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Rothers JL, Calton CM, Stepp JMB, Halpern MD. Enteral Feeding and Antibiotic Treatment Do Not Influence Increased Coefficient of Variation of Total Fecal Bile Acids in Necrotizing Enterocolitis. NEWBORN (CLARKSVILLE, MD.) 2023; 2:128-132. [PMID: 37559695 PMCID: PMC10411330 DOI: 10.5005/jp-journals-11002-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Introduction Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants. In animal models, the accumulation of ileal bile acids (BAs) is a crucial component of NEC pathophysiology. Recently, we showed that the coefficient of variation of total fecal BAs (CV-TBA) was elevated in infants who develop NEC compared to matched controls. However, neither the type of enteral nutrition nor antibiotic treatments-parameters that could potentially influence BA levels-were used to match pairs. Thus, we assessed the relationships between exposure to enteral feeding types and antibiotic treatments with NEC status and CV-TBA. Materials and methods Serial fecal samples were collected from 79 infants born with birth weight (BW) ≤1800 gm and estimated gestational age (EGA) ≤32 weeks; eighteen of these infants developed NEC. Total fecal BA levels (TBA) were determined using a commercially available enzyme cycling kit. Relationships between CV-TBA and dichotomous variables (NEC status, demographics, early exposure variables) were assessed by independent samples t-tests. Fisher's exact tests were used to assess relationships between NEC status and categorical variables. Results High values for CV-TBA levels perfectly predicted NEC status among infants in this study. However, feeding type and antibiotic usage did not drive this relationship. Conclusions As in previous studies, high values for the CV-TBA levels in the first weeks of life perfectly predicted NEC status among infants. Importantly, feeding type and antibiotic usage-previously identified risk factors for NEC-did not drive this relationship.
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Affiliation(s)
- Janet L Rothers
- BIO5 Institute Statistics Consulting Lab, University of Arizona, Tucson, Arizona, United States of America
| | - Christine M Calton
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Jennifer MB Stepp
- Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Melissa D Halpern
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States of America
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Elevated Coefficient of Variation in Total Fecal Bile Acids Precedes Diagnosis of Necrotizing Enterocolitis. Sci Rep 2020; 10:249. [PMID: 31937876 PMCID: PMC6959237 DOI: 10.1038/s41598-019-57178-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/24/2019] [Indexed: 12/15/2022] Open
Abstract
Accumulation of bile acids (BAs) may mediate development of necrotizing enterocolitis (NEC). Serial fecal samples were collected from premature infants with birth weight (BW) ≤ 1800 g, estimated gestational age (EGA) ≤ 32 weeks, and <30 days old prior to initiation of enteral feeding. Nine infants that developed Bell’s Stage ≥ II NEC were matched with control infants based on BW, EGA, day of life (DOL) enteral feeding was initiated and DOL of the first sample. From each subject, five samples matched by DOL collected were analyzed for BA levels and composition. Fifteen individual BA species were measured via LC-MS/MS and total BA levels were measured using the Diazyme Total Bile Acid Assay kit. No statistically significant differences in composition were observed between control and NEC at the level of individual species (p = 0.1133) or grouped BAs (p = 0.0742). However, there was a statistically significant difference (p = 0.000012) in the mean coefficient of variation (CV) between the two groups with infants developing NEC having more than four-fold higher mean CV than controls. Importantly, these variations occurred prior to NEC diagnosis. These data suggest fluctuations in total fecal BA levels could provide the basis for the first predictive clinical test for NEC.
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Abstract
Necrotizing enterocolitis is a devastating disease afflicting premature infants, though after 50 years of investigation, the pathophysiology remains elusive. This report describes the possible etiologic factors from a historical perspective, and outlines the importance of human milk, intestinal blood flow, and intestinal blood flow changes from a developmental perspective over the last 40-50 years.
