1
|
van den Elsen LJW, Rekima A, Lynn MA, Isnard C, Machado S, Divakara N, Patalwala D, Middleton A, Stevens N, Servant F, Burcelin R, Lynn DJ, Verhasselt V. Diet at birth is critical for healthy growth, independent of effects on the gut microbiota. MICROBIOME 2024; 12:139. [PMID: 39068488 DOI: 10.1186/s40168-024-01852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/30/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Colostrum is the first milk for a newborn. Its high content in microbiota shaping compounds and its intake at the time of gut microbiota seeding suggests colostrum may be critical in the establishment of a healthy microbiota. There is also accumulating evidence on the importance of the gut microbiota for healthy growth. Here, we aimed to investigate the contribution of colostrum, and colostrum-induced microbiota to growth promotion. Addressing this question is highly significant because (1) globally, less than half of the newborns are fully colostrum fed (2) the evidence for the importance of the microbiota for the prevention of undernutrition has only been demonstrated in juvenile or adult pre-clinical models while stunting already starts before weaning. RESULTS To address the importance of diet at birth in growth failure, we developed a unique mouse model in which neonates are breastfed by mothers at an advanced stage of lactation who no longer provide colostrum. Feeding newborn mice with mature milk instead of colostrum resulted in significant growth retardation associated with the biological features of chronic undernutrition, such as low leptin levels, dyslipidemia, systemic inflammation, and growth hormone resistance. We next investigated the role of colostrum in microbiota shaping. At the end of the lactation period, we found a major difference in gut microbiota alpha diversity, beta diversity, and taxa distribution in control and colostrum-deprived mice. To determine the causal relationship between changes in microbiota and growth trajectories, we repeated our experiment in germ-free mice. The beneficial effect of colostrum on growth remained in the absence of microbiota. CONCLUSION Our data suggest that colostrum may play an important role in the prevention of growth failure. They highlight that the interplay between neonatal gut microbiome assembly and diet may not be as crucial for growth control in the developing newborn as described in young adults. This opens a paradigm shift that will foster research for colostrum's bioactives that may exert a similar effect to microbiota-derived ligands in promoting growth and lead to new avenues of translational research for newborn-tailored prevention of stunting. Video Abstract.
Collapse
Affiliation(s)
- Lieke J W van den Elsen
- Larsson-Rosenquist Centre for Immunology and Breastfeeding, School of Medicine, The University of Western Australia, Perth, WA, Australia.
- Telethon Kids Institute, Perth, WA, Australia.
| | - Akila Rekima
- Larsson-Rosenquist Centre for Immunology and Breastfeeding, School of Medicine, The University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Miriam A Lynn
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | | | - Savannah Machado
- Larsson-Rosenquist Centre for Immunology and Breastfeeding, School of Medicine, The University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Nivedithaa Divakara
- Larsson-Rosenquist Centre for Immunology and Breastfeeding, School of Medicine, The University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Diana Patalwala
- National Imaging Facility, Centre for Microscopy Characterisation and Analysis, University of Western Australia, Perth, WA, Australia
| | - Alana Middleton
- Larsson-Rosenquist Centre for Immunology and Breastfeeding, School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Natalie Stevens
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | | | | | - David J Lynn
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Valerie Verhasselt
- Larsson-Rosenquist Centre for Immunology and Breastfeeding, School of Medicine, The University of Western Australia, Perth, WA, Australia.
- Telethon Kids Institute, Perth, WA, Australia.
| |
Collapse
|
2
|
Nordsten MJB, Winther CL, Haugaard MM, Skovgaard K, Thymann T, Sangild PT. Enteral plasma feeding improves gut function and immunity in piglets after birth asphyxia. Pediatr Res 2024:10.1038/s41390-024-03376-0. [PMID: 39034356 DOI: 10.1038/s41390-024-03376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/17/2024] [Accepted: 06/17/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Birth asphyxia may negatively affect gut function and immunity in newborns. Conversely, immunomodulatory milk diets may protect the gut and immune system against damage caused by asphyxia. Using caesarean-derived pigs as models, we hypothesised that enteral feeding with plasma improves gut and immune functions in asphyxiated newborns. METHODS Near-term pig fetuses (98% gestation,) were delivered by caesarean section after 8 min umbilical cord occlusion, leading to transient birth asphyxia (ASP, n = 75) and compared with non-occluded controls (CON, n = 69). Piglets were further randomised to supplementation with/without porcine plasma (plasma, PLA/vehicle, VEH), into bovine colostrum (first 24 h) or formula (until 72 h). RESULTS Compared with CON, ASP piglets took longer to achieve stable respiration and showed reduced blood pH, weight gain and survival. Independent of asphyxia, plasma supplementation reduced gut haemorrhagic lesions, permeability and inflammatory cytokines together with improved villous morphology and brush-border enzyme activities. Asphyxia reduced blood cytokine responses to ex vivo bacterial stimulation, whereas plasma supplementation ameliorated this effect. CONCLUSION Dietary plasma supplementation improves survival, gut functions and immunity in both normal and asphyxiated newborns. The components in plasma that mediate gut-protective effects in piglets remain to be identified, but may benefit also birth-compromised newborn infants. IMPACT Complicated deliveries leading to birth asphyxia, may negatively affect gut, liver and immune adaptation in the first days after birth. Using a model of birth asphyxia in caesarean-derived piglets, we show that enteral feeding with maternal plasma exerts gut maturational and immunomodulatory effects in both control and asphyxiated animals in the first days of life. The mechanisms behind the gut-protective effects of plasma are unknown, but plasma components hold potential for new oral therapies for compromised newborn infants as well as piglets.
Collapse
Affiliation(s)
- Mads Jacob Bagi Nordsten
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina L Winther
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Maria Mathilde Haugaard
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Skovgaard
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Thomas Thymann
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Per T Sangild
- Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics, Odense University Hospital, Odense, Denmark
- Faculty of Theology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Grzeskowiak LE, Rumbold AR, Williams L, Kam RL, Ingman WV, Keir A, Martinello KA, Amir LH. Effect of brewer's yeast or beta-glucan on breast milk supply following preterm birth: the BLOOM study - protocol for a multicentre randomised controlled trial. Int Breastfeed J 2024; 19:43. [PMID: 38902831 PMCID: PMC11188178 DOI: 10.1186/s13006-024-00650-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Many individuals who experience preterm birth struggle with early breast milk supply, which can translate into suboptimal longer-term breastfeeding outcomes. Further investigations into the potential role of early non-pharmacological and pharmacological interventions in improving breast milk production soon after birth is growing. While natural galactagogues, such as brewer's yeast, are widely perceived by women to be safer than pharmaceutical galactagogues and are taken by many women, evidence to support their efficacy is largely absent. The BLOOM study has been designed to determine the efficacy and safety of brewer's yeast and beta-glucans, derived from Saccharomyces cerevisiae, when administered soon after birth for increasing early breast milk supply in mothers who have delivered preterm. METHODS The BLOOM study is a multicentre, double-blinded, randomised controlled trial that will assess if brewer's yeast or beta-glucan can increase early breast milk production following preterm birth. Target population are mothers of preterm infants born at less than 34 weeks' gestation who intend to provide breast milk for their infant, are less than 72 h following birth and able to give informed consent. Participants will be randomly allocated into three parallel groups at 1:1:1 ratio (n = 33 per group) to receive either brewer's yeast, beta-glucan or placebo capsules for seven days. The primary outcome is total expressed breast milk volume over a 24-hour period on day 7 of intervention. Participants and their infants will be followed until the infant reaches term corrected age or is discharged home from the neonatal unit (whichever occurs first). DISCUSSION The use of brewer's yeast as a galactagogue to enhance milk production is extremely common amongst breastfeeding mothers, however, there are no trials evaluating its efficacy and safety. This will be the first randomised controlled trial to evaluate the efficacy and safety of two commonly used galactagogues, brewer's yeast and beta-glucan, compared with placebo in improving maternal breast milk supply following preterm birth. The trial will also evaluate whether early intervention with galactagogues soon after a preterm birth improves longer-term breastfeeding outcomes. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12622000968774 (registered on 8 July 2022) and UTN U1111-1278-8827.
Collapse
Affiliation(s)
- Luke E Grzeskowiak
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia.
- Flinders Medical Centre, SA Pharmacy, SA Health, Bedford Park, SA, Australia.
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, SA, Australia.
| | - Alice R Rumbold
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Lauren Williams
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, SA, Australia
| | - Renee L Kam
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Wendy V Ingman
- Discipline of Surgical Specialities, Adelaide Medical School, University of Adelaide, The Queen Elizabeth Hospital, Woodville, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Amy Keir
- Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, SA, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
- Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Kathryn A Martinello
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia
- Department of Neonatal and Perinatal Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, VIC, Australia
- Breastfeeding Service, The Royal Women's Hospital, Parkville, VIC, Australia
| |
Collapse
|
4
|
García-Lara NR, Escuder-Vieco D, Cabrera-Lafuente M, Keller K, De Diego-Poncela C, Jiménez-González C, Núñez-Ramos R, Flores-Antón B, Escribano-Palomino E, Alonso-Díaz C, Vázquez-Román S, Ureta-Velasco N, Cruz-Bértolo JDL, Pallás-Alonso CR. Clinical Impact of Supplementation with Pasteurized Donor Human Milk by High-Temperature Short-Time Method versus Holder Method in Extremely Low Birth Weight Infants: A Multicentre Randomized Controlled Trial. Nutrients 2024; 16:1090. [PMID: 38613123 PMCID: PMC11013736 DOI: 10.3390/nu16071090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Nosocomial infections are a frequent and serious problem in extremely low birth weight (ELBW) infants. Donor human milk (DHM) is the best alternative for feeding these babies when mother's own milk (MOM) is not available. Recently, a patented prototype of a High-Temperature Short-Time (HTST) pasteurizer adapted to a human milk bank setting showed a lesser impact on immunologic components. We designed a multicentre randomized controlled trial that investigates whether, in ELBW infants with an insufficient MOM supply, the administration of HTST pasteurized DHM reduces the incidence of confirmed catheter-associated sepsis compared to DHM pasteurized with the Holder method. From birth until 34 weeks postmenstrual age, patients included in the study received DHM, as a supplement, pasteurized by the Holder or HTST method. A total of 213 patients were randomized; 79 (HTST group) and 81 (Holder group) were included in the analysis. We found no difference in the frequency of nosocomial sepsis between the patients of the two methods-41.8% (33/79) of HTST group patients versus 45.7% (37/81) of Holder group patients, relative risk 0.91 (0.64-1.3), p = 0.62. In conclusion, when MOM is not available, supplementing during admission with DHM pasteurized by the HTST versus Holder method might not have an impact on the incidence of catheter-associated sepsis.
Collapse
Affiliation(s)
- Nadia Raquel García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Diana Escuder-Vieco
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Marta Cabrera-Lafuente
- Department of Neonatology, La Paz University Hospital, 28046 Madrid, Spain; (M.C.-L.); (C.J.-G.); (E.E.-P.)
