1
|
Inchingolo F, Inchingolo AM, Latini G, Ferrante L, de Ruvo E, Campanelli M, Longo M, Palermo A, Inchingolo AD, Dipalma G. Difference in the Intestinal Microbiota between Breastfeed Infants and Infants Fed with Artificial Milk: A Systematic Review. Pathogens 2024; 13:533. [PMID: 39057760 PMCID: PMC11280328 DOI: 10.3390/pathogens13070533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
The gut microbiota (GM) plays a crucial role in human health, particularly during the first years of life. Differences in GM between breastfed and formula (F)-fed infants may influence long-term health outcomes. This systematic review aims to compare the gut microbiota of breastfed infants with that of F-fed infants and to evaluate the clinical implications of these differences. We searched databases on Scopus, Web of Science, and Pubmed with the following keywords: "gut microbiota", "gut microbiome", and "neonatal milk". The inclusion criteria were articles relating to the analysis of the intestinal microbiome of newborns in relation to the type of nutrition, clinical studies or case series, excluding reviews, meta-analyses, animal models, and in vitro studies. The screening phase ended with the selection of 13 publications for this work. Breastfed infants showed higher levels of beneficial bacteria such as Bifidobacterium and Lactobacillus, while F-fed infants had a higher prevalence of potentially pathogenic bacteria, including Clostridium difficile and Enterobacteriaceae. Infant feeding type influences the composition of oral GM significantly. Breastfeeding promotes a healthier and more diverse microbial ecosystem, which may offer protective health benefits. Future research should explore strategies to improve the GM of F-fed infants and understand the long-term health implications.
Collapse
Affiliation(s)
- Francesco Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (G.L.); or (L.F.); or (E.d.R.); (M.L.); or (A.D.I.); or (G.D.)
| | - Angelo Michele Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (G.L.); or (L.F.); or (E.d.R.); (M.L.); or (A.D.I.); or (G.D.)
| | - Giulia Latini
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (G.L.); or (L.F.); or (E.d.R.); (M.L.); or (A.D.I.); or (G.D.)
| | - Laura Ferrante
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (G.L.); or (L.F.); or (E.d.R.); (M.L.); or (A.D.I.); or (G.D.)
| | - Elisabetta de Ruvo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (G.L.); or (L.F.); or (E.d.R.); (M.L.); or (A.D.I.); or (G.D.)
| | - Merigrazia Campanelli
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (G.L.); or (L.F.); or (E.d.R.); (M.L.); or (A.D.I.); or (G.D.)
| | - Marialuisa Longo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (G.L.); or (L.F.); or (E.d.R.); (M.L.); or (A.D.I.); or (G.D.)
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Alessio Danilo Inchingolo
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (G.L.); or (L.F.); or (E.d.R.); (M.L.); or (A.D.I.); or (G.D.)
| | - Gianna Dipalma
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy or (A.M.I.); or (G.L.); or (L.F.); or (E.d.R.); (M.L.); or (A.D.I.); or (G.D.)
| |
Collapse
|
2
|
Chou FS, Zhang J, Nguyen C, Faison GM, Thompson LR, Villosis MFB, Barseghyan K, Lakshmanan A. The impact of exclusive human milk diet on short-term growth of very preterm infants. J Perinatol 2024:10.1038/s41372-024-01980-w. [PMID: 38678082 DOI: 10.1038/s41372-024-01980-w] [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: 02/17/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES The impact of exclusive human milk diet (EHMD) on postnatal growth remains controversial. This study aims to investigate the association between EHMD and short-term growth. METHODS This multicenter retrospective study aims to compare growth between the EHMD and non-EHMD groups among infants <32 weeks of gestation. Primary outcomes include weight, length, and head circumference growth trajectories between birth and 34 weeks postmenstrual age. Sensitivity and subgroup analyses were performed. RESULTS An EHMD was independently associated with poorer length growth, especially in infants born at ≥28 weeks' gestation or those exposed to hypertensive disorders of pregnancy. While initiating fortification at <26 kcal/oz on an EHMD showed inferior growth, initiating fortification at ≥26 kcal/oz was associated with improved weight growth, and similar length and head circumference growth when compared to the non-EHMD group. CONCLUSIONS An EHMD with initial fortification at ≥26 kcal/oz may be implemented to avoid bovine milk exposure while sustaining comparable growth.
Collapse
Affiliation(s)
- Fu-Sheng Chou
- Southern California Permanente Medical Group, Pasadena, CA, USA.