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Affiliation(s)
- Michael S Caplan
- Department of Pediatrics, Chief Scientific Officer, Northshore University, Healthsystem, Clinical Professor of Pediatrics, University of Chicago, Pritzker School of Medicine.
| | - Avroy Fanaroff
- Eliza Henry Barnes chair in Neonatology, Rainbow Babies and Children's Hospital
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4
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Rentea RM, Wagner AJ, Gourlay DM, Christensen M, Liedel JL. Effects of anticipated neonatal surgical intervention on maternal milk cytokine production. J Pediatr Surg 2017; 52:45-49. [PMID: 27836369 DOI: 10.1016/j.jpedsurg.2016.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 10/20/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Maternal stress on neonatal outcomes of infants admitted to the NICU is incompletely understood. We previously demonstrated breast milk derived cytokines remain biologically active in the neonatal intestine. We hypothesized that the need for neonatal surgical intervention would be stimulus leading to maternal cytokine production thus affecting neonatal outcome. METHODS Discarded expressed breast milk (EBM) in the first 3weeks following delivery was analyzed for IL-23 and IL-10 by ELISA. Variables analyzed included: the need for a pediatric surgical procedure, the need for cardiac surgical procedure, no surgical interventions, and survival. All values are expressed as mean±SEM. Statistical analysis utilized Kruskal and Mann-Whitney test. RESULTS EBM from mothers whose infants required any surgical procedure (n=19) revealed significant elevation in IL-10 but not IL-23 compared to nonsurgical EBM (n=18). Subdivided by procedure type, there was no difference between those undergoing a cardiac (n=9) versus pediatric surgical (n=10) procedure in both IL-10 and IL-23. Mothers whose infants requiring surgical intervention or whose infants did not survive in the first 3weeks of life had elevation of IL-10. CONCLUSION Results suggest maternal stress impacts the cytokine profile of breast milk. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO.
| | - Amy J Wagner
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - David M Gourlay
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Melissa Christensen
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Jennifer L Liedel
- Department of Pediatrics and Critical Care, Albert Einstein College Medicine, Montefiore Medical Center, New York, NY
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5
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Shulhan J, Dicken B, Hartling L, Larsen BM. Current Knowledge of Necrotizing Enterocolitis in Preterm Infants and the Impact of Different Types of Enteral Nutrition Products. Adv Nutr 2017; 8:80-91. [PMID: 28096129 PMCID: PMC5227976 DOI: 10.3945/an.116.013193] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Preterm infants are extremely vulnerable to a range of morbidities and mortality. Underdeveloped cardiac, respiratory, gastrointestinal, and immune systems in the preterm period increase the risk of necrotizing enterocolitis (NEC), a serious disease of the gut. NEC affects 5-12% of very-low birth-weight infants, leads to surgery in 20-40% of cases, and is fatal in 25-50% of cases. There are multiple factors that may contribute to NEC, but the exact cause is not yet fully understood. Severe cases can result in intestinal resection or death, and the health care costs average >$300,000/infant when surgical management is required. Different types of nutrition may affect the onset or progression of NEC. Several studies have indicated that bovine milk-based infant formulas lead to a higher incidence of NEC in preterm infants than does human milk (HM). However, it is not clear why HM is linked to a lower incidence of NEC or why some infants fed an exclusively HM diet still develop NEC. An area that has not been thoroughly explored is the use of semielemental or elemental formulas. These specialty formulas are easy to digest and absorb in the gut and may be an effective nutritional intervention for reducing the risk of NEC. This review summarizes what is known about the factors that contribute to the onset and progression of NEC, discusses its health care cost implications, and explores the impact that different formulas and HM have on this disease.
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Affiliation(s)
- Jocelyn Shulhan
- Departments of Pediatrics and
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Canada
| | - Bryan Dicken
- Surgery, Faculty of Medicine and Dentistry, and
- Stollery Children's Hospital, Edmonton, Canada; and
| | - Lisa Hartling
- Departments of Pediatrics and
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Canada
| | - Bodil Mk Larsen
- Departments of Pediatrics and
- Stollery Children's Hospital, Edmonton, Canada; and
- Nutrition Services, Alberta Health Services, Edmonton, Canada
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6
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Risk factors and outcome in neonatal necrotising enterocolitis. Indian J Pediatr 2014; 81:425-8. [PMID: 24385263 DOI: 10.1007/s12098-013-1311-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 11/18/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To analyze multiple risk factors of necrotizing enterocolitis (NEC) and the outcome. METHODS Hundred neonates with NEC were compared with 100 normal neonates matched for sex, gestation and weight. Their data including antenatal, natal, course of illness, hospital stay, progress and outcome were collected. Univariate analysis and logistic regression were used to analyze the risk factors. RESULTS Mean age of onset of NEC was 2.35 ± 1.11 d. Stage I, II and III were noted in 48 %, 39 % and 13 % of cases respectively. Most common clinical features were abdominal distension (85 %) and feed intolerance (70 %). Important risk factors associated with NEC were sepsis, top feeding, perinatal asphyxia, respiratory distress and mechanical ventilation. Antenatal steroids and breast feeding had beneficial effect. No association was found with occurrence of NEC and cyanotic heart disease or administration of H2 blockers. Outcome in stage III was very poor. CONCLUSIONS Early identification of risk factors and appropriate intervention may reduce the incidence and improve the outcome in NEC.