- Institute for Health Research–IdiPaz, La Paz University Hospital, 28046 Madrid, Spain
| | - Kristin Keller
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Cristina De Diego-Poncela
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
| | - Concepción Jiménez-González
- Department of Neonatology, La Paz University Hospital, 28046 Madrid, Spain; (M.C.-L.); (C.J.-G.); (E.E.-P.)
- Institute for Health Research–IdiPaz, La Paz University Hospital, 28046 Madrid, Spain
| | - Raquel Núñez-Ramos
- Department of Pediatric Nutrition, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Beatriz Flores-Antón
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Esperanza Escribano-Palomino
- Department of Neonatology, La Paz University Hospital, 28046 Madrid, Spain; (M.C.-L.); (C.J.-G.); (E.E.-P.)
- Institute for Health Research–IdiPaz, La Paz University Hospital, 28046 Madrid, Spain
| | - Clara Alonso-Díaz
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Sara Vázquez-Román
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Noelia Ureta-Velasco
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| | - Javier De La Cruz-Bértolo
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
- Clinical Research Platform IC+12, Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carmen Rosa Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain; (C.D.D.-P.); (B.F.-A.); (C.A.-D.); (S.V.-R.); (N.U.-V.); (C.R.P.-A.)
- Aladina-MGU-Regional Human Milk Bank, 12 de Octubre University Hospital, 28041 Madrid, Spain; (D.E.-V.); (K.K.)
- Research Institute i+12, 12 de Octubre University Hospital, 28041 Madrid, Spain;
| |
Collapse
|
5
|
Parker LA. Taking Human Milk Fortification to the Next Level. J Perinat Neonatal Nurs 2024; 38:15-17. [PMID: 38278639 DOI: 10.1097/jpn.0000000000000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Affiliation(s)
- Leslie A Parker
- College of Nursing University of Florida Gainesville, Florida
| |
Collapse
|
6
|
Luo F, Zhang M, Zhang L, Zhou P. Nutritional and health effects of bovine colostrum in neonates. Nutr Rev 2023:nuad145. [PMID: 38052234 DOI: 10.1093/nutrit/nuad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
High concentrations of immunoglobulins, bioactive peptides, and growth factors are found in bovine colostrum (BC), the milk produced by cows in the first few days after parturition. Various biological functions make it increasingly used to provide nutritional support and immune protection to the offspring of many species, including humans. These biological functions include cell growth stimulation, anti-infection, and immunomodulation. The primary components and biological functions of colostrum were reviewed in the literature, and the authors also looked at its latent effects on the growth and development of neonates as well as on conditions such as infections, necrotizing enterocolitis, short bowel syndrome, and feeding intolerance. The importance of BC in neonatal nutrition, immune support, growth and development, and gut health has been demonstrated in a number of experimental and animal studies. BC has also been shown to be safe at low doses without adverse effects in newborns. BC supplementation has been shown to be efficient in preventing several disorders, including rotavirus diarrhea, necrotizing enterocolitis, and sepsis in animal models of prematurity and some newborn studies. Therefore, BC supplementation should be considered in cases where maternal milk is insufficient or donor milk is unavailable. The optimal age, timing, dosage, and form of BC administration still require further investigation.
Collapse
Affiliation(s)
- Fangmei Luo
- Department of Neonatology, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Min Zhang
- Department of Neonatology, Jinan University-Affiliated Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Lian Zhang
- Department of Neonatology, Jinan University-Affiliated Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| | - Ping Zhou
- Department of Neonatology, Jinan University-Affiliated Shenzhen Baoan Women's and Children's Hospital, Shenzhen, China
| |
Collapse
|
7
|
Wang H, Hu XL, Li QF, Zhou J, Wu MY. Operation Status of the Mutual Aid Human Milk Bank for Preterm Infants and Data Analysis. J Multidiscip Healthc 2023; 16:3521-3530. [PMID: 38024124 PMCID: PMC10658946 DOI: 10.2147/jmdh.s440114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This study aimed to investigate the matching degree between the donated supply and demand, clinical characteristics of both donors and recipients, along with the operation cost. Methods From January 1, 2018 to December 31, 2021, the data on human milk donation and usage, the clinical characteristics of donors and recipients, and the cost of each operating center were collected from the Manual Donation Registration Form and Information Management System of the selected human milk bank. Results During the four years that the human milk bank was in operation, the volume of donated milk was slightly greater than the volume of consumed milk. A total of 1364 donors donated 2434.63 liters of qualified human milk, for RMB 1,791,000 (USD 257, 202), ie, RMB 385.3 (USD 55.3)/L; 97.8% of the donors were preterm puerperae, and 59% of the donors donated between 1 week and 1 month after delivery. All recipients were preterm infants and received donated human milk for a duration of 9.4 days on average. During the four years of operation, the proportion of donors who had previously received donated milk among all donors showed an overall increasing trend, while the incidence of NEC in preterm infants gradually decreased. Conclusions The increasingly optimized structure of donors, the more economical operation, and the fact that the use of donated milk may not affect breastfeeding of the recipients have made it a human milk bank operation mode worthy of promotion.
Collapse
Affiliation(s)
- Hua Wang
- Department of NICU, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Xiao-Li Hu
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Qiu-Fang Li
- Department of Nursing, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Jie Zhou
- Department of NICU, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| | - Ming-Yuan Wu
- Department of NICU, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, People’s Republic of China
| |
Collapse
|
8
|
Siziba LP, Baier C, Pütz E, Ascherl R, Wendt T, Thome UH, Gebauer C, Genuneit J. A descriptive analysis of human milk dispensed by the Leipzig Donor Human Milk Bank for neonates between 2012 and 2019. Front Nutr 2023; 10:1233109. [PMID: 38035356 PMCID: PMC10684730 DOI: 10.3389/fnut.2023.1233109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background Human milk banking has become an important aspect of Nutritional medicine. It is not just about the provision of mother's own milk (MOM) or donor human milk (DHM) in the hospital, but also a strategy to encourage breastfeeding in the clinical setting and beyond. Objective To describe the feeding patterns of hospitalised infants including human milk dispensed by the Leipzig Donor Human Milk Bank (LMB). Design A descriptive analysis of daily data on milk feeds dispensed by LMB for hospitalised infants distinguishing between MOM or DHM, either fresh or frozen, and raw/pasteurised milk from 2012-2019. Results We included 2,562 infants with median hospitalisation of 23 days, for whom human milk was dispensed on median 76% of those days and other nutrition on the remaining days. Raw MOM and raw DHM comprised 52% and 8% of the dispensed milk, respectively. Dispensing exclusive DHM instead of MOM for at least one full day was required for 55% of the infants, mostly at the beginning but also later during hospitalisation. Exclusive raw DHM was dispensed on at least 1 day for 37% of the infants, in different birthweight strata <1,000 g: 10%, 1,000-1500 g: 11%, 1,500-2500 g: 13% and > 2,500 g: 3%. At discharge, MOM was dispensed for more than 60% of the infants. Conclusion During an infant's hospital stay, LMB dispenses various human milk feeds with interspersed DHM resulting in complex intra-individual and time-variant feeding patterns. LMB dispenses raw MOM and especially raw DHM with the intention to retain the properties of human milk unlike a diet containing pasteurised DHM and/or formula. Although raw DHM comprises a small percentage of all dispensed milk, raw DHM is dispensed for a substantial portion of infants. Our results document that dispensing raw DHM, is possible in routine settings.
Collapse
Affiliation(s)
- Linda P. Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Caroline Baier
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Pütz
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Rudolf Ascherl
- Division of Neonatology, Department of Pediatrics, University of Leipzig Medical Centre, Leipzig, Germany
| | - Thomas Wendt
- Data Integration Centre, University of Leipzig Medical Centre, Leipzig, Germany
| | - Ulrich H. Thome
- Division of Neonatology, Department of Pediatrics, University of Leipzig Medical Centre, Leipzig, Germany
| | - Corinna Gebauer
- Division of Neonatology, Department of Pediatrics, University of Leipzig Medical Centre, Leipzig, Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
- German Center for Child and Youth Health (DZKJ), Leipzig, Germany
| |
Collapse
|
9
|
Nagel E, Elgersma KM, Gallagher TT, Johnson KE, Demerath E, Gale CA. Importance of human milk for infants in the clinical setting: Updates and mechanistic links. Nutr Clin Pract 2023; 38 Suppl 2:S39-S55. [PMID: 37721461 PMCID: PMC10513735 DOI: 10.1002/ncp.11037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/15/2023] [Accepted: 06/10/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Human milk (HM) is the optimal source of nutrition for infants and has been implicated in multiple aspects of infant health. Although much of the existing literature has focused on the individual components that drive its nutrition content, examining HM as a biological system is needed for meaningful advancement of the field. Investigation of the nonnutritive bioactive components of HM and the maternal, infant, and environmental factors which affect these bioactives is important to better understand the importance of HM provision to infants. This information may inform care of clinical populations or infants who are critically ill, hospitalized, or who have chronic diseases and may benefit most from receiving HM. METHODS In this narrative review, we reviewed literature examining maternal and infant influences on HM composition with a focus on studies published in the last 10 years that were applicable to clinical populations. RESULTS We found multiple studies examining HM components implicated in infant immune and gut health and neurodevelopment. Additional work is needed to understand how donor milk and formula may be used in situations of inadequate maternal HM. Furthermore, a better understanding of how maternal factors such as maternal genetics and metabolic health influence milk composition is needed. CONCLUSION In this review, we affirm the importance of HM for all infants, especially clinical populations. An understanding of how HM composition is modulated by maternal and environmental factors is important to progress the field forward with respect to mechanistic links between HM biology and infant health outcomes.
Collapse
Affiliation(s)
- Emily Nagel
- School of Public Health, University of Minnesota-Twin Cities, Minnesota, USA
| | | | | | - Kelsey E Johnson
- Department of Genetics, Cell Biology, and Development, University of Minnesota-Twin Cities, Minnesota, USA
| | - Ellen Demerath
- School of Public Health, University of Minnesota-Twin Cities, Minnesota, USA
| | - Cheryl A. Gale
- Department of Pediatrics, University of Minnesota-Twin Cities, Minnesota, USA
| |
Collapse
|
10
|
Arslanoglu S, Moro GE, Tonetto P, De Nisi G, Ambruzzi AM, Biasini A, Profeti C, Gagliardi L, Salvatori G, Bertino E. Recommendations for the establishment and operation of a donor human milk bank. Nutr Rev 2023; 81:1-28. [PMID: 36892193 PMCID: PMC9997086 DOI: 10.1093/nutrit/nuad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
In Europe, an increasing number of human milk banks (HMBs) collect donor human milk to feed preterm infants when their mother's milk is not available or not enough. Moreover, donor milk is a bridge to breastfeeding, with positive clinical and psychological advantages for both mother and infant. Italy, with 41 HMBs actively operating in 2022, has the highest number of HMBs in Europe. The process of human milk donation is complex, so activity of HMBs must be regulated according to well-established rules. The present recommendations have been prepared as a tool to standardize the organization, management, and procedures of HMBs operating in Italy and to determine the minimal essential requirements to establish new HMBs. This article covers all the aspects of human milk donation and human milk banking, including general recommendations, donor recruitment and screening, expression, handling and storage of donor human milk, milk screening, and milk treatment (pasteurization). A pragmatic approach was taken to drafting the recommendations. Items for which there was consensus or robust published evidence on which to base recommendations were included. When there were differences that could not be resolved by reference to published research, a statement of explanation based on the expert opinion of the authors (all members of the Italian Association of Human Milk Banks) was included. Implementation of these recommendations can contribute to promotion of breastfeeding.