- Kaiser Permanente Riverside Medical Center, Riverside, CA, USA.
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Jing Zhang
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA, USA
| | - Cammie Nguyen
- Kaiser Permanente Riverside Medical Center, Riverside, CA, USA
| | - Giulia M Faison
- Southern California Permanente Medical Group, Pasadena, CA, USA
- Kaiser Permanente Riverside Medical Center, Riverside, CA, USA
| | - Lindsey R Thompson
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Maria Fe B Villosis
- Southern California Permanente Medical Group, Pasadena, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Kaiser Permanente Panorama City Medical Center, Panorama City, CA, USA
| | - Karine Barseghyan
- Southern California Permanente Medical Group, Pasadena, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Kaiser Permanente Panorama City Medical Center, Panorama City, CA, USA
| | - Ashwini Lakshmanan
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| |
Collapse
|
3
|
Shenker N, Linden J, Wang B, Mackenzie C, Hildebrandt AP, Spears J, Davis D, Nangia S, Weaver G. Comparison between the for-profit human milk industry and nonprofit human milk banking: Time for regulation? MATERNAL & CHILD NUTRITION 2024; 20:e13570. [PMID: 37830377 PMCID: PMC10749996 DOI: 10.1111/mcn.13570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023]
Abstract
Human milk (HM) is a highly evolutionary selected, complex biofluid, which provides tailored nutrition, immune system support and developmental cues that are unique to each maternal-infant dyad. In the absence of maternal milk, the World Health Organisation recommends vulnerable infants should be fed with screened donor HM (DHM) from a HM bank (HMB) ideally embedded in local or regional lactation support services. However, demand for HM products has arisen from an increasing awareness of the developmental and health impacts of the early introduction of formula and a lack of prioritisation into government-funded and nonprofit milk banking and innovation. This survey of global nonprofit milk bank leaders aimed to outline the trends, commonalities and differences between nonprofit and for-profit HM banking, examine strategies regarding the marketing and placement of products to hospital and public customers and outline the key social, ethical and human rights concerns. The survey captured information from 59 milk bank leaders in 30 countries from every populated continent. In total, five companies are currently trading HM products with several early-stage private milk companies (PMCs). Products tended to be more expensive from PMC than HMB, milk providers were financially remunerated and lactation support for milk providers and recipients was not a core function of PMCs. Current regulatory frameworks for HM vary widely, with the majority of countries lacking any framework, and most others placing HM within food legislation, which does not include the support and care of milk donors and recipient prioritisation. Regulation as a Medical Product of Human Origin was only in place to prevent the sale of HM in four countries; export and import of HM was banned in two countries. This paper discusses the safety and ethical concerns raised by the commodification of HM and the opportunities policymakers have globally and country-level to limit the potential for exploitation and the undermining of breastfeeding.
Collapse
Affiliation(s)
- Natalie Shenker
- Department of Surgery and Cancer, Imperial College LondonIRDBLondonUK
- The Human Milk FoundationRothamsted Institute, HertsHarpendenUK
| | - Jonathan Linden
- Centre for Environmental PolicyImperial College LondonLondonUK
| | - Betty Wang
- Centre for Environmental PolicyImperial College LondonLondonUK
| | | | | | - Jacqui Spears
- Centre for Environmental PolicyImperial College LondonLondonUK
| | - Danielle Davis
- Centre for Environmental PolicyImperial College LondonLondonUK
| | - Sushma Nangia
- Department of NeonatologyLady Hardinge Medical CollegeNew DelhiIndia
| | - Gillian Weaver
- The Human Milk FoundationRothamsted Institute, HertsHarpendenUK
| |
Collapse
|
4
|
Pados BF. State of the Science on the Benefits of Human Milk for Hospitalized, Vulnerable Neonates. Nurs Womens Health 2023; 27:121-140. [PMID: 36871597 DOI: 10.1016/j.nwh.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 03/06/2023]
Abstract
Research on human milk has increased dramatically in recent years. The purpose of this review is to describe the literature on the health benefits of human milk for hospitalized, vulnerable neonates. PubMed, CINAHL, and Embase were searched for research articles reporting the health outcomes of hospitalized neonates who were exposed to human milk. Human milk, particularly a mother's own milk, has the potential to reduce the risk of death and the risk and severity of necrotizing enterocolitis, infection, retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage, kidney disease, and liver disease. Dose and timing of human milk is important, with more human milk and earlier introduction having a greater impact on health. When a mother's own milk is not available, donor human milk provides benefits over infant formula.
