Human milk vs. formula feeding: Reflux patterns and outcomes in infants

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Created On: 29/12/2025

Gastroesophageal reflux in preterm infants

This research explored how gastroesophageal reflux patterns and clinical outcomes vary between preterm infants diagnosed with gastroesophageal reflux disease (GERD) who are fed human breast milk compared with those who receive formula milk.

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Key take away

Human milk-fed preterm infants show more acid reflux events but demonstrate better receptive language and fine motor development by 2 years of age.

Background

Method

This retrospective study examined prospectively gathered data from 316 preterm infants (average gestational age: 30.1 ± 3.4 weeks) suspected of having GERD, all of whom received 24-hour pH-impedance monitoring at 39.8 ± 1.4 weeks postmenstrual age. Gastroesophageal reflux features and both short- and long-term health outcomes were analyzed and compared between breast milk-fed infants and formula-fed infants.

Result

Breast milk-fed infants demonstrated a higher acid reflux index, more frequent acid reflux episodes, longer acid exposure duration, and increased proximal acid exposure (P < 0.05) than formula-fed infants. However, no pivotal differences were found in clinical symptoms, acid or bolus clearance time, distal baseline impedance, or hospital discharge outcomes (P > 0.05). At 2-year follow-up, Bayley developmental assessments revealed favorable distributions in receptive language and fine motor performance among infants who received human milk (P < 0.05).

Conclusion

Although human milk-fed infants exhibited more pronounced acid-reflux events, the bioactive components of breast milk may support improved neurosensory and neuromotor regulation during esophageal challenges—suggesting potential long-term developmental benefits.