Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT

American Academy of Pediatrics (AAP) - Tập 135 Số 2 - Trang e357-e366 - 2015
Ju Young Lee1, Han‐Suk Kim2, Young Hwa Jung1, Ka Young Choi3, Seung Han Shin1, Ee‐Kyung Kim1, Jung-Hwan Choi1
1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea; and.
2aDepartment of Pediatrics, Seoul National University College of Medicine, Seoul, Korea; and
3Department of Pediatrics, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea.

Tóm tắt

OBJECTIVE: To determine the immunologic effects of oropharyngeal colostrum administration in extremely premature infants. METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving 48 preterm infants born before 28 weeks’ gestation. Subjects received 0.2 mL of their mother’s colostrum or sterile water via oropharyngeal route every 3 hours for 3 days beginning at 48 to 96 hours of life. To measure concentrations of secretory immunoglobulin A, lactoferrin, and several immune substances, urine and saliva were obtained during the first 24 hours of life and at 8 and 15 days. Clinical data during hospitalization were collected. RESULTS: Urinary levels of secretory immunoglobulin A at 1 week (71.4 vs 26.5 ng/g creatinine, P = .04) and 2 weeks (233.8 vs 48.3 ng/g creatinine, P = .006), and lactoferrin at 1 week (3.5 vs 0.9 μg/g creatinine, P = .01) were significantly higher in colostrum group. Urine interleukin-1β level was significantly lower in colostrum group at 2 weeks (55.3 vs 91.8 μg/g creatinine, P = .01). Salivary transforming growth factor-β1 (39.2 vs 69.7 μg/mL, P = .03) and interleukin-8 (1.2 vs 4.9 ng/mL, P = .04) were significantly lower at 2 weeks in colostrum group. A significant reduction in the incidence of clinical sepsis was noted in colostrum group (50% vs 92%, P = .003). CONCLUSIONS: This study suggests that oropharyngeal administration of colostrum may decrease clinical sepsis, inhibit secretion of pro-inflammatory cytokines, and increase levels of circulating immune-protective factors in extremely premature infants. Larger studies to confirm these findings are warranted.

Từ khóa


Tài liệu tham khảo

Kelleher, 2001, Immunological activities associated with milk., 10, 39

Garofalo, 2010, Cytokines in human milk., J Pediatr, 156, S36, 10.1016/j.jpeds.2009.11.019

Hurley, 2011, Perspectives on immunoglobulins in colostrum and milk., Nutrients, 3, 442, 10.3390/nu3040442

Lönnerdal, 2010, Bioactive proteins in human milk: mechanisms of action., J Pediatr, 156, S26, 10.1016/j.jpeds.2009.11.017

Underwood, 2013, Human milk for the premature infant., Pediatr Clin North Am, 60, 189, 10.1016/j.pcl.2012.09.008

Dvorak, 2003, Increased epidermal growth factor levels in human milk of mothers with extremely premature infants., Pediatr Res, 54, 15, 10.1203/01.PDR.0000065729.74325.71

Gross, 1981, Elevated IgA concentration in milk produced by mothers delivered of preterm infants., J Pediatr, 99, 389, 10.1016/S0022-3476(81)80323-X

Koenig, 2005, Immunologic factors in human milk: the effects of gestational age and pasteurization., J Hum Lact, 21, 439, 10.1177/0890334405280652

Montagne, 1999, Immunological and nutritional composition of human milk in relation to prematurity and mother’s parity during the first 2 weeks of lactation., J Pediatr Gastroenterol Nutr, 29, 75, 10.1097/00005176-199907000-00018

Ronayne de Ferrer, 2000, Lactoferrin levels in term and preterm milk., J Am Coll Nutr, 19, 370, 10.1080/07315724.2000.10718933

Gephart, 2014, Colostrum as oral immune therapy to promote neonatal health., Adv Neonatal Care, 14, 44, 10.1097/ANC.0000000000000052

Rodriguez, 2009, Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives., J Perinatol, 29, 1, 10.1038/jp.2008.130

Thibeau, 2013, Exploring the use of mothers’ own milk as oral care for mechanically ventilated very low-birth-weight preterm infants., Adv Neonatal Care, 13, 190, 10.1097/ANC.0b013e318285f8e2

Rodriguez, 2010, A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother’s colostrum to extremely low-birth-weight infants., Adv Neonatal Care, 10, 206, 10.1097/ANC.0b013e3181e94133

Rodriguez, 2011, A randomized controlled trial of the oropharyngeal administration of mother’s colostrum to extremely low birth weight infants in the first days of life., Neonatal Intensive Care, 24, 31

Seigel, 2013, Early administration of oropharyngeal colostrum to extremely low birth weight infants., Breastfeed Med, 8, 491, 10.1089/bfm.2013.0025

Levy, 2003, 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference., Intensive Care Med, 29, 530, 10.1007/s00134-003-1662-x

Ishiguro, 