Collapse
|
5
|
Weeks CL, Marino LV, Johnson MJ. A systematic review of the definitions and prevalence of feeding intolerance in preterm infants. Clin Nutr 2021; 40:5576-5586. [PMID: 34656954 DOI: 10.1016/j.clnu.2021.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/03/2021] [Accepted: 09/07/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Feeding intolerance (FI) is a common phenomenon experienced in preterm infants in neonatal intensive care units, as well as being a focus of many research studies into feeding methods, particularly in relation to comorbidities. There is no widely accepted definition of FI. This systematic review aimed to explore the range of definitions used for FI and provide an estimate of the prevalence amongst preterm infants. METHODS Searches were completed on MEDLINE (includes the Cochrane library), Embase, PsycInfo, CINAHL, NHS Evidence and Web of Science. Inclusion criteria; preterm infants in neonatal units, a clear definition of FI, >10 patients and be available in English language. Case reports were excluded. RESULTS One hundred studies were included. Definitions of FI were inconsistent. Studies were grouped according to definition used into: Group A - measuring gastric residual volume (GRV) only; group B - GRV and abdominal distension (AD); group C - GRV, AD and gastrointestinal symptoms (GI) which included any of vomiting, bilious vomiting and blood in stool; group D- GRV and GI; group E - AD and GI; group F - GI only and group G - any other elements used. Meta-analysis demonstrated that prevalence of FI between groups varied from 15 to 30% with an overall prevalence of 27% (95% confidence interval 23-31%). Group A had the highest prevalence. Review of time to full enteral feed was performed (37 studies) which demonstrated a range of 11.3-18.3 days depending on which FI definition used. DISCUSSION Definitions of FI in research are inconsistent, a similar finding to that seen in studies in both paediatric and adult critical care populations. The difficulty of defining FI in the preterm population is the concern regarding necrotising enterocolitis, with some studies using an overlap in their definitions, despite differing pathophysiology and management. Due to the heterogeneity of data obtained in this review regarding definitions used, further robust research is required in order to conclude which elements which should be used to define FI in this population. PROSPERO NUMBER CRD42019155596. Registered November 2019.
Collapse
Affiliation(s)
- Charlotte L Weeks
- Paediatric Intensive Care Unit, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK.
| | - Luise V Marino
- Department of Dietetics/SLT, University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Mark J Johnson
- NIHR Biomedical Research Centre Southampton, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK; Department of Neonatal Medicine, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| |
Collapse
|
6
|
Gates A, Thompson AB, Marin T, Waller JL, Patel J, Stansfield BK. Novel multinutrient human milk-based human milk fortifier promotes growth and tolerance in premature infants. JPEN J Parenter Enteral Nutr 2021; 46:817-827. [PMID: 34370335 DOI: 10.1002/jpen.2249] [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: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to determine whether human milk supplemented with a novel human milk-based human milk fortifier (Novel HMF), compared with a bovine milk-based HMF (Bovine HMF), supports preterm infant growth through 36 weeks' postmenstrual age (PMA). METHODS This single-center, prospective trial compared growth and nutrition outcomes of preterm infants provided a human milk-based diet (mother's own milk or donor milk) supplemented with a Novel HMF with historic controls provided Bovine HMF. Preterm infants with an estimated gestational age (EGA) between 23 and 33 weeks' PMA and birth weight between 750 and 1800 g were eligible for study inclusion. Weight, length, and head circumference (HC) were monitored weekly. The occurrence of late-onset sepsis, nil per os (NPO) days, necrotizing enterocolitis, metabolic acidosis, and serious adverse events were monitored. RESULTS Birth weight, length, HC, and EGA were similar between the Novel HMF (n = 37) and Bovine HMF (n = 49) groups. The days to regain birth weight was shorter in the Novel HMF group (9.4 ± 4.0 vs 11.4 ± 4.8, P = .0343), with similar weight gain (g/day) from birth to 36 weeks' PMA. Adjusted weight growth velocity (g/kg/day) was significantly higher in the Novel HMF group at 14 and 21 days but similar at 36 weeks' PMA. The Novel HMF group experienced fewer NPO days with a similar total number of feeding days. CONCLUSIONS A novel, multinutrient, human milk-based HMF is well tolerated and meets the nutrition needs of preterm infants.