Collapse
Affiliation(s)
- Sertac Arslanoglu
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,is with the Division of Neonatology, Department of Pediatrics, İstanbul Medeniyet University, School of Medicine, İstanbul, Turkey
| | - Guido E Moro
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Paola Tonetto
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,are with the Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
| | - Giuseppe De Nisi
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Amalia Maria Ambruzzi
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Augusto Biasini
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Claudio Profeti
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy
| | - Luigi Gagliardi
- is with the Woman and Child Health Department, Azienda USL Toscana Nord-Ovest, Lucca, Italy
| | - Guglielmo Salvatori
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,is with the Donor Human Milk Bank, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Enrico Bertino
- are with the Italian Association of Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato), Milan, Italy.,are with the Neonatal Care Unit of the University, City of Health and Science Hospital, Turin, Italy
| |
Collapse
|
11
|
Slagle CL, Riddle SL, McNelis K, Claes D. Single-Center Experience on Growth in Infants Born With End-Stage Kidney Disease. J Ren Nutr 2023; 33:236-242. [PMID: 36179955 DOI: 10.1053/j.jrn.2022.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 08/22/2022] [Accepted: 09/10/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Children with chronic kidney disease display poor growth that impacts health outcomes; data on infants with severe congenital anomalies of the kidney and urinary tract (CAKUT) are limited. We examined growth patterns in infants with CAKUT requiring dialysis in the first 30 days. METHODS This study evaluated infants with severe CAKUT from 2014 to 2018 surviving past 30 days. Somatic growth parameters as per standard infant curves and nutritional information were recorded. RESULTS Twenty four infants met inclusion criteria. Seventeen infants received dialysis, demonstrating somatic growth disruption most profound at a 1-2 months postnatal age. Growth trends were improved compared to infants with CAKUT who did not require dialysis. Linear growth failed to normalize by 1 year of age. CONCLUSIONS Infants with severe CAKUT are at high risk for early growth failure. Understanding of this deficit and impacts of early dialysis on growth and long-term outcomes are needed to identify targeted nutritional strategies.
Collapse
Affiliation(s)
- Cara L Slagle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Nephrology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Stefanie L Riddle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kera McNelis
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Donna Claes
- Division of Nephrology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
12
|
Ramos-Garcia V, Ten-Doménech I, Moreno-Giménez A, Campos-Berga L, Parra-Llorca A, Ramón-Beltrán A, Vaya MJ, Mohareb F, Molitor C, Refinetti P, Silva A, Rodrigues LA, Rezzi S, Hodgson ACC, Canarelli S, Bathrellou E, Mamalaki E, Karipidou M, Poulimeneas D, Yannakoulia M, Akhgar CK, Schwaighofer A, Lendl B, Karrer J, Migliorelli D, Generelli S, Gormaz M, Vasileiadis M, Kuligowski J, Vento M. Fact-based nutrition for infants and lactating mothers-The NUTRISHIELD study. Front Pediatr 2023; 11:1130179. [PMID: 37144153 PMCID: PMC10151649 DOI: 10.3389/fped.2023.1130179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/31/2023] [Indexed: 05/06/2023] Open
Abstract
Background Human milk (HM) is the ideal source of nutrients for infants. Its composition is highly variable according to the infant's needs. When not enough own mother's milk (OMM) is available, the administration of pasteurized donor human milk (DHM) is considered a suitable alternative for preterm infants. This study protocol describes the NUTRISHIELD clinical study. The main objective of this study is to compare the % weight gain/month in preterm and term infants exclusively receiving either OMM or DHM. Other secondary aims comprise the evaluation of the influence of diet, lifestyle habits, psychological stress, and pasteurization on the milk composition, and how it modulates infant's growth, health, and development. Methods and design NUTRISHIELD is a prospective mother-infant birth cohort in the Spanish-Mediterranean area including three groups: preterm infants <32 weeks of gestation (i) exclusively receiving (i.e., >80% of total intake) OMM, and (ii) exclusively receiving DHM, and (iii) term infants exclusively receiving OMM, as well as their mothers. Biological samples and nutritional, clinical, and anthropometric characteristics are collected at six time points covering the period from birth and until six months of infant's age. The genotype, metabolome, and microbiota as well as the HM composition are characterized. Portable sensor prototypes for the analysis of HM and urine are benchmarked. Additionally, maternal psychosocial status is measured at the beginning of the study and at month six. Mother-infant postpartum bonding and parental stress are also examined. At six months, infant neurodevelopment scales are applied. Mother's concerns and attitudes to breastfeeding are registered through a specific questionnaire. Discussion NUTRISHIELD provides an in-depth longitudinal study of the mother-infant-microbiota triad combining multiple biological matrices, newly developed analytical methods, and ad-hoc designed sensor prototypes with a wide range of clinical outcome measures. Data obtained from this study will be used to train a machine-learning algorithm for providing dietary advice to lactating mothers and will be implemented in a user-friendly platform based on a combination of user-provided information and biomarker analysis. A better understanding of the factors affecting milk's composition, together with the health implications for infants plays an important role in developing improved strategies of nutraceutical management in infant care. Clinical trial registration https://register.clinicaltrials.gov, identifier: NCT05646940.
Collapse
Affiliation(s)
| | - Isabel Ten-Doménech
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Alba Moreno-Giménez
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Laura Campos-Berga
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Amparo Ramón-Beltrán
- Division of Neonatology, University & Polytechnic Hospital La Fe (HULAFE), Valencia, Spain
| | - María J. Vaya
- Blood Transfusion Center from the Valencian Community, Valencia, Spain
| | - Fady Mohareb
- The Bioinformatics Group, Cranfield Soil and Agrifood Institute, Cranfield University, Bedford, United Kingdom
| | - Corentin Molitor
- The Bioinformatics Group, Cranfield Soil and Agrifood Institute, Cranfield University, Bedford, United Kingdom
| | | | | | | | - Serge Rezzi
- Swiss Nutrition and Health Foundation, Epalinges, Switzerland
| | | | | | - Eirini Bathrellou
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Eirini Mamalaki
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Melina Karipidou
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece
| | - Christopher K. Akhgar
- Research Division of Environmental Analytics, Process Analytics and Sensors, Institute of Chemical Technologies and Analytics, Technische Universität Wien, Vienna, Austria
| | - Andreas Schwaighofer
- Research Division of Environmental Analytics, Process Analytics and Sensors, Institute of Chemical Technologies and Analytics, Technische Universität Wien, Vienna, Austria
| | - Bernhard Lendl
- Research Division of Environmental Analytics, Process Analytics and Sensors, Institute of Chemical Technologies and Analytics, Technische Universität Wien, Vienna, Austria
| | | | - Davide Migliorelli
- Swiss Center for Electronics and Microtechnology (CSEM), Landquart, Suiza
| | - Silvia Generelli
- Swiss Center for Electronics and Microtechnology (CSEM), Landquart, Suiza
| | - María Gormaz
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Division of Neonatology, University & Polytechnic Hospital La Fe (HULAFE), Valencia, Spain
| | | | - Julia Kuligowski
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Correspondence: Julia Kuligowski
| | - Máximo Vento
- Neonatal Research Group, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Division of Neonatology, University & Polytechnic Hospital La Fe (HULAFE), Valencia, Spain
| |
Collapse
|
13
|
Hair AB, Good M. Dilemmas in feeding infants with intestinal failure: a neonatologist's perspective. J Perinatol 2023; 43:114-119. [PMID: 36127395 DOI: 10.1038/s41372-022-01504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
Intestinal failure in neonatal and pediatric populations can be debilitating for patients and difficult to manage for clinicians. Management strategies include referral to an intestinal rehabilitation center, small volume trophic feeds to stimulate the intestine with cautious advancement of enteral nutrition using a standardized and evidence-based feeding protocol, and supplemental parenteral nutrition to optimize an infant's growth and nutrition. In this review, we discuss the causes of intestinal failure, parenteral nutrition strategies, enteral feeding initiation and advancement protocols, as well as the challenges in feeding an infant with intestinal failure.
Collapse
Affiliation(s)
- Amy B Hair
- Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Misty Good
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
14
|
Dilemmas in human milk fortification. J Perinatol 2023; 43:103-107. [PMID: 36097287 DOI: 10.1038/s41372-022-01502-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/10/2022] [Accepted: 08/26/2022] [Indexed: 02/07/2023]
Abstract
Fortification of human milk is the standard of care for very low birth weight (VLBW) infants and is required to support adequate postnatal growth and development. Achieving adequate growth velocity and preventing growth faltering is critical for the developing neonatal brain and optimizing long-term neurodevelopmental outcomes. Mother's milk is the gold standard nutrition to feed preterm infants, however, it does not provide the nutrients needed to support the growth of VLBW infants. After the decision is made to use mother's milk (if available) or alternatively, donor human milk, many dilemmas exist with regards to additional treatment decisions surrounding the type of fortification to use, when to fortify, and the duration of fortification. In this article, we will review the differences in mother's milk compared to donor milk, the different types of human milk fortifiers, the optimal timing of fortification, and discuss when to discontinue human milk fortification.
Collapse
|
15
|
Differences in Neonatal Outcomes Among Premature Infants Exposed to Mother's Own Milk Versus Donor Human Milk. Adv Neonatal Care 2022; 22:539-549. [PMID: 35939792 DOI: 10.1097/anc.0000000000001002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Growing evidence supports the superior benefits of exposure to mother's own milk (MOM) in reducing prematurity-related comorbidities. Neonatal exposure to donor human Milk (DHM) is a suitable alternative when MOM is insufficient or unavailable. However, the same protective composition and bioactivity in MOM are not present in DHM. Additional evidence is needed to justify and inform evidence-based practices increasing MOM provision while optimizing adequate use of DHM for premature infants. PURPOSE A systematic review of the literature was conducted to determine differences in neonatal outcomes among premature infants exposed to predominately MOM versus DHM. METHODS/SEARCH STRATEGY Databases including PubMed, CINAHL and Cochrane were searched (2020-2021) using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. Evidence was classified using the John Hopkins evidence-based practice levels and quality of evidence. RESULTS Eleven studies met inclusion criteria. Studied neonatal outcomes included ( a ) growth parameters (n = 8), ( b ) neonatal morbidities (n = 6), and ( c ) gut microbiome (n = 4). Overall, evidence suggests DHM exposure is beneficial but not equivalent to MOM feeding. Compared with DHM, greater doses of MOM are ideal to enhance protection primarily related to infant growth, as well as gut microbiome diversity and richness. IMPLICATIONS FOR PRACTICE Standardized and evidence-based practices are needed to clearly delineate optimal use of DHM without undermining maternal and neonatal staff efforts to support and promote provision of MOM. IMPLICATIONS FOR RESEARCH Additional evidence from high-quality studies should further examine differences in neonatal outcomes among infants exposed to predominately MOM or DHM in settings using standardized and evidence-based feeding practices.