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Abstract
Necrotizing enterocolitis (NEC), a common cause of neonatal morbidity and mortality, is strongly associated with prematurity and typically occurs following initiation of enteral feeds. Mild NEC is adequately treated by cessation of enteral feeding, empiric antibiotics, and supportive care. Approximately 50% of affected infants will develop progressive intestinal necrosis requiring urgent operation. Several surgical techniques have been described, but there is no clear survival benefit for any single operative approach. While debate continues regarding the optimal surgical management for infants with severe NEC, future progress will likely depend on the development of improved diagnostic tools and preventive therapies.
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9
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Abstract
The incidence of necrotising enterocolitis (NEC) has not changed significantly despite the dramatic advances in perinatal-neonatal care. The absolute number of survivors of NEC is expected to rise, as prevention of prematurity, the single most important risk factor for the illness, continues to be difficult. Prevention of NEC has thus become an area of research priority. Given the role of inflammatory mediators in its pathogenesis newer immune modulators are being studied as potential agents for prevention/treatment of NEC. Caution, however, is warranted because the failure of sepsis trials in adults has clearly indicated that the concept of down-regulating the inflammatory response is deceptively simple. Clinical trials of any such promising preventative agent(s) need to be designed carefully and must include long-term neurodevelopmental outcomes as almost an entire population of high-risk preterm neonates will be exposed to their adverse effects. As new frontiers continue to be explored, the proven benefits of simple and safe interventions like antenatal glucocorticoid therapy and the preferential use of breast milk for feeding high-risk neonates must not be forgotten. Given that a single effective agent is unlikely in the near future, utilizing a package of "potentially better practices" seems to be the most appropriate strategy to prevent and minimize NEC.
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Affiliation(s)
- Sanjay Patole
- Department of Neonatal Paediatrics, KEM Hospital for Women, University of Western Australia, Perth, WA, Australia.
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Schnabl KL, Aerde JEV, Thomson ABR, Clandinin MT. Necrotizing enterocolitis: A multifactorial disease with no cure. World J Gastroenterol 2008; 14:2142-61. [PMID: 18407587 PMCID: PMC2703838 DOI: 10.3748/wjg.14.2142] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Necrotizing enterocolitis is an inflammatory bowel disease of neonates with significant morbidity and mortality in preterm infants. Due to the multifactorial nature of the disease and limitations in disease models, early diagnosis remains challenging and the pathogenesis elusive. Although preterm birth, hypoxic-ischemic events, formula feeding, and abnormal bacteria colonization are established risk factors, the role of genetics and vasoactive/inflammatory mediators is unclear. Consequently, treatments do not target the specific underlying disease processes and are symptomatic and surgically invasive. Breast-feeding is the most effective preventative measure. Recent advances in the prevention of necrotizing enterocolitis have focused on bioactive nutrients and trophic factors in human milk. Development of new disease models including the aspect of prematurity that consistently predisposes neonates to the disease with multiple risk factors will improve our understanding of the pathogenesis and lead to discovery of innovative therapeutics.