Collapse
Affiliation(s)
- Amy Gates
- Division of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Amy B Thompson
- Division of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Terri Marin
- College of Nursing, Augusta University, Augusta, Georgia, USA
| | - Jennifer L Waller
- Division of Biostatistics and Data Science, Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Jenny Patel
- Division of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Brian K Stansfield
- Division of Neonatology, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| |
Collapse
|
7
|
Huston R, Lee M, Rider E, Stawarz M, Hedstrom D, Pence M, Chan V, Chambers J, Rogers S, Sager N, Riemann L, Cohen H. Early fortification of enteral feedings for infants <1250 grams birth weight receiving a human milk diet including human milk based fortifier. J Neonatal Perinatal Med 2021; 13:215-221. [PMID: 31707377 PMCID: PMC7369034 DOI: 10.3233/npm-190300] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND An exclusive human milk diet (EHM) including fortification with a human milk-based fortifier has been shown to decrease the occurrence of necrotizing enterocolitis (NEC) but growth velocity may be less for infants receiving EHM compared to a bovine diet. OBJECTIVE The objective of this study was to determine if growth is improved by earlier fortification of breast milk for preterm infants supported with a human milk based fortifier. STUDY DESIGN A multi-center retrospective cohort study of the outcomes of infants of 500- 1250 g birth weight whose breast milk feedings were fortified at >60 mL/kg/day (late) versus <60 mL/kg/day (early) of enteral feeding volume. RESULTS Median±IQR range for gestational age (27.6±3.4 vs 27.0±2.9 weeks, p = 0.03) and chronic lung disease (CLD: 42.6 vs 27.6%, p = 0.008) were higher, and weight gain (12.9±2.6 vs 13.3±2.6 g/kg/day, p = 0.03) was lower in the late (N = 102) vs the early (N = 292) group. Adjusted multiple linear regression analysis found that early fortification was associated with improved growth velocity for weight (p = 0.007) and head circumference (HC) (p = 0.021) and less negative changes in z-scores for weight (p = 0.022) and HC (p = 0.046) from birth to discharge. Adjusted multiple logistic regression found that early fortification was associated with decreased occurrence of CLD (p = 0.004). No other outcomes, including NEC, were associated with early versus late fortification. CONCLUSION The study results suggested that early HM fortification appears to positively affect growth for infants whose human milk feedings are fortified with a human milk based fortifier without adverse effects. The incidence of CLD was also reduced in the early fortification group.
Collapse
Affiliation(s)
- Robert Huston
- Northwest Newborn Specialists, PC and Pediatrix Medical Group, Portland, OR, USA
| | | | - Evelyn Rider
- Providence Alaska Medical Center, Anchorage, AK, USA
| | | | | | | | - Vera Chan
- Prolacta Bioscience, Duarte, CA, USA
| | | | | | | | | | - Howard Cohen
- Salem Health Hospitals and Clinics, Salem, OR, USA
| |
Collapse
|
8
|
Nascimento MB, Martins LC, Draghi PF, Fonseca FL. Evaluation of Human Milk Quality during its Distribution Flow at Neonatal Assistance Units. CURRENT NUTRITION & FOOD SCIENCE 2021. [DOI: 10.2174/1573401316999200918161010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Premature babies have physiological vulnerabilities that influence their absorption
and digestion capacity, compromising their clinical condition. Human milk from human
milk banks has contributed enormously to providing these newborns with complete nutrition.
Objective:
To evaluate the quality of human milk collected at the Human Milk Bank during its distribution
in neonatal units.
Methods:
A cross-sectional study, with a quantitative approach, was carried out in a maternity hospital
with Human Milk Bank. After the pasteurization of milk and its consequent release to these
units, a new test was carried out for the analysis of acid titration, caloric and microbiological content.
Results:
Human Milk showed a decrease of approximately 20% in caloric content and a reduction
in acidity. Approximately 12.3% of the samples were contaminated by fecal coliforms.
Conclusion:
There is a need for a second moment of evaluation of human milk, after the flow, or
to rethink the new ways of preserving the initial quality of human milk.