Collapse
|
16
|
The impact of a Donor Human Milk Program on the provision of mothers' own milk at discharge in very low birth weight infants. J Perinatol 2022; 42:1473-1479. [PMID: 35864217 DOI: 10.1038/s41372-022-01439-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine the effect of a donor human milk (DHM) program on mothers' own milk feedings at discharge for very low birth weight (VLBW) infants. STUDY DESIGN A single center retrospective analysis of feeding outcomes in preterm infants. Data were assigned as: (1) pre DHM era (2) Bridge DHM era (3) Full DHM era. Each era was divided into infants <1500 g (n = 724) or ≥1500 g (n = 784). RESULTS Both the percentage of mothers' own milk feeds and percent of infants exclusively receiving mothers' own milk at discharge were increased in the <1500 g (p = 0.003, p = 0.002) and the ≥1500 g group (p = 0.007, p = 0.004) respectively, following the introduction of DHM for VLBW infants. CONCLUSION Practice changes that accompany a donor milk program likely play a prominent role in the provision of mothers' own milk and exclusivity of breast milk feedings at discharge for very low birth weight infants.
Collapse
|
17
|
Adamkin DH. Use of human milk and fortification in the NICU. J Perinatol 2022; 43:551-559. [PMID: 36257977 DOI: 10.1038/s41372-022-01532-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022]
Abstract
Human milk is the gold standard to provide nutritional support for all healthy and sick newborn infants including the very low birth weight (VLBW) infant (<1500 g). It has both nutritional and anti-infective properties which are especially important for these infants at risk for sepsis and necrotizing enterocolitis. Human milk alone is insufficient to meet the nutritional needs for VLBW infants, especially protein and minerals. There is a conundrum between achieving the nutritional, immunologic, developmental, psychological, social, and economic benefit with human milk vs. the inadequate growth with unfortified human milk for VLBW leading to nutritional inadequacy, growth failure and poor neurodevelopmental outcome. The use of multicomponent fortifiers to increase calories and provide additional protein, vitamins, and minerals has been associated with short-term benefits in growth. Most current fortifiers are derived from cow's milk, however there are concerns regarding a possible association between the use of cow's milk-based fortifier and NEC. There is also an exclusive human milk diet with a fortifier derived solely from human milk. There are three approaches for fortifying human milk and include fixed dosage or "blind fortification", adjustable fortification using the blood urea nitrogen as a surrogate for protein nutriture to modify dosage of fortification, and targeted, individualized fortification that is based on periodic human milk analysis.
Collapse
Affiliation(s)
- David H Adamkin
- Division of Neonatal Medicine, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA.
| |
Collapse
|
18
|
Rural Nurses' Views on Breastmilk Banking in Limpopo Province, South Africa: A Qualitative Study. NURSING REPORTS 2022; 12:747-757. [PMID: 36278767 PMCID: PMC9589964 DOI: 10.3390/nursrep12040074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/26/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
Abstract
The development of breastmilk banks is being established among the African population, including in Limpopo Province. However, the views of nurses directly handling the donated breastmilk in the province remain unknown. This study was aimed at exploring and describing the views of nurses towards breastmilk banking in the Mankweng area, Limpopo Province. A qualitative, descriptive, and explorative study was undertaken at a tertiary hospital and a rural feeder clinic in the Mankweng area. Purposive sampling was employed to obtain participants for the interviews. One-on-one, semi-structured interviews were conducted to explore the views of these nurses. Data were analysed using Tesch’s open coding method, with the information obtained being grouped into different themes and sub-themes. Almost all nurses were willing to donate their breastmilk to the bank. However, receiving donated breastmilk for their own children seemed to be a challenge due to the safety of the donated breastmilk, uncertainty about the screening process, and cultural issues. Although donation of breastmilk appeared to be well supported by almost all the nurses, the use of donated breastmilk seemed to be not fully acceptable. Increased awareness about breastmilk donation and banking should be prioritised in the province.
Collapse
|
19
|
Gomez J, Wardell D. Nurse-Driven Interventions for Improving ELBW Neurodevelopmental Outcomes. J Perinat Neonatal Nurs 2022; 36:362-370. [PMID: 36288443 DOI: 10.1097/jpn.0000000000000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Survival rates for extremely low-birth-weight (ELBW) infants are improving as neurodevelopmental impairment (NDI) rates stay stable, thereby increasing the overall number of infants with NDI. Although there are many determinants of NDI in this population, nutritional factors are of interest because they are readily modifiable in the clinical setting. Nurses can influence nutritional factors such as improving access to human milk feeding, using growth monitoring, establishing feeding policies, implementing oral care with colostrum, facilitating kangaroo care, and providing lactation education for the mother. All of these measures assist in leading to a decrease in NDI rates among ELBW infants.
Collapse
Affiliation(s)
- Jessica Gomez
- Section of Neonatology, Department of Pediatrics, The University of Texas Health Science Center at Houston, Houston (Ms Gomez); and Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston (Dr Wardell)
| | | |
Collapse
|
20
|
Kumbhare SV, Jones WD, Fast S, Bonner C, Jong G', Van Domselaar G, Graham M, Narvey M, Azad MB. Source of human milk (mother or donor) is more important than fortifier type (human or bovine) in shaping the preterm infant microbiome. Cell Rep Med 2022; 3:100712. [PMID: 36029771 PMCID: PMC9512671 DOI: 10.1016/j.xcrm.2022.100712] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/13/2022] [Accepted: 07/14/2022] [Indexed: 12/20/2022]
Abstract
Milk fortifiers help meet the nutritional needs of preterm infants receiving their mother's own milk (MOM) or donor human milk. We conducted a randomized clinical trial (NCT03214822) in 30 very low birth weight premature neonates comparing bovine-derived human milk fortifier (BHMF) versus human-derived fortifier (H2MF). We found that fortifier type does not affect the overall microbiome, although H2MF infants were less often colonized by an unclassified member of Clostridiales Family XI. Secondary analyses show that MOM intake is strongly associated with weight gain and microbiota composition, including Bifidobacterium, Veillonella, and Propionibacterium enrichment. Finally, we show that while oxidative stress (urinary F2-isoprostanes) is not affected by fortifier type or MOM intake, fecal calprotectin is higher in H2MF infants and lower in those consuming more MOM. Overall, the source of human milk (mother versus donor) appears more important than the type of milk fortifier (human versus bovine) in shaping preterm infant gut microbiota.
Collapse
Affiliation(s)
- Shreyas V Kumbhare
- Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, MB, Canada; Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - William-Diehl Jones
- Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada; Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | - Sharla Fast
- Department of Nutrition and Food Services, Health Sciences Centre, Winnipeg, MB, Canada
| | - Christine Bonner
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Geert 't Jong
- Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Gary Van Domselaar
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada; Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Morag Graham
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada; Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Michael Narvey
- Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, MB, Canada; Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
| |
Collapse
|
21
|
Huang J, Zheng Z, Zhao X, Huang L, Wang L, Zhang X, Lin X. Short-term effects of fresh mother's own milk in very preterm infants. MATERNAL & CHILD NUTRITION 2022; 19:e13430. [PMID: 36098334 PMCID: PMC9749607 DOI: 10.1111/mcn.13430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
Fresh mother's own milk (MOM) can protect preterm infants from many complications. Often MOM is pasteurized for safety, which can deactivate cellular and bioactive components with protective benefits. Questions remain regarding whether pasteurized MOM provides the same benefits as fresh MOM. The aim of this study was to evaluate the association and feasibility of feeding very preterm infants with fresh MOM. This prospective cohort study included 157 very preterm infants born before 32 weeks' gestational age and with a birthweight below 1500 g. Of these, 82 infants were included in the fresh MOM without any processing group and 75 infants were included in the pasteurized never-frozen MOM (PNFMOM) group. The mortality rate, survival rate without severe complication, incidence of complications, feeding indexes and growth velocities were compared to assess the association and feasibility of feeding fresh MOM. Compared with the PNFMOM group, the fresh MOM group had a higher survival rate without severe complications (p = 0.014) and a lower incidence of bronchopulmonary dysplasia (p = 0.010) after adjustment for confounders. The fresh MOM group regained birthweight earlier (p = 0.021), reached total enteral feeding earlier (p = 0.024), and received total parenteral nutrition for less time (p = 0.045). No adverse events associated with fresh MOM feeding were recorded. Feeding fresh MOM may reduce the incidence of complications in very premature infants. Fresh MOM was shown to be a feasible feeding strategy to improve preterm infants' outcomes.
Collapse
Affiliation(s)
- Jing Huang
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Zhi Zheng
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Xiao‐yan Zhao
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Li‐han Huang
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Lian Wang
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Xiao‐lan Zhang
- Department of NeonatologyXiamen Humanity HospitalXiamenChina
| | - Xin‐zhu Lin
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| |
Collapse
|
22
|
Xiaoshan H, Xue C, Jun Z, Feng L, Xiaohui C, Zhangbin Y, Shuping H. Eight-year operation status and data analysis of the first human milk bank in East China. Int Breastfeed J 2022; 17:65. [PMID: 36050709 PMCID: PMC9435425 DOI: 10.1186/s13006-022-00502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Human milk banks (HMBs) are essential facilities for the selection, collection, testing, transportation,storage, and distribution of DHM for special medical needs. The aim of this analysis was to analyze the operation status and data over the last 8 years of operation of the first human milk bank (HMB) in East China. Methods Data related to the costs, donors, donation, pasteurization, and recipients were extracted from the web-based electronic monitoring system of the HMB for the period August 1, 2013 to July 31, 2021. Results Over the 8 years of operation, 1,555 qualified donors donated 7,396.5L of qualified milk at a cost of ¥1.94 million($306,051), with the average cost per liter of donor human milk being ¥262.3($41.4). The donors were between 25 and 30 years of age, and the majority (80.1%) were primipara. All the donated milk was pasteurized and subjected to bacteriological tests before and after pasteurization: 95.4% passed the pre-pasteurization tests, and 96.3% passed the post-pasteurization tests. A total of 9,207 newborns received 5,775.2L of pasteurized donor milk. The main reason for the prescription of donor human milk was preterm birth. As a result of continuous quality improvements, January 2016 witnessed a significant increase in the volume of qualified DHM and the number of qualified donors. However, in 2020, as a result of the restrictions related to the COVID-19 pandemic, the volume of qualified DHM and the number of qualified donors decreased. Conclusions Over its 8 years of operation, our HMB has made steady quality improvements in its screening and information processes. Continuous quality improvement is on ongoing need, along with recruiting more qualified donors and collecting donor human milk for vulnerable newborns.
