racine, Andrea Poretti, Jonathan Murnick, Marine Bouyssi-Kobar, Robert McCarter, Adre J. du Plessis, Catherine Limperopoulos. Cerebellar Microstructural Organization is Altered by Complications of Premature Birth: A Case-Control Study. The Journal of Pediatrics. DOI: http://dx.doi.org/10.1016/j.jpeds.2016.10.034
Lauren L. Emberson, Alex M. Boldin, Julie E. Riccio, Ronnie Guillet, Richard N. Aslin. Deficits in Top-Down Sensory Prediction in Infants At Risk due to Premature Birth. Current Biology, 2017; DOI: 10.1016/j.cub.2016.12.028
Scholz, J., Klein, M. C., Behrens, T. E. J., & Johansen-Berg, H. (2009). Training induces changes in white matter architecture. Nature Neuroscience. DOI: 10.1038/nn.2412
Mandy B. Belfort, MD, MPH et al. Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks' Gestation. The Journal of Pediatrics, July 2016 DOI: 10.1016/j.jpeds.2016.06.045
Sean C.L. Deoni, Douglas C. Dean, Irene Piryatinksy, Jonathan O'Muircheartaigh, Nicole Waskiewicz, Katie Lehman, Michelle Han, Holly Dirks. Breastfeeding and early white matter development: A cross-sectional study. NeuroImage, 2013; DOI: 10.1016/j.neuroimage.2013.05.090