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Moon TC, Son SY, Chang HW. Purification and Characterization of 45 kDa PAF Acetylhydrolase from Bovine Colostrum. Biol Pharm Bull 2007; 30:1668-73. [PMID: 17827718 DOI: 10.1248/bpb.30.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Platelet activating factor (1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine; PAF) acetylhydrolase (PAF-AH) activity has been identified in bovine colostrum and high levels of this activity are found in early colostrum (within 24 h after parturition). In this study, PAF-AH in early colostrum was purified by ammonium sulfate precipitation, and sequential use of butyl-Toyopearl 650M, DEAE-Sepharose, heparin-Sepharose, hydroxyapatite, chelating-Sepharose and Mono Q HPLC column chromatography. This enzyme is a monomeric polypeptide with a molecular weight of approximately 45 kDa on 12.5% SDS-PAGE. The V(max) and K(m) for PAF-AH were 87.6 microM and 7.96 nmol/min/mg respectively. This enzyme was inhibited by phenylmethylsulfonyl fluoride, iodoacetamide and p-bromophenacylbromide, suggesting that both serine and histidine residues are required for enzyme activity. It was not inactivated by NaF or dithiothreitol. The purified enzyme did not degrade phospholipids with a long chain fatty acyl group at the sn-2 position. Accordingly, this enzyme is distinct from phospholipase A(2). In addition, PAF-AH selectively hydrolyzed oxidatively modified phosphatidylcholine. Furthermore, this enzyme was shown by Western blot analysis using antibody to human plasma PAF-AH to be plasma type PAF-AH. These results clearly demonstrate that 45 kDa plasma type PAF-AH activity exists in bovine colostrum.
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Affiliation(s)
- Tae Chul Moon
- College of Pharmacy, Yeungnam University, Gyeongsan 712-749, Korea
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12
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Patole S. Strategies for prevention of feed intolerance in preterm neonates: a systematic review. J Matern Fetal Neonatal Med 2006; 18:67-76. [PMID: 16105795 DOI: 10.1080/14767050500127724] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Postnatal growth restriction and failure to thrive have been recently identified as a major issue in preterm, especially extremely-low-birth-weight neonates. An increased length of time to reach full enteral feedings is also significantly associated with a poorer mental outcome in preterm neonates at 24 months corrected age. Optimization of enteral nutrition without increasing the risk of necrotizing enterocolitis (NEC) has thus become a priority in preterm neonates. A range of feeding strategies currently exists for preventing/minimizing feed intolerance in preterm neonates reflecting the dilemma surrounding the definition and significance of signs of feed intolerance due to ileus of prematurity and the fear of NEC. The results of a systematic review of current strategies for preventing/minimizing feed intolerance in preterm neonates are discussed. The need for clinical research in the area of signs of feed intolerance is emphasized to develop a scientific basis to feeding strategies. Only large pragmatic trials based on such strategies will reveal whether the benefits (improved growth and long term neurodevelopmental outcomes) of aggressive enteral nutrition can outweigh the risks of a potentially devastating illness like NEC, and of prolonged parenteral nutrition in preterm neonates.
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Affiliation(s)
- Sanjay Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women and University of Western Australia, Perth, Australia.
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14
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Patole SK, de Klerk N. Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed 2005; 90:F147-51. [PMID: 15724039 PMCID: PMC1721845 DOI: 10.1136/adc.2004.059741] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND A significant and prolonged decline in the incidence of necrotising enterocolitis (NEC), nearing virtual elimination in some centres, has been observed consistently since implementation of a standardised feeding regimen. AIM To systematically review the observational studies reporting incidence of NEC in preterm, low birth weight (LBW) neonates "before" and "after" implementation of a standardised feeding regimen. METHODS The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2002), Medline, Embase, Cinahl, and proceedings of the Pediatric Academic Societies (published in Pediatric Research from 1980) were searched in July and again in October 2003. The reference lists of identified observational studies, and personal files, were searched. No language restriction was applied. Key words were: standardised, enteral, feeding, neonates, necrotising enterocolitis. Authors were contacted for clarification of data. RESULTS Six eligible studies (1978-2003) were identified. A significant heterogeneity was noted between the studies indicating the variations in the population characteristics and feeding practices over a period of 25 years. Meta-analysis of the six studies using a random effects model revealed a pooled risk ratio of 0.13 (95% confidence interval 0.03 to 0.50)-that is, introduction of a standardised feeding regimen reduced the incidence of NEC by 87%. CONCLUSION Standardised feeding regimens may provide the single most important global tool to prevent/minimise NEC in preterm neonates. Randomised controlled trials are needed.