Collapse
Affiliation(s)
- Hu Xiaoshan
- Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital, 123 Tianfeixiang,Mochou Road, Nanjing, China
| | - Chu Xue
- Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital, 123 Tianfeixiang,Mochou Road, Nanjing, China
| | - Zhang Jun
- Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital, 123 Tianfeixiang,Mochou Road, Nanjing, China
| | - Liu Feng
- Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital, 123 Tianfeixiang,Mochou Road, Nanjing, China
| | - Chen Xiaohui
- Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital, 123 Tianfeixiang,Mochou Road, Nanjing, China
| | - Yu Zhangbin
- Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital, 123 Tianfeixiang,Mochou Road, Nanjing, China
| | - Han Shuping
- Department of Pediatrics, Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital, 123 Tianfeixiang,Mochou Road, Nanjing, China.
| |
Collapse
|
23
|
Patra K, Greene MM, Tobin G, Casini G, Esquerra-Zwiers AL, Meier PP, Patel AL. Neurodevelopmental Outcome in Very Low Birth Weight Infants Exposed to Donor Milk. Am J Perinatol 2022; 39:1348-1353. [PMID: 33406537 PMCID: PMC8257749 DOI: 10.1055/s-0040-1722597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study was aimed to evaluate the impact of donor milk (DM) received in the first 28 days of life (DOL) on neurodevelopmental (ND) outcome at 20-months corrected age (CA) in very low birth weight (VLBW) infants. STUDY DESIGN A total of 84 infants born in 2011 to 2012 who received only mother's own milk (MOM) and/or preterm formula (PF) was compared with 69 infants born in 2013 to 2014 who received MOM and/or DM. Daily enteral intake of MOM, DM, and PF was collected through 28 DOL. ND outcomes were assessed with the Bayley-III. Multiple regression analyses adjusted for the effect of social and neonatal risk factors alongside era of birth on ND outcome. RESULTS Infants exposed to DM were born to older mothers (p < 0.01) and had higher incidence of severe brain injury (p = 0.013). Although DM group infants received first feed at earlier DOL (p < 0.001), there were no differences in MOM intake at DOL 14 or 28 between the two groups. In regression analyses, DM group did not predict 20-month ND outcome. CONCLUSION There were no differences in ND outcome between infants born before and after the introduction of DM. This may have been due to the similar percent of MOM at DOL 14 and 28 in the two eras. KEY POINTS · Donor milk use is increasing in VLBW infant. The impact of donor milk on neurodevelopment is unclear.. · Provision of mother's own milk was high at days of life 14 and 28 for both groups of infants.. · Donor milk was not associated with improved neurodevelopmental outcome..
Collapse
Affiliation(s)
- Kousiki Patra
- Department of Pediatrics, Rush University Children’s Hospital, Chicago, Illinois
| | - Michelle M. Greene
- Department of Pediatrics, Rush University Children’s Hospital, Chicago, Illinois
| | - Grace Tobin
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota
| | - Gina Casini
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Paula P. Meier
- Department of Pediatrics, Rush University Children’s Hospital, Chicago, Illinois
| | - Aloka L. Patel
- Department of Pediatrics, Rush University Children’s Hospital, Chicago, Illinois
| |
Collapse
|
24
|
Hayashi M, Huber K, Rankin C, Boyajian B, Martinez A, Grover T, Roosevelt G. BLOSSoM: Improving Human Milk Provision in Preterm Infants Through Texting Support. Pediatr Qual Saf 2022; 7:e600. [PMID: 36168514 PMCID: PMC9509171 DOI: 10.1097/pq9.0000000000000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Mother’s own milk (MOM) reduces complications of preterm birth. Despite high initiation rates of expression, half of preterm infants do not receive MOM at discharge. Frequent outreach and a short message service (SMS) have improved MOM provision in term dyads. We aimed to improve MOM provision rate from 61% to >80% by implementing standardized lactation education and Breastfeeding & Lactation Outreach via SMS Supporting Mothers (BLOSSoM).
Collapse
|
25
|
Meier PP. More evidence: Mothers’ own milk is personalized medicine for very low birthweight infants. Cell Rep Med 2022; 3:100710. [PMID: 35977466 PMCID: PMC9418736 DOI: 10.1016/j.xcrm.2022.100710] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
“Human milk sources and fortification: Impact on fecal microbiota and calprotectin in premature infants” highlights improved outcomes in predominantly mothers’ own milk-fed versus predominantly pasteurized donor human milk-fed VLBW infants, regardless of fortifier type. Research and practice implications are reviewed.
Collapse
|
26
|
Slagle C, Schuh M, Grisotti G, Riddle S, Reddy P, Claes D, Lim FY, VanderBrink B. In utero renal failure. Semin Pediatr Surg 2022; 31:151195. [PMID: 35725056 DOI: 10.1016/j.sempedsurg.2022.151195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Cara Slagle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7009, United States.
| | - Meredith Schuh
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Gabriella Grisotti
- Division of Pediatric General and Thoracic Surgery and Center for Fetal Care, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| | - Stefanie Riddle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7009, United States
| | - Pramod Reddy
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| | - Donna Claes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Foong-Yen Lim
- Division of Pediatric General and Thoracic Surgery and Center for Fetal Care, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| | - Brian VanderBrink
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| |
Collapse
|
27
|
Bergner EM, Taylor SN, Gollins LA, Hair AB. Human Milk Fortification: A Practical Analysis of Current Evidence. Clin Perinatol 2022; 49:447-460. [PMID: 35659096 DOI: 10.1016/j.clp.2022.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Human milk (HM) with appropriate fortification is the recommended nutrition for very low birth weight (VLBW) infants. Fortification provides additional nutrients, vitamins, and minerals to support the growing preterm infant during critical periods of development. This article discusses the variability of HM including differences between maternal and pasteurized donor human milk (DHM), fortification of HM through the use of single- and multi-nutrient fortifiers, and clinical controversies including the timing of fortification, volume of feedings, and future innovations in HM fortification.
Collapse
Affiliation(s)
- Erynn M Bergner
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 North Everett Drive, ETNP 7504 Oklahoma City, OK 73104, USA. https://twitter.com/ErynnBergner
| | - Sarah N Taylor
- Section of Neonatology, Department of Pediatrics, Yale School of Medicine, PO Box 208064 New Haven, CT 06520, USA
| | - Laura A Gollins
- Neonatal Nutrition Program, Neonatology, Texas Children's Hospital, 6621 Fannin Street, Suite WT6104, Houston, TX 77030, USA
| | - Amy B Hair
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Suite WT6104, Houston, TX 77030, USA.
| |
Collapse
|
28
|
Perrin MT, Friend LL, Sisk PM. Fortified Donor Human Milk Frequently Does Not Meet Sodium Recommendations for the Preterm Infant. J Pediatr 2022; 244:219-223.e1. [PMID: 35093320 DOI: 10.1016/j.jpeds.2022.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/28/2021] [Accepted: 01/17/2022] [Indexed: 12/18/2022]
Abstract
We measured the sodium content of donor human milk (DHM) and calculated the estimated intake at a feeding volume of 160 mL/kg/day. The mean sodium content of unfortified DHM was 102.0 mg/L (4.4 mEq). Because <1% of bovine-fortified samples met the recommended sodium content, infants born preterm who are fed predominantly DHM likely require additional sodium.
Collapse
Affiliation(s)
- Maryanne T Perrin
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC.
| | - Linda L Friend
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC
| | - Paula M Sisk
- Neonatal Intensive Care Unit, Forsyth Medical Center, Winston-Salem, NC
| |
Collapse
|
29
|
Wu T, Jiang PP, Luo P, Chen Y, Liu X, Jiang YN, Ma L, Zhou P. Availability of donor milk improves enteral feeding but has limited effect on body growth of infants with very-low birthweight: Data from a historic cohort study. MATERNAL & CHILD NUTRITION 2022; 18:e13319. [PMID: 35043572 PMCID: PMC8932717 DOI: 10.1111/mcn.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/02/2021] [Accepted: 01/04/2022] [Indexed: 01/01/2023]
Abstract
Compare with preterm formula, donor human milk (DM) is associated with a lower risk of mortality and morbidity in preterm infants. It is thus deemed superior to preterm formula as the sole diet or supplement to own mother's milk (OMM) for preterm infants, especially for those with very low birthweight (VLBW). This historic cohort study investigated the relationship between DM availability, and enteral feeding, body growth of VLBW infants by comparing two cohorts before and after the establishment of a human milk bank. A sub‐analysis was also conducted between small‐for‐gestational‐age (SGA) and non‐SGA infants in our cohorts. Our results showed that DM availability was associated with earlier initiation and faster advancement of enteral feeding, earlier attainment of full enteral feeding, and a higher proportion of OMM in enteral feeding. DM availability was also associated with earlier regain of birthweight, but not with better body growth. SGA and non‐SGA infants responded differently to DM availability with only the non‐SGA group showing improved enteral feeding associated with DM availability. The poor growth of VLBW infants with fortified DM warrants further investigations on better fortification strategies to further improve body growth. Studies are also needed on long‐term effects of DM feeding on the development of VLBW infants. Compared with the infants before the introduction of donor human milk (DM), very low birthweight infants after that had improved enteral feeding process, shown as earlier enteral feeding introduction, faster advancement, and earlier attainment of full enteral feeding. DM availability affects body growth to a limited extent, which calls for a better fortification strategy for DM‐fed infants. The setup of a human donor milk bank increased the use of own mother's milk for enteral feeding.
Collapse
Affiliation(s)
- Tong Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ping-Ping Jiang
- School of Public Health, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
| | - Ping Luo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - You Chen
- Department of Neonatology, Baoan Women's and Children's Hospital, Shenzhen, China
| | - Xudong Liu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-Nan Jiang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Liya Ma
- Department of Child Health, Baoan Women's and Children's Hospital, Shenzhen, China
| | - Ping Zhou
- Department of Neonatology, Baoan Women's and Children's Hospital, Shenzhen, China
| |
Collapse
|
30
|
Bagga N, Kurian S, Mohamed A, Reddy P, Chirla DK. Pasteurized Donor Human Milk Should Not Replace Mother's Own Milk in Preterm Neonates: A Quality Initiative Toward Decreasing the "PDHM Dependency". Breastfeed Med 2022; 17:252-258. [PMID: 34883022 DOI: 10.1089/bfm.2021.0155] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aim: Mother's own milk (MOM) is the preferred source of neonatal nutrition. Due to various challenges, mothers are often unable to provide exclusive MOM to neonates admitted in neonatal intensive care units (NICUs) and depend on pasteurized donor human milk (PDHM). The aim of this quality improvement (QI) initiative was to enable mothers to provide MOM and consequently decrease the "PDHM dependency." Methods: Neonates <32 weeks of gestation (n = 120) were included. A multidisciplinary team was formed, and a detailed root cause analysis was done to understand the cause of PDHM dependency during the observation phase (November 1 to December 15, 2019). Various evidence-based practices were planned, tested, and implemented through Plan-Do-Study-Act cycles during the intervention phase (December 16, 2019 to January 31, 2020). These were further strengthened and adopted as a unit culture during the maintenance phase (February 1 to July 31, 2020). Results from the observation and intervention phases were compared. Results: Within 6 weeks of QI interventions, the average proportion of MOM significantly increased from 74.4% to 93.5% (p = 0.0003), and the proportion of PDHM significantly decreased from 20.5% to 4.6% (p = 0.005). The proportion of MOM remained at 82.5% during the maintenance phase. There was a significant decrease in the number of days to reach full feeds and regain birth weight. Conclusions: Provision of PDHM from our newly functional milk bank led to a reduced drive to express MOM in mothers of NICU babies. Our QI project focused on various strategies to improve MOM feeding and reduce PDHM dependence.
