Necrotizing enterocolitis and its association with the neonatal abstinence syndrome

Modulation of intestinal TLR4 expression in infants with neonatal opioid withdrawal syndrome

OBJECTIVE

Neonatal Opioid Withdrawal Syndrome (NOWS) has been associated with the development of necrotizing enterocolitis (NEC) in term and late-preterm neonates. In this study, we used stool gene expression to determine if an increase in baseline inflammation in the intestine of infants with NOWS is associated with these findings.

STUDY DESIGN

Stool samples were prospectively collected between days 1-3 and days 4-9 after delivery for opioid-exposed ( n = 9) or non-exposed neonates (n = 8). Stool gene expression for TLR4 and HMGB1 was determined via real-time PCR.

RESULTS

TLR4 expression was higher in the stool of the non-exposed group in both time periods, between days 1-3 (P < 0.0001) and days 4-9 (P < 0.05) after delivery. No significant difference in HMGB1 expression was found at either time point (P > 0.05).

CONCLUSION

These findings point to an important interplay between opioid exposure and/or NOWS and the inflammatory milieu of the neonatal intestine.

A Scoping Review of Neonatal Opioid Withdrawal and the Infant Gut Microbiome: Does Human Milk Optimize Infant Outcomes?

BACKGROUND

While a growing body of literature has established the role of human milk as a mechanism of protection in the formation of the infant gut microbiome, it remains unclear the extent to which this association exists for infants with neonatal opioid withdrawal syndrome.

PURPOSE

The purpose of this scoping review was to describe the current state of the literature regarding the influence of human milk on infant gut microbiota in infants with neonatal opioid withdrawal syndrome.

DATA SOURCES

CINAHL, PubMed, and Scopus databases were searched for original studies published from January 2009 through February 2022. Additionally, unpublished studies across relevant trial registries, conference proceedings, websites, and organizations were reviewed for possible inclusion. A total of 1610 articles met selection criteria through database and register searches and 20 through manual reference searches.

STUDY SELECTION

Inclusion criteria were primary research studies, written in English, published between 2009 and 2022, including a sample of infants with neonatal opioid withdrawal syndrome/neonatal abstinence syndrome, and focusing on the relationship between the receipt of human milk and the infant gut microbiome.

DATA EXTRACTION

Two authors independently conducted title/abstract and full-text review until there was consensus of study selection.

RESULTS

No studies satisfied the inclusion criteria, which resulted in an empty review.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Findings from this study document the paucity of data exploring the associations between human milk, the infant gut microbiome, and subsequent neonatal opioid withdrawal syndrome. Further, these results highlight the timely importance of prioritizing this area of scientific inquiry.

Potential Prenatal Origins of Necrotizing Enterocolitis

Necrotizing enterocolitis is a serious and yet incompletely understood gastrointestinal disease of infancy that predominately impacts premature neonates. Prevention is a key strategy for the management of necrotizing enterocolitis. Although postnatal risk factors have been the focus of prevention efforts, obstetric complications, including intrauterine inflammation and infection, growth restriction, preeclampsia, and prenatal medications, have been associated with an increased risk of necrotizing enterocolitis. This article reviews the evidence behind the prenatal risk factors for necrotizing enterocolitis, and discusses how these risk factors may elucidate the pathogenesis of necrotizing enterocolitis and provide insight into prevention and treatment.

Immunologic Properties of Human Milk and Clinical Implications in the Neonatal Population

Human milk contains various bioactive substances including hormones, immunoglobulins, enzymes, and growth factors in addition to its macro- and micronutrients. It has been suggested that human milk is a vehicle of communication between the maternal and infant immune systems, providing passive protection as well as direct active immunomodulation. Human milk protects newborns against pathogens by acting directly on multiple physiologic systems. Bioactive and immunologic factors regulate the infant's immune, metabolic, and microbiome systems. Breastfeeding protects infants in all socioeconomic groups, showing a pattern of protective dose/duration-response effects. This review summarizes the immune components and immunologic properties of human milk and provides an update of their potential implications in the neonatal population.