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Affiliation(s)
- S K Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, University of Western Australia, Perth, Western Australia 6008.
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Miracle DJ, Meier PP, Bennett PA. Mothers' decisions to change from formula to mothers' milk for very-low-birth-weight infants. J Obstet Gynecol Neonatal Nurs 2005; 33:692-703. [PMID: 15561657 DOI: 10.1177/0884217504270665] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine maternal decisions about providing milk for a very-low-birth-weight (VLBW) infant, when the initial maternal intent was to formula-feed. DESIGN Using prospective, purposive sampling, semistructured interviews were conducted with 21 of 23 eligible mothers over a 9-month period. Audio-recorded data were transcribed verbatim, coded, categorized, and subjected to dimensional analysis. SETTING The study took place in a 52-bed, tertiary urban neonatal intensive-care unit. PATIENTS/PARTICIPANTS Mean maternal age was 26.5 years (range = 18-38), and mean infant birth weight and gestational age were 705.4 g (range = 504-1,310), and 25.8 weeks (range = 23-33), respectively. Of the 21 mothers, 76% were African American or Latina; 62% were low income. MAIN OUTCOME MEASURES We evaluated mothers' initial reasons for selecting formula and changing the decision to provide their milk, whether they were made to feel guilty or coerced, the processes of establishing and maintaining lactation, and breastfeeding outcomes at 1-month postbirth. RESULTS Mothers initially chose formula because they had no breastfeeding role models and were fearful of pain and lifestyle modifications. They changed this decision after the nurse or physician talked with them about the health benefits for their infant. Of the 21 women, all denied feeling pressured, coerced, or guilty about the decision change, and all identified rewards to themselves and their infants. All mothers provided milk for greater than or equal to 30 days, 19 went on to feed at breast, and 2 became certified breastfeeding peer counselors for the Rush Mothers' Milk Club. CONCLUSION These findings underscore the role of nurses and physicians in providing evidence-based information about mothers' milk and indicate that sharing this knowledge does not make mothers of VLBW infants feel pressured, coerced, or guilty.
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Affiliation(s)
- Donna Jo Miracle
- CLE, Rush University, 818 Longford Way, Noblesville, IN 46062, USA.
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Diaz RL, Hoang L, Wang J, Vela JL, Jenkins S, Aranda R, Martín MG. Maternal adaptive immunity influences the intestinal microflora of suckling mice. J Nutr 2004; 134:2359-64. [PMID: 15333729 DOI: 10.1093/jn/134.9.2359] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The microflorae in the intestine of breast-fed infants are distinct from those that typically populate the intestine of formula-fed infants. Although the acquisition of passive immunity through breast-feeding may play a critical role in influencing the pattern of bacterial colonization of the gut, the precise mechanisms underlying the differences in the commensal microflorae of breast and formula-fed children have not been established. We hypothesized that the assemblage of commensal microflorae in suckling and weaned mice may be influenced by the maternal adaptive immune system. To test this hypothesis, we analyzed the intestinal microflorae of mice reared in the presence (wild-type) or absence of an intact maternal immune system (T- and B-cell deficient). Several types of bacteria (Lactobacillus, Enterococcus, Clostridium perfringens, Bifidobacterium, and Bacteroides) were isolated and enumerated from both the small and large intestine of 10-, 18-, 25- and 40- to 60-d old mice using selective media. The densities of bacteria were significantly lower in the small intestine of weaned mice that were reared by wild-type (WT) compared with immunodeficient (ID) dams. However, the microflorae were generally more abundant in the large intestine of suckling pups reared by WT compared with ID dams. Our results indicate that intestinal microflorae change throughout the suckling phase of development and that the maternal adaptive immune system influences the pattern and abundance of bacteria within the gut in an age- and site-specific manner.