Collapse
Affiliation(s)
- Nitasha Bagga
- Neonatology, Rainbow Children's Hospital, Hyderabad, India
| | - Simi Kurian
- Neonatology, Rainbow Children's Hospital, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Pradeep Reddy
- Neonatology, Rainbow Children's Hospital, Hyderabad, India
| | | |
Collapse
|
31
|
García-González I, Corona-Cervantes K, Hernández-Quiroz F, Villalobos-Flores LE, Galván-Rodríguez F, Romano MC, Miranda-Brito C, Piña-Escobedo A, Borquez-Arreortúa FG, Rangel-Calvillo MN, García-Mena J. The Influence of Holder Pasteurization on the Diversity of the Human Milk Bacterial Microbiota Using High-Throughput DNA Sequencing. J Hum Lact 2022; 38:118-130. [PMID: 33906488 DOI: 10.1177/08903344211011946] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Human milk is the best food for infants; however, when breastfeeding is not possible, pasteurized milk from human milk banks is the best alternative. Little has been reported about variations in the bacterial microbiota composition of human milk after pasteurization. RESEARCH AIM To characterize and compare the bacterial microbiota composition and diversity within human milk among Mexican mothers before and after the Holder pasteurization process. METHODS A cross-sectional, observational, and comparative design was used. The effect of the pasteurization process on the bacterial composition and diversity of human milk samples of donors (N = 42) from a public milk bank was assessed before and after pasteurization by high throughput deoxyribonucleic acid sequencing of V3-16S rRNA gene libraries. Sequencing data were examined using the Quantitative Insights into Microbial Ecology software and Phyloseq in R environment. RESULTS A varied community of bacteria was found in both raw and pasteurized human milk. The bacterial diversity of the milk samples was increased by the pasteurization, where some thermoduric bacteria of the phyla Proteobacteria, Firmicutes, and Actinobacteria were more abundant. The source tracker analysis indicated that at most 1.0% of bacteria may have come from another source, showing the safety of the process used to treat milk samples. CONCLUSION The pasteurization process increased the bacterial diversity. We selected taxa capable of surviving the process, which could proliferate after the treatment without being a risk for infants.
Collapse
Affiliation(s)
- Igrid García-González
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | - Karina Corona-Cervantes
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | - Fernando Hernández-Quiroz
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | | | | | - Marta Catalina Romano
- Departamento de Fisiología, Biofísica y Neurociencias, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | - Carolina Miranda-Brito
- Departamento de Fisiología, Biofísica y Neurociencias, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | - Alberto Piña-Escobedo
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| | | | | | - Jaime García-Mena
- 42576 Departamento de Genética y Biología Molecular, Cinvestav-Unidad Zacatenco. Ciudad de México, México
| |
Collapse
|
32
|
Johnson TJ, Meier PP, Schoeny ME, Bucek A, Janes JE, Kwiek JJ, Zupancic JAF, Keim SA, Patel AL. Study protocol for reducing disparity in receipt of mother's own milk in very low birth weight infants (ReDiMOM): a randomized trial to improve adherence to sustained maternal breast pump use. BMC Pediatr 2022; 22:27. [PMID: 34996401 PMCID: PMC8739536 DOI: 10.1186/s12887-021-03088-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Black very low birth weight (VLBW; < 1500 g birth weight) and very preterm (VP, < 32 weeks gestational age, inclusive of extremely preterm, < 28 weeks gestational age) infants are significantly less likely than other VLBW and VP infants to receive mother's own milk (MOM) through to discharge from the neonatal intensive care unit (NICU). The costs associated with adhering to pumping maternal breast milk are borne by mothers and contribute to this disparity. This randomized controlled trial tests the effectiveness and cost-effectiveness of an intervention to offset maternal costs associated with pumping. METHODS This randomized control trial will enroll 284 mothers and their VP infants to test an intervention (NICU acquires MOM) developed to facilitate maternal adherence to breast pump use by offsetting maternal costs that serve as barriers to sustaining MOM feedings and the receipt of MOM at NICU discharge. Compared to current standard of care (mother provides MOM), the intervention bundle includes three components: a) free hospital-grade electric breast pump, b) pickup of MOM, and c) payment for opportunity costs. The primary outcome is infant receipt of MOM at the time of NICU discharge, and secondary outcomes include infant receipt of any MOM during the NICU hospitalization, duration of MOM feedings (days), and cumulative dose of MOM feedings (total mL/kg of MOM) received by the infant during the NICU hospitalization; maternal duration of MOM pumping (days) and volume of MOM pumped (mLs); and total cost of NICU care. Additionally, we will compare the cost of the NICU acquiring MOM versus NICU acquiring donor human milk if MOM is not available and the cost-effectiveness of the intervention (NICU acquires MOM) versus standard of care (mother provides MOM). DISCUSSION This trial will determine the effectiveness of an economic intervention that transfers the costs of feeding VLBWand VP infants from mothers to the NICU to address the disparity in the receipt of MOM feedings at NICU discharge by Black infants. The cost-effectiveness analysis will provide data that inform the adoption and scalability of this intervention. TRIAL REGISTRATION ClinicalTrials.gov: NCT04540575 , registered September 7, 2020.
Collapse
Affiliation(s)
- Tricia J Johnson
- Department of Health Systems Management, Rush University, 1700 West Van Buren Street, TOB Suite 126B, Chicago, USA.
| | - Paula P Meier
- Department of Pediatrics, Rush University Medical Center, Chicago, USA.,College of Nursing, Rush University, Chicago, USA
| | - Michael E Schoeny
- Department of Community, Systems and Mental Health Nursing, Rush University, Chicago, USA
| | - Amelia Bucek
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| | - Judy E Janes
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| | - Jesse J Kwiek
- Department of Microbiology, The Center for Retrovirus Research and the Infectious Disease Institute, The Ohio State University, Columbus, USA
| | - John A F Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, USA.,Harvard Medical School, Boston, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, USA.,Division of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
| | - Aloka L Patel
- Department of Pediatrics, Rush University Medical Center, Chicago, USA
| |
Collapse
|
33
|
Knowledge gaps in late-onset neonatal sepsis in preterm neonates: a roadmap for future research. Pediatr Res 2022; 91:368-379. [PMID: 34497356 DOI: 10.1038/s41390-021-01721-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
Late-onset neonatal sepsis (LONS) remains an important threat to the health of preterm neonates in the neonatal intensive care unit. Strategies to optimize care for preterm neonates with LONS are likely to improve survival and long-term neurocognitive outcomes. However, many important questions on how to improve the prevention, early detection, and therapy for LONS in preterm neonates remain unanswered. This review identifies important knowledge gaps in the management of LONS and describe possible methods and technologies that can be used to resolve these knowledge gaps. The availability of computational medicine and hypothesis-free-omics approaches give way to building bedside feedback tools to guide clinicians in personalized management of LONS. Despite advances in technology, implementation in clinical practice is largely lacking although such tools would help clinicians to optimize many aspects of the management of LONS. We outline which steps are needed to get possible research findings implemented on the neonatal intensive care unit and provide a roadmap for future research initiatives. IMPACT: This review identifies knowledge gaps in prevention, early detection, antibiotic, and additional therapy of late-onset neonatal sepsis in preterm neonates and provides a roadmap for future research efforts. Research opportunities are addressed, which could provide the means to fill knowledge gaps and the steps that need to be made before possible clinical use. Methods to personalize medicine and technologies feasible for bedside clinical use are described.
Collapse
|
34
|
An Interdisciplinary Approach to Reducing NEC While Optimizing Growth: A 20-Year Journey. Adv Neonatal Care 2021; 21:433-442. [PMID: 34510070 DOI: 10.1097/anc.0000000000000929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) and postnatal growth restriction are significant clinical dilemmas that contribute to short- and long-term morbidities for the most premature infants. PURPOSE After a rise in NEC rates in a regional neonatal intensive care unit (NICU), improvement practices were implemented by an interdisciplinary quality improvement (QI) work group whose focus was initially on nutrition and growth. QI work was refocused to address both NEC and growth concurrently. METHODS Through various QI initiatives and with evolving understanding of NEC and nutrition, the work group identified and implemented multiple practices changes over 2-decade time span. A standardized tool was used to review each case of NEC and outcomes were continually tracked to guide QI initiatives. LOCAL FINDINGS Focused QI work contributed to a significant reduction in NEC rates from 16.2% in 2007 to 0% in 2018 for inborn infants. Exclusive human milk diet was a critical part of the success. Postnatal growth outcomes initially declined after initial NEC improvement work. Improvement work that focused jointly on NEC and nutrition resulted in improved growth outcomes without impacting NEC. IMPLICATIONS FOR PRACTICE Use of historical perspective along with evolving scientific understanding can guide local improvement initiatives. Work must continue to optimize lactation during NICU hospitalization. More research is needed to determine impact of care practices on gastrointestinal inflammation including medication osmolality, probiotics, and noninvasive respiratory support.
Collapse
|
35
|
Effect of breast milk oral care in infants who underwent surgical correction of ventricular septal defect. Cardiol Young 2021; 31:2015-2018. [PMID: 33883048 DOI: 10.1017/s1047951121001438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study explored the clinical effect of employing breast milk oral care for infants who underwent surgical correction of ventricular septal defect. METHODS A prospective randomised controlled study was conducted in a provincial hospital between January, 2020 and July, 2020 in China. Patients were randomly divided into an intervention group (breast milk oral care, n = 28) and a control group (physiological saline oral care, n = 28). The intervention group was given oral nursing using breast milk for infants in the early post-operative period, and the control group was given oral nursing using physiological saline. Related clinical data were recorded and analysed. RESULTS There were no significant differences in age, gender, weight, operation time, cardiopulmonary bypass time, or aortic cross-clamping time between the two groups. Compared with the physiological saline oral care group, the mechanical ventilation duration, the length of ICU stay in the breast milk oral care group were significantly shorter. The time of start feeding and total enteral nutrition were significantly earlier in the intervention group than those in the control group. The incidence of post-operative pneumonia in the breast milk oral care group was 3.6%, which was significantly lower than that of the physiological saline oral care group. CONCLUSION The use of breast milk for oral care in infants who underwent surgical correction of VSD can reduce the incidence of post-operative pneumonia and promote the recovery of gastrointestinal function.
