Enteral administration of hematopoietic growth factors in the neonatal intensive care unit

Simulated amniotic fluid-like solution given enterally to neonates after obstructive bowel surgeries: A randomized controlled trial

OBJECTIVES

Withholding postoperative feeding is common in neonates recovering from surgeries for congenital abnormalities of the gastrointestinal tract (GIT), which leads to prolonged exposure to total parenteral nutrition, intestinal atrophy, and feeding intolerance. Because amniotic fluid plays a significant role in fetal gut maturation and development, the aim of this study was to test a hypothesis suggesting that feeding tolerance could be improved in neonates recovering from surgeries for congenital obstructive bowel abnormalities by enteral administration of simulated amniotic fluid-like solution given enterally (SAFE) containing recombinant human granulocyte colony-stimulating factor and erythropoietin.

METHODS

This prospective, double-blind, randomized, placebo-controlled trial was conducted with 40 late preterm/term neonates recovering from GIT surgeries. Neonates were randomly divided postoperatively into two groups: 20 neonates received the test solution (SAFE group) and 20 neonates received distilled water (placebo group) with a gestational age range (34.3-40.4 versus 34-40 wk, respectively) and mean gestational age (37.10 ± 1.68 versus 36.90 ± 1.83 wk, respectively). Treatment was started postoperatively and the test solution (or distilled water) was discontinued when daily enteral intake reached 100 mL/kg.

RESULTS

The study group showed better feeding tolerance as demonstrated as reflected by an earlier achievement of 50, 100, 120, and 150 mL/kg enteral feeding per day with a higher enteral caloric intake on day 7 post SAFE administration and a higher rate of weight gain (P < 0.05 for all).

CONCLUSION

Enteral administration of SAFE may improve postoperative feeding tolerance, enteral caloric intake, and weight gain.

The role of gut microbiota in programming the immune phenotype

The human fetus lives in a germ-free intrauterine environment and enters the outside world containing microorganisms from several sources, resulting in gut colonization. Full-term, vaginally born infants are completely colonized with a diverse array of bacterial families in clusters (Phyla) and species (>1000) by the first year of life. Colonizing bacteria communicating with the gut epithelium and underlying lymphoid tissues ('bacterial-epithelial crosstalk') result in a functional immune phenotype and no expression of disease (immune homeostasis). Appropriate colonization is influenced by the prebiotic effect of breast milk oligosaccharides. Adequate colonization results in an innate and adaptive mucosal immune phenotype via communication between molecular patterns on colonizing bacteria and pattern-recognition receptors (e.g., toll-like receptors) on epithelial and lymphoid cells. This ontogeny affects the immune system's capacity to develop oral tolerance to innocuous bacteria and benign antigens. Inadequate intestinal colonization with premature delivery, delivery by Cesarean section and excessive use of perinatal antibiotics results in the absence of adequate bacterial-epithelial crosstalk and an increased incidence of immune-mediated diseases [e.g., asthma, allergy in general and necrotizing enterocolitis (NEC)]. Fortunately, infants with inadequate intestinal colonization can be restored to a bacterial balance with the intake of probiotics. This has been shown to prevent debilitating diseases such as NEC. Thus, understanding the role of gut microbiota in programming of the immune phenotype may be important in preventing disease expression in later childhood and adulthood.

Decreased human milk concentration of epidermal growth factor after preterm delivery of intrauterine growth-restricted newborns

BACKGROUND AND AIM

The aim of the study was to compare epidermal growth factor (EGF) concentration in 81 colostrum samples collected from mothers of newborns in the following growth categories: preterm appropriate for gestational age (AGA), preterm small for gestational age (SGA), and full term (FT).

RESULTS

Significantly higher concentrations of EGF were found in the colostrum of mothers who delivered premature AGA infants at less than 32 weeks of gestation compared with mothers who delivered premature SGA babies at the same gestational age.

CONCLUSIONS

We concluded that the maternal compensatory mechanism accelerating the development of immature breast-fed infants may be disturbed when gestation is complicated by intrauterine growth retardation.

Effect of six-and ten-day-old chick embryo amniotic fluid on development of two-cell mouse embryos

The purpose of this study was to investigate the effect of six-and ten-day-old chick embryo amniotic fluid (CEAF) on the development of two-cell mouse embryos. Six- and ten-day-old CEAF (6-AF, 10-AF) were aspirated separately from the amniotic cavity and two experiments were performed. In the first experiment, two-cell mouse embryos were cultured in different supplements of heat-inactivated 6-AF, pure heat-inactivated 6-AF and pure active 6-AF. The second experiment was also carried out in the same manner using the 10-AF. The rate of the development of embryos in all groups were daily determined and statistically compared with that of control (Ham's F-10 supplemented with 5 mg/ml human serum albumin). During the cultivation period, more embryos reached to the blastocyst stage in all groups of CEAF compared to the control. The result hatched blastocysts embryos also increased from days 3 till 5 of cultivation in all groups of CEAF. The developmental potential of embryos appears to be almost identical in six- and ten-day-old CEAF. In conclusion, CEAF as a supplement or a natural medium could support the development of two-cell mouse embryos.

Tolerance of an enterally administered simulated amniotic fluid-like solution by neonates recovering from surgery for congenital bowel abnormalities

OBJECTIVE

We report a single-centered, Phase I pilot trial, testing the enteral administration of an experimental amniotic fluid-like solution to 10 neonates who were otherwise "NPO" following surgery for congenital bowel abnormalities. The overall hypothesis was that the trophic effect of the solution on intestinal villi would facilitate advancement to full enteral feedings. The specific hypothesis tested in this pilot trial was that the solution would be tolerated.

STUDY DESIGN

Ten neonates who were NPO following surgery for congenital bowel abnormalities, were studied before any "trophic" feedings were begun. Each received an experimental, sterile, isotonic, amniotic fluid-like solution at a dose of 20 ml/kg/day enterally. When milk feedings were begun they were mixed with the experimental solution. Increases in the volume of milk feedings occurred at the discretion of the neonatologist and surgeon, and the experimental solution was discontinued any time the neonatologist or surgeon felt it was not tolerated, or when 100 ml of milk feedings/kg/day was achieved. We quantified the amount and character of emesis, stools, and gastric residuals, measured abdominal girth and blood pressure, looked for skin rashes, and sought any signs of intolerance or adverse events. We recorded the days to achieve milk feedings of 20, 50, 100, and 120 ml/kg/day and length of hospital stay.

RESULTS

The experimental solution was begun 4 to 32 days after surgery, invariably prior to the institution of "trophic" milk feedings. All subjects completed the doses with no evidence of intolerance. All achieved 100 ml/kg of milk feedings 14 days, or fewer, following institution of the experimental solution (mean 11.1 days, range, 3 to 14). All lived and were discharged home 20.2 days (range, 8 to 42) after the experimental solution was begun.

CONCLUSIONS

In this pilot trial involving 10 neonates who had surgery for congenital bowel abnormalities, the enteral administration of a sterile, isotonic, amniotic fluid-like solution was tolerated.