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Affiliation(s)
- Rosa L Diaz
- Department of Pediatrics, Division of Gastroenterology and Nutrition, David Geffen School of Medicine at UCLA, University of California-Los Angeles, Los Angeles, CA, USA
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Patole S, McGlone L, Muller R. Virtual elimination of necrotising enterocolitis for 5 years - reasons? Med Hypotheses 2004; 61:617-22. [PMID: 14592797 DOI: 10.1016/s0306-9877(03)00251-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED A standardised feeding regimen was adopted in 1997 for guiding enteral feeding of neonates <32 weeks' gestation during clinical trials (18 months each) involving erythromycin (n=73) as a prokinetic and carboxymethylcellulose (n=70) as a laxative as well as for during 2 years (n=155) without any trials. Most aspects of the feeding regimen (e.g., milk increments-total volume/day, use of breast milk by choice, etc) were not significantly different from current practices. RESULTS 298 neonates <32 weeks' gestation (<28 weeks; n=78) were enterally fed during the 5 years. Their demographic characteristics and median (interquartile) age in days at starting (AST) and days to reach full enteral feeds (FFT) of 150 ml/kg/day were not significantly different during these 5 years: [AST: 5 (3-7.5)], [FFT: 4 (3-7)] Only one case of definite NEC (> or =Stage II) occurred during the 5 years. The time to reach full feeds was also reduced by over 54% (including for neonates <28 weeks gestation) compared with a historical cohort. CONCLUSION Sustained reduction in the time to reach full feeds with virtual elimination of > or =Stage II NEC for 5 years indicates continued benefits of a standardised feeding regimen as a simple preventive strategy to prevent NEC. Whether our specific policy of no enteral feeds in presence of hemodynamic instability associated with PDA requiring indomethacin, and/or sepsis played a role in achieving the significant results needs controlled trials.
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Affiliation(s)
- S Patole
- King Edward Memorial Hospital for Women, Western Australia 6008, Subiaco, Australia.
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Dvorak B, Halpern MD, Holubec H, Dvorakova K, Dominguez JA, Williams CS, Meza YG, Kozakova H, McCuskey RS. Maternal milk reduces severity of necrotizing enterocolitis and increases intestinal IL-10 in a neonatal rat model. Pediatr Res 2003; 53:426-33. [PMID: 12595590 DOI: 10.1203/01.pdr.0000050657.56817.e0] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Necrotizing enterocolitis (NEC) is a devastating intestinal disease of premature infants. Maternal milk has been suggested to be partially protective against NEC; however, the mechanisms of this protection are not defined. The aim of this study was to examine the effect(s) of artificial feeding of rat milk (RM)-versus cow milk-based rat milk substitute (RMS) on the development of NEC in a neonatal rat model and elucidate the role of inflammatory cytokines in NEC pathogenesis. Newborn rats were artificially fed with either collected RM or RMS. Experimental NEC was induced by exposure to asphyxia and cold stress and evaluated by histologic scoring of damage in ileum. Intestinal cytokine mRNA expression was determined by real-time PCR. Cytokine histologic localization was performed by confocal microscopy. Similar to human NEC, artificial feeding of RM reduces the incidence and severity of NEC injury in neonatal rats. Freezing and thawing of collected RM did not eliminate the protective effect of maternal milk. Ileal IL-10 expression was significantly increased in the RM group compared with RMS. Increased IL-10 peptide production was detected in the RM group with signal localized predominantly in the cytoplasm of villus epithelial cells. These results suggest that the protective effect of maternal milk is associated with increased production of anti-inflammatory IL-10 in the site of injury. Better understanding of the mechanisms underlying these protective effects could be beneficial either in the prevention of NEC or in the development of future therapeutic strategies to cure NEC.
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MESH Headings
- Animals
- Animals, Newborn
- Asphyxia/immunology
- Asphyxia/metabolism
- Cold Temperature
- Disease Models, Animal
- Enteral Nutrition
- Enterocolitis, Necrotizing/diet therapy
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/immunology
- Female
- Ileum/immunology
- Ileum/metabolism
- Ileum/ultrastructure
- Incidence
- Interleukin-10/metabolism
- Intestinal Mucosa/immunology
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/ultrastructure
- Microscopy, Electron, Scanning
- Milk
- Rats
- Rats, Sprague-Dawley
- Severity of Illness Index
- Stress, Physiological/immunology
- Stress, Physiological/metabolism
- Weight Gain
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Affiliation(s)
- Bohuslav Dvorak
- Department of Pediatrics and Steele Memorial Children's Research Center, University of Arizona, Tucson, Arizona 85724, USA.
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