Collapse
|
36
|
Percent mother's own milk feedings for preterm neonates predicts discharge feeding outcomes. J Perinatol 2021; 41:2766-2773. [PMID: 34526659 DOI: 10.1038/s41372-021-01205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION No studies have determined if there is a threshold whereby use of mother's own milk (MOM) during hospitalization predicts exclusive MOM feeding at discharge. METHODS Among 113 very low birthweight neonates, the ratio of MOM to enteral feeds was measured in the first 14 days, 28 days, and overall hospital stay. The primary outcome was exclusive MOM feeding at discharge. RESULTS For every 1% increase in MOM consumption in the first 14 and 28 days, the odds of being discharge home on an exclusive MOM diet increased nearly 7-fold (OR 7.01, 95% CI: 2.09-23.50) and 17-fold (OR 17.46, 95% CI 4.67-63.31), respectively. A threshold of >50%, >83%, and >85% MOM consumption compared to overall enteral feeds in the first 14 days, 28 days, and throughout hospitalization, respectively, is recommended. CONCLUSIONS Promotion of MOM consumption in the first 2-4 weeks is of paramount importance, with negligible impact of increasing MOM consumption after 28 days.
Collapse
|
37
|
Human Milk Growth Factors and Their Role in NEC Prevention: A Narrative Review. Nutrients 2021; 13:nu13113751. [PMID: 34836007 PMCID: PMC8620589 DOI: 10.3390/nu13113751] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 12/25/2022] Open
Abstract
Growing evidence demonstrates human milk's protective effect against necrotizing enterocolitis (NEC). Human milk derives these properties from biologically active compounds that influence intestinal growth, barrier function, microvascular development, and immunological maturation. Among these protective compounds are growth factors that are secreted into milk with relatively high concentrations during the early postnatal period, when newborns are most susceptible to NEC. This paper reviews the current knowledge on human milk growth factors and their mechanisms of action relevant to NEC prevention. It will also discuss the stability of these growth factors with human milk pasteurization and their potential for use as supplements to infant formulas with the goal of preventing NEC.
Collapse
|
38
|
Hanford J, Mannebach K, Ohler A, Patten M, Pardalos J. Rates of Comorbidities in Very Low Birth Weight Infants Fed an Exclusive Human Milk Diet Versus a Bovine Supplemented Diet. Breastfeed Med 2021; 16:814-820. [PMID: 34415775 DOI: 10.1089/bfm.2020.0345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Our level III neonatal intensive care unit (NICU) implemented the use of an exclusive human milk diet (EHD) and sought to determine its effect on the severe co-morbidities of preterm infants as well as the potential cost-savings due to the anticipated reduction in these co-morbidities. Methods: A retrospective cohort study was completed to determine if an EHD statistically decreased the rate of co-morbidities including length of stay (LOS), days on total parental nutrition (TPN), rates of late onset sepsis, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity (ROP). Results: An EHD significantly decreased the odds of severe ROP (adjusted odds-ratio (aOR)=0.349; 95%CI [0.156, 0.739]; p=0.008) and late onset sepsis (aOR=0.323; 95%CI [0.123, 0.768]; p=0.014). Analysis of cost-effectiveness of an EHD relative to a BSD based on the incremental costs of these co-morbidities determined the net loss in direct hospital costs per patient were estimated to be $420 in 2016 US dollars; however, given the long-term health-care costs and non-pecuniary damages from the co-morbidities of severe ROP and sepsis this net loss appears negligible. Conclusion: This study found that an EHD significantly decreased the odds of severe ROP and late onset sepsis; though not significant, there was a positive trend in decreasing cases of medical NEC; our surgical NEC rates dropped to 0. The benefits of human milk are vital, and the costs are nominal.
Collapse
Affiliation(s)
- Jennifer Hanford
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
| | - Kimberly Mannebach
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
| | - Adrienne Ohler
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
| | - Michael Patten
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
| | - John Pardalos
- Division of Neonatology, Department of Child Health, Women's and Children's Hospital, University of Missouri Health Care, Columbia, Missouri, USA
| |
Collapse
|
39
|
Von Kohorn I, Flaherman V. Human Milk for the Term Newborn. Clin Perinatol 2021; 48:513-531. [PMID: 34353578 DOI: 10.1016/j.clp.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Human milk provides optimal nutrition for term newborns, but the prevalence of its use is below target, and risks have been identified. Infants of black mothers as well as term newborns admitted to the neonatal intensive care unit are at risk for not receiving human milk. To improve human milk intake, multiple individual-level interventions have been shown to be effective, but some popular system-level interventions are ineffective or harmful. Expressed milk and donor milk may be less beneficial than direct breastfeeding. Nuanced public policies can help support lactation while promoting individual choice and equity.
Collapse
Affiliation(s)
- Isabelle Von Kohorn
- Department of Pediatrics, Holy Cross Health, 1500 Forest Glen Road, Silver Spring, MD 20910, USA; Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, 3333 California Street, Box 0503, San Francisco, CA 94118, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
40
|
Abbas S, Keir AK, Makrides M, Klein LD, Grzeskowiak LE, McPhee AJ, Rumbold AR. Tailoring Human Milk Oligosaccharides to Prevent Necrotising Enterocolitis Among Preterm Infants. Front Nutr 2021; 8:702888. [PMID: 34395496 PMCID: PMC8357978 DOI: 10.3389/fnut.2021.702888] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
Necrotising enterocolitis (NEC) is a devastating disease affecting preterm infants, with little improvement in mortality rates and treatment strategies in the last 30 years. Human milk oligosaccharides (HMOs) are emerging as a potential preventive therapy, with multiple protective functions postulated. Our aim is to summarise the evidence concerning the role of HMOs in NEC development and emerging strategies to tailor the delivery of HMOs to preterm infants. Most research efforts to date have focused on supplementing preterm infants with simple oligosaccharides, which are structurally different to HMOs and derived mainly from plants. Clinical trials demonstrate limited benefits for NEC prevention arising from the use of these supplements. Alternative strategies under investigation include optimising HMOs for infants receiving donor human milk, concentrating oligosaccharides from donor human milk and from animal milks, as well as more sophisticated synthetic oligosaccharide production strategies. Critically, high quality evidence to support implementation of any of these approaches in the neonatal unit is lacking. Whether it is a specific HMO alone or a combination of HMOs that exert protective effects remains to be elucidated. Further challenges include how best to manufacture and administer oligosaccharides whilst retaining bioactivity and safety, including evaluation of the long-term effects of altering the balance of HMOs and gut microbiota in preterm infants. While several human clinical trials are underway, further research is needed to understand whether a tailored approach to oligosaccharide supplementation is beneficial for preterm infants.
Collapse
Affiliation(s)
- Safiyyah Abbas
- Women's and Children's Health Network, Adelaide, SA, Australia
| | - Amy K Keir
- Women's and Children's Health Network, Adelaide, SA, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Laura D Klein
- Business Growth and Innovation, Australian Red Cross Lifeblood, Sydney, NSW, Australia
| | - Luke E Grzeskowiak
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Alice R Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
41
|
Bai Y, Kuscin J. The Current State of Donor Human Milk Use and Practice. J Midwifery Womens Health 2021; 66:478-485. [PMID: 34250723 DOI: 10.1111/jmwh.13244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 01/05/2023]
Abstract
Human milk contains nutrients and immune factors that promote health and growth of an infant. Donor human milk is recommended as the best alternative for infants whose mothers' breast milk is unavailable. This article describes the current status of donor human milk practice and suggests the areas of educational and research needs. Articles published in the last 10 years were reviewed, and findings were summarized under 4 themes: (1) women's knowledge and concerns about donor human milk use, (2) hospital practices, (3) cost-effectiveness, and (4) access and affordability of donor human milk. Women were concerned about donor human milk contamination, disease transmission, cost, and access to bank donor human milk, due to lack of knowledge and awareness of donor human milk benefits and its processing procedures. The absence of health care providers' support for donor human milk adds to the confusion. There is a rising trend of donor human milk use in hospitals for both healthy and vulnerable newborns and infants with varying policies on screening for donor human milk use, cost coverage, or consent procedure. However, a shortage of safe and affordable donor human milk is a barrier to its adoption. A standardized guideline is needed for hospitals regarding donor human milk implementation and cost coverage. Education programs for health care providers are needed to improve knowledge and understanding of donor human milk benefits and safety to provide guidance to parents. It is crucial to develop legislation expanding insurance coverage to achieve donor human milk equity and optimizing long-term human milk diet outcomes.
Collapse
Affiliation(s)
- Yeon Bai
- Department of Nutrition and Food Studies, College of Education and Human Services, Montclair State University, Montclair, New Jersey
| | - Jennifer Kuscin
- Department of Nutrition and Food Studies, College of Education and Human Services, Montclair State University, Montclair, New Jersey
| |
Collapse
|
42
|
Prazad P, Donovan R, Won B, Cortes D. Migration of cyclohexanone and 3,3,5-trimethylcyclohexanone from a neonatal enteral feeding system into human milk. J Perinatol 2021; 41:1074-1082. [PMID: 33758393 DOI: 10.1038/s41372-021-01036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/31/2021] [Accepted: 03/01/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Estimate the migration of volatile organic compounds (VOCs) which have been identified by the EPA as a public health concern, from the enteral feeding system into human milk. STUDY DESIGN Unfortified human milk samples were infused through an enteral feeding system with varying duration of infusion, incubator temperature, and pre-infusion tube priming. Purge & Trap analysis and GC/MS were used to identify the VOC profile of milk pre- and post-infusion. RESULT Cyclohexanone and 3,3,5-trimethylcyclohexanone (3,3,5-TMC) accumulated significantly in milk samples post-infusion. Duration of infusion had a significant effect on VOC accumulation (p = 0.001). Accumulation patterns of cyclohexanone and 3,3,5-TMC differed significantly based on milk type (donor vs. mother's own milk). CONCLUSIONS VOCs, migrate from plastic-based feeding equipment into human milk. Based on these findings, limiting the duration of feeding infusion would reduce VOC exposure derived from enteral feeding in the neonatal intensive care unit.
Collapse
Affiliation(s)
| | | | - Brian Won
- Rosaland Franklin University of Medicine and Science, North Chicago, IL, USA
| | | |
Collapse
|
43
|
Abstract
Human milk is the preferred enteral diet for preterm infants. It provides macronutrients, micronutrients, and bioactive factors that support physical growth and neurodevelopment. Challenges of the human milk diet include the variability in its composition and a need for fortification to mirror placental nutrient delivery and prevent extrauterine growth restriction. Various strategies exist to attain target nutrient provision and optimize growth, including leveraging new technology for point-of-care human milk analysis. When maternal milk is unavailable or in short supply, pasteurized donor human milk is the preferred alternative. Infants fed donor milk may have slower weight gain than those fed exclusively maternal milk or formula, whereas infants fed fortified maternal milk have similar weight gain to preterm formula-fed infants. Future directions include more rigorous characterization of the variation in human milk, further investigation of the clinical benefits of non-nutrient bioactive factors in milk, and novel approaches to optimize fortification.
