Regulation of Gut Microbiota through Breast Milk Feeding Benefits Language and Cognitive Development of Preterm Toddlers

Feeding practice is essential to growth and development of preterm toddlers. However, the relationship of feeding mode with gut microbiota and neurodevelopment outcomes of preterm toddlers has not been characterized fully. We conducted this cohort study to assess neurodevelopment outcomes and gut microbiota community structures of preterm toddlers who received either breast milk, formula or mixed feeding. Fifty-five preterm toddlers born <37 weeks and 24 term toddlers were recruited in the study. Bayley III mental and physical index scores were measured among preterm toddlers at 12 ± 2 and 18 ± 2 months corrected age (CA). Gut microbiome composition was analyzed by 16S rRNA gene sequencing in fecal samples collected from all participants at 12 months, 16 months and 20 months after birth. We found exclusive breast milk feeding for over three months in the first six months after birth was associated with significant increase in language composite score at 12 months CA (86 (79,97) vs. 77 (71.75,79), p = 0.008) and both language (106.05 ± 14.68 vs. 90.58 ± 12.25, p = 0.000) and cognitive composite score at 18 months CA (107.17 ± 10.85 vs. 99.00 ± 9.24, p = 0.007). The alpha diversity, beta diversity and composition of gut microbiota from those breastfed preterm toddlers not only resembled healthy term toddlers but also followed similar structure of preterm toddlers with enhanced language and cognitive performance. Our results suggest exclusive breast milk feeding for over three months in preterm toddlers leads to optimal cognitive and language development and well-balanced microbiota.