Two-Year Follow-Up of the Different Approaches to Feeding Infants Born Moderate-to-Late Preterm: Determinants of Feed Intolerance, Body Composition, and Development (DIAMOND) Randomized Trial

OBJECTIVE: To determine the impact of different feeding strategies in children born moderate-and-late preterm (MLPT) on later neurosensory impairment. STUDY DESIGN: weeks) recruited to the Different Approaches to Moderate & Late Preterm Nutrition: Determinants of Feed Intolerance, Body Composition, and Development (DIAMOND) factorial randomized trial from New Zealand neonatal units were randomized to intravenous amino acids vs intravenous dextrose, exclusive maternal breastmilk vs milk supplement, and taste/smell of milk before gastric tube feeds or not. Neurosensory impairment (blindness, deafness, cerebral palsy, or developmental delay [Bayley III composite cognitive/language/motor scores <85]) was assessed at 2 years of corrected age. Outcomes were compared using generalized linear mixed models. RESULTS: Of 529 eligible children, 425 were assessed at mean (SD) 25.6 (1.9) months. Rates of neurosensory impairment were similar in amino acids vs dextrose and in milk supplement vs maternal breastmilk only groups, but impairments were less frequent in children randomized to taste/smell of milk (43/203 [21%] vs 68/220 [31%]; adjusted risk ratio 0.7; 95% CI 0.5-0.9; P = .02). This difference was primarily attributable to mild developmental delay, particularly language delay (35/199 [18%] vs 61/218 [28%]; adjusted risk ratio 0.6; 95% CI 0.4-0.9; P = .01). Growth, general health, and behavior were similar between groups. CONCLUSIONS: Early parenteral and enteral nutrition strategies in children born MLPT did not alter outcomes at 2 years. However, exposure to taste/smell of milk before gastric tube feeds was associated with a lower risk of neurosensory impairment. TRIAL REGISTRATION: anzctr.org.au Identifier: ACTRN12616001199404 (https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371006&isReview=true).