Collapse
Affiliation(s)
- Margaret L Ong
- Division of Newborn Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Mandy Brown Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
44
|
Abstract
Mother's own milk (MOM) feeding is a cost-effective strategy to reduce risks of comorbidities associated with prematurity and improve long-term health of infants hospitalized in the Neonatal Intensive Care Unit (NICU). Significant racial and socioeconomic disparities exist in MOM provision in the NICU, highlighting the importance of developing strategies to reduce these disparities. Mothers of infants in the NICU experience many health concerns which may negatively impact lactation physiology. Objective measures of lactation physiology are limited but may assist in identifying mothers at particular risk. Several strategies to assist mothers of hospitalized infants are essential, including maternal education, qualified lactation professionals, early and frequent milk expression with a hospital-grade double electric breast pump, and providing support for transitioning to direct breastfeeding prior to discharge from the NICU.
Collapse
|
45
|
Schinkel ER, Nelson ER, Young BE, Bernstein RM, Taylor SN, Hay WW, Brown LD, Brown KJ, Prenni J. Concentrating human milk: an innovative point-of-care device designed to increase human milk feeding options for preterm infants. J Perinatol 2021; 41:582-589. [PMID: 33060780 PMCID: PMC9848740 DOI: 10.1038/s41372-020-00820-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/17/2020] [Accepted: 09/14/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether a point-of-care osmotic device concentrates important human milk (HM) nutrients to support feeding neonates requiring high-nutrient, low-volume feedings. STUDY DESIGN Raw and pasteurized HM samples were concentrated to determine the effects of time and temperature on concentration. Concentrated samples were compared with matched baseline samples to measure changes in selected nutrient concentrations. Furthermore, changes in concentration of certain bioactive components of raw milk samples were measured. RESULT The device significantly increased the concentrations of the majority of the measured nutrient and bioactive levels (p < 0.05). Increasing temperature of HM from 4 to 37 °C increased the concentration rate >30%. In all cases, the concentration rate of pasteurized HM was greater than that of raw HM. CONCLUSIONS The osmotic concentration of HM is a promising option for neonatal nutrition. Further studies are needed to establish an evidence base for the practical applications of this point-of-care device.
Collapse
Affiliation(s)
| | | | - Bridget E. Young
- Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry
| | - Robin M. Bernstein
- Department of Anthropology and Institute of Behavioral Science, University of Colorado, Boulder
| | | | | | | | - Kitty J. Brown
- Center for Proteomics and Metabolomics at Colorado State University
| | - Jessica Prenni
- Center for Proteomics and Metabolomics at Colorado State University
| |
Collapse
|
46
|
Abstract
BACKGROUND Human milk is recommended as the only nutritional source during the first 6 months of life. For preterm infants, the benefits of human milk are even more important and can alleviate the negative influences of preterm birth. RESEARCH AIM To describe how Swedish human milk donors experienced the donation process. METHOD A prospective mixed methods mail survey was designed. It was sent to human milk donors (N = 72) at two Swedish hospitals. Quantitative data are presented with descriptive statistics and qualitative data were analyzed using qualitative content analysis. RESULTS The infants were between newborn and 17 weeks of age when the participants started their human milk donations, and the duration of the donation period lasted 1-24 weeks. The overall theme identified was the participants' strong desire to help infants, often expressed as being involved in saving infants' lives. Many participants experienced difficulties getting the information needed to become human milk donors; for others, expressing milk required both time and energy that they could otherwise spend with their own newborn infants. CONCLUSION Donating human milk can be experienced as a demanding and strenuous task. Therefore, it is important that women who donate human milk receive the practical help from health care staff that they feel they need. Furthermore, information and knowledge about the possibility of donating human milk, and how important human milk is for preterm and/or sick infants, are important in order to increase the number of women willing to donate human milk.
Collapse
Affiliation(s)
- Emma Olsson
- 6233 Department of Pediatricsm, Faculty of Medicine and Health, Örebro University, Sweden.,Faculty of Medicine and Health, School of Health Sciences, Örebro University, Sweden
| | - Barbro Diderholm
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden.,8097 Department of Women's and Children's Health, Uppsala University, Sweden
| | - Ylva Thernström Blomqvist
- University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden.,8097 Department of Women's and Children's Health, Uppsala University, Sweden
| |
Collapse
|
47
|
Yu XR, Xu N, Huang ST, Zhang QL, Wang ZC, Cao H, Chen Q. Effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery: a prospective randomized controlled study. Transl Pediatr 2021; 10:359-365. [PMID: 33708522 PMCID: PMC7944187 DOI: 10.21037/tp-20-295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To explore the effects of different oral care strategies on postoperative pneumonia in infants with mechanical ventilation after cardiac surgery. METHODS A prospective randomized controlled study was conducted at a hospital in Fujian Province, China. Participants were randomly divided into the breast milk oral care group, physiological saline oral care group, and sodium bicarbonate oral care group to explore the effects of different oral care strategies on postoperative pneumonia in infants on mechanical ventilation cardiac surgery. RESULTS The mechanical ventilation duration, the hospitalization costs, and the length of intensive care unit (ICU) stay and postoperative hospital stay in the breast milk oral care group were significantly shorter than those in the physiological saline oral care group and the sodium bicarbonate oral care group. The incidence of postoperative pneumonia in the breast milk oral care group was 3.2%, which was significantly lower than that in the physiological saline oral care group (22.6%) and the sodium bicarbonate oral care group (19.4%). CONCLUSIONS Using breast milk for oral care in infants after cardiac surgery has a lower incidence of postoperative pneumonia than traditional oral care strategies of physiological saline and sodium bicarbonate, and it is worthy of clinical application.
Collapse
Affiliation(s)
- Xian-Rong Yu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qi-Liang Zhang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Zeng-Chun Wang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Chin
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Women and Children's Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Chin
| |
Collapse
|
48
|
Quitadamo PA, Palumbo G, Cianti L, Lurdo P, Gentile MA, Villani A. The Revolution of Breast Milk: The Multiple Role of Human Milk Banking between Evidence and Experience-A Narrative Review. Int J Pediatr 2021; 2021:6682516. [PMID: 33623528 PMCID: PMC7872774 DOI: 10.1155/2021/6682516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 02/05/2023] Open
Abstract
The review recalls the importance of breast milk and deepens the theme of human milk banking, a virtuous reality that is expanding all over the world but is still little known. In the last 15 years, modern biological technologies have crystallized the concept of uniqueness and irreproducibility of human milk, by establishing three new principles: first: human milk: a "life-saving" drug; second: human milk: the best food for preterm infants; and third: human milk: the main component of premature infant care. Our experience teaches us that human milk banking plays many roles that need to be known and shared.
Collapse
Affiliation(s)
- Pasqua Anna Quitadamo
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Giuseppina Palumbo
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Liliana Cianti
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Paola Lurdo
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Maria Assunta Gentile
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Villani
- NICU, HMB “Casa Sollievo della Sofferenza” Foundation, San Giovanni Rotondo, Foggia, Italy
| |
Collapse
|
49
|
Esquerra-Zwiers A, Schoeny ME, Engstrom J, Wicks J, Szotek J, Meier P, Patel AL. The Interaction of Donor Human Milk Availability and Race/Ethnicity on Provision of Mother's Own Milk for Very Low Birth Weight Infants. Breastfeed Med 2021; 16:46-53. [PMID: 33325782 PMCID: PMC7826434 DOI: 10.1089/bfm.2020.0212] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: To compare (1) differences in mother's own milk (MOM) provision and enteral feeding outcomes, (2) differences in preterm formula and donor human milk (DHM) uses as bridges to exclusive MOM feedings at discharge, and (3) MOM and enteral feeding outcomes for racial/ethnic subgroups before and after the implementation of a hospital DHM feeding program. Methods: Retrospective data from 313 very low birth weight (VLBW; birth weight <1,500 g) infants born between January 2011 to December 2012 (pre-DHM, n = 157) and April 2013 to March 2015 (DHM, n = 156) were analyzed. Results: For this predominantly low-income and minority VLBW infant cohort, the percent of enteral fed hospitalization days was higher in the DHM group (pre-DHM 94% [88, 97] versus DHM 98% [95, 99], p < 0.001). Although MOM remained the predominant first enteral feeding type, significantly fewer DHM infants received MOM (pre-DHM 89% versus DHM 75%, p = 0.001). During days of life 1-14, a lower percentage of DHM infants received 100% MOM (pre-DHM 68% versus DHM 55%, p = 0.02). For the entire cohort, the risk for MOM discontinuation was significantly associated with maternal young age, multiparity, non-Hispanic Black race/ethnicity, and low income. Implementation of a DHM program did not predict duration of MOM feedings. However, non-Hispanic White infants had a longer duration of MOM feedings with DHM availability. Conclusions: Our findings highlight the importance of using precise dose and exposure period methodology to determine the impact of DHM on MOM provision. In addition, DHM availability may be associated with varying effects on MOM provision among racial/ethnic groups.
Collapse
Affiliation(s)
- Anita Esquerra-Zwiers
- Department of Nursing, Hope College, Holland, Michigan, USA.,College of Nursing, Rush University, Chicago, Illinois, USA
| | | | - Janet Engstrom
- College of Nursing, Rush University, Chicago, Illinois, USA
| | - Jennifer Wicks
- Department of Pediatrics, Rush University, Chicago, Illinois, USA
| | - Jennifer Szotek
- Rush Medical College, Rush University, Chicago, Illinois, USA
| | - Paula Meier
- College of Nursing, Rush University, Chicago, Illinois, USA.,Section of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| | - Aloka L Patel
- Section of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
50
|
Davis JA, Baumgartel K, Morowitz MJ, Giangrasso V, Demirci JR. The Role of Human Milk in Decreasing Necrotizing Enterocolitis Through Modulation of the Infant Gut Microbiome: A Scoping Review. J Hum Lact 2020; 36:647-656. [PMID: 32845798 DOI: 10.1177/0890334420950260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Necrotizing enterocolitis is associated with a high incidence of morbidity and mortality in premature infants. Human milk minimizes necrotizing enterocolitis risk, although the mechanism of protection is not thoroughly understood. Increasingly, dysbiosis of the infant gut microbiome, which is affected by infant diet, is hypothesized to play a role in necrotizing enterocolitis pathophysiology. RESEARCH AIM The aim of this scoping review was to summarize the state of the science regarding the hypothesis that the gut microbiome composition is a mediator of the relationship between human milk and decreased incidence of necrotizing enterocolitis within a sample of human infants. METHODS Electronic databases and reference lists were searched for peer-reviewed primary research articles addressing the link between human milk, gut microbiome composition, and subsequent incidence of necrotizing enterocolitis among human infants. RESULTS A total of four studies met criteria for inclusion in this review. Of these, evidence supporting the link between human milk, gut microbiome composition, and necrotizing enterocolitis was found in two (50%) studies. CONCLUSION Some evidence linking all three variables is provided in this review. Given the small number of available studies, and the limitations of those studies, more research is urgently needed to thoroughly understand the protection against necrotizing enterocolitis gained through the provision of human milk.
Collapse
Affiliation(s)
- Jessica A Davis
- 6614 University of Pittsburgh School of Nursing, Pittsburgh, USA
| | | | - Michael J Morowitz
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Vivianna Giangrasso
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, USA
| | - Jill R Demirci
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, USA
| |
Collapse
|