Collapse
Affiliation(s)
- Maria B.G. Nascimento
- Department of Health Sciences, Faculdade de Medicina do ABC, Universidade Federal de Campina Grande, Brazil
| | - Lourdes C. Martins
- Nucleus of Studies in Environmental Epidemiology, Laboratory of Experimental Atmospheric Pollution, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Patricia F. Draghi
- Clinical Laboratory of FMABC, Faculdade de Medicina do ABC, Universidade Federal de Campina Grande, Campina Grande, Paraiba, Brazil
| | - Fernando L.A. Fonseca
- Laboratory Research in Public Health, Clinical Analysis Laboratory, Faculdade de Medicina do ABC, Universidade Federal de Campina Grande, Campina Grande, Paraiba, Brazil
| |
Collapse
|
9
|
Bushati C, Chan B, Harmeson Owen A, Woodbury A, Yang M, Fung C, Lechtenberg E, Rigby M, Baserga M. Challenges in Implementing Exclusive Human Milk Diet to Extremely Low-Birth-Weight Infants in a Level III Neonatal Intensive Care Unit. Nutr Clin Pract 2021; 36:1198-1206. [PMID: 33624353 DOI: 10.1002/ncp.10625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PROBLEM Extremely low-birth-weight (ELBW) infants require fortification of human milk (HM) to prevent growth failure. Bovine milk-based fortifiers (BOV-f) may be associated with feeding intolerance and necrotizing enterocolitis. Evidence suggests that an exclusive HM diet (EHMD) using HM-based fortifier (HM-f) may improve these outcomes. INTERVENTION EHMD was introduced as a quality improvement project to improve feeding tolerance in ELBW infants. METHOD Implementation included establishing EHMD feeding protocol and growth monitoring. We compared infants receiving HM with BOV-f (n = 49) with infants receiving an EHMD (n = 15). The primary outcome was a reduction of no oral intake days due to feeding intolerance. RESULTS The EHMD cohort had a more advanced GA (28 vs 26 weeks; P = .03), more males (66.7% vs 42.9%; P = .02), and higher incidence of SGA (40.0% vs 18.4%; P = .16) compared with the HM-f group. The EHMD cohort had fewer days with no oral intake (2 vs 5; P < .005), which is insignificant when adjusted for small for gestational age (SGA) (P = .26). The EHMD cohort vs. the HM-f cohort had a significant decrease in weight and length z-scores from birth to discharge (-1.09 vs -0.26 [P = .002]; -1.76 vs -0.83 [P = .02]). Inadequate weight gain persisted after adjustment for SGA. Interventions were performed to increase caloric intake and institute milk preparation changes. CONCLUSION EHMD improved feeding tolerance in our ELBW infants. Observed growth failure might be skewed by SGA prevalence. We highlight that implementation of EHMD requires close growth assessment, especially for SGA infants.
Collapse
Affiliation(s)
- Charity Bushati
- Women's and Children's Services, University of Utah Hospital, Salt Lake City, Utah, USA
| | - Belinda Chan
- Neonatology Division, University of Utah, Salt Lake City, Utah, USA
| | | | - Anne Woodbury
- Nutrition Care Services, University of Utah, Salt Lake City, Utah, USA
| | - Michelle Yang
- Neonatology Division, University of Utah, Salt Lake City, Utah, USA
| | - Camille Fung
- Neonatology Division, University of Utah, Salt Lake City, Utah, USA
| | - Ellen Lechtenberg
- Lactation Service, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Marilyn Rigby
- Neonatology APC Group, Intermountain Health Care, Salt Lake City, Utah, USA
| | - Mariana Baserga
- Neonatology Division, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
10
|
Growth outcomes of small for gestational age preterm infants before and after implementation of an exclusive human milk-based diet. J Perinatol 2021; 41:1859-1864. [PMID: 34012050 PMCID: PMC8342303 DOI: 10.1038/s41372-021-01082-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/30/2021] [Accepted: 04/28/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Small for gestational age (SGA) preterm infants (PT) are at greatest risk for growth failure. Our objective was to assess the impact of an exclusive human milk diet (HUM) on growth velocities and neonatal morbidities from birth to discharge in a SGA population. STUDY DESIGN Multicenter, retrospective cohort study, subgroup analysis of SGA PT comparing a cow's milk diet (CMD) with HUM diet. RESULTS At birth 420 PT were classified as SGA (197 CMD group, 223 HUM group). Demographics and anthropometric measurements were similar. HUM group PT showed improvement in length Z score at discharge (p = 0.024) and reduction in necrotizing enterocolitis (NEC) (p = 0.004). CONCLUSION SGA PT fed a HUM diet had significantly decreased incidence of NEC, surgical NEC, and late-onset sepsis. Due to concerns about growth in a HUM diet, it is reassuring SGA infants fed the HUM diet had similar growth to CMD diet with trends toward improvement.
Collapse
|
11
|
Gao X, Li Y, Olin AB, Nguyen DN. Fortification With Bovine Colostrum Enhances Antibacterial Activity of Human Milk. JPEN J Parenter Enteral Nutr 2020; 45:1417-1424. [PMID: 33305396 PMCID: PMC8647157 DOI: 10.1002/jpen.2060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
Objectives Human milk (HM) is the optimal diet for neonates, but it does not provide enough nutrients for preterm infants. HM fortifiers based on highly processed mature bovine milk (BMFs) are routinely used for preterm infants despite risks of causing gut dysfunction and systemic infection. Gently‐processed bovine colostrum as a fortifier (BCF) may better protect against infection and inflammation. We hypothesized that BCF‐fortified HM has enhanced antimicrobial activity against pathogens that commonly cause neonatal sepsis, relative to BMF‐fortified HM. Methods Holder‐pasteurized HM samples (10 mothers) were aliquoted into 3 fractions: unfortified HM and HM fortified with either BMF or BCF. The samples were analyzed for pH, lactoferrin concentrations, and antimicrobial activities against Staphylococcus epidermidis, Escherichia coli, and Enterococcus faecalis. Results HM+BCF had a lower pH and higher lactoferrin levels than HM+BMF, with HM being intermediate. Relative to infant formula, HM decreased the growth of S epidermidis, E coli, and E faecalis, with no difference between preterm and term HM. Addition of BMF abolished the antimicrobial effect of HM against S epidermidis and E faecalis but not E coli. By contrast, addition of BCF into HM enhanced antimicrobial activity against S epidermidis and E coli, relative to unfortified HM. HM+BCF was superior to HM+BMF in inhibiting growth of all tested bacteria. Conclusion BMF fortification decreased whereas BCF fortification enhanced in vitro antimicrobial activity of HM. This effect may partly be derived from the high levels of antimicrobial factors found in BCF, including lactoferrin. BCF may be a better fortifier than BMF for preterm infants.
Collapse
Affiliation(s)
- Xiaoyan Gao
- Department of Neonatology, Affiliated Foshan Maternity Child Healthcare Hospital, Southern Medical University, Foshan, China.,Department of Neonatology, Foshan Maternity Child Healthcare Hospital, Foshan, China.,Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yanqi Li
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Bille Olin
- National Human Milk Bank, Hvidovre Hospital, Copenhagen, Denmark
| | - Duc Ninh Nguyen
- Section for Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
[Clinical guidelines for the diagnosis and treatment of feeding intolerance in preterm infants (2020)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22. [PMID: 33059799 PMCID: PMC7568993 DOI: 10.7499/j.issn.1008-8830.2008132] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Feeding intolerance (FI) is one of the most common clinical problems in preterm infant and often leads to the delay in reaching total enteral nutrition and prolonged hospital stay. The prevention and treatment of FI are of great significance in improving the survival rate of preterm infants. With reference to current evidence in China and overseas, the clinical guidelines for the diagnosis and treatment of FI in preterm infants were developed based on Grading of Recommendations Assessment, Development and Evaluation (GRADE), so as to help neonatal pediatricians, nursing staff, and nutritionists with early identification and standard management of FI in preterm infants.
Collapse
|
13
|
中国医师协会新生儿科医师分会循证专业委员会. [Clinical guidelines for the diagnosis and treatment of feeding intolerance in preterm infants (2020)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1047-1055. [PMID: 33059799 PMCID: PMC7568993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 03/31/2024]
Abstract
Feeding intolerance (FI) is one of the most common clinical problems in preterm infant and often leads to the delay in reaching total enteral nutrition and prolonged hospital stay. The prevention and treatment of FI are of great significance in improving the survival rate of preterm infants. With reference to current evidence in China and overseas, the clinical guidelines for the diagnosis and treatment of FI in preterm infants were developed based on Grading of Recommendations Assessment, Development and Evaluation (GRADE), so as to help neonatal pediatricians, nursing staff, and nutritionists with early identification and standard management of FI in preterm infants.
Collapse
Affiliation(s)
- 中国医师协会新生儿科医师分会循证专业委员会
- 唐军, 女, 教授, 四川大学华西第二医院儿科/出生缺陷与相关妇儿疾病教育部重点实验室, ; 封志纯, 男, 教授, 解放军总医院第七医学中心附属八一儿童医院NICU, ; 母得志, 男, 教授, 四川大学华西第二医院儿科/出生缺陷与相关妇儿疾病教育部重点实验室,
| |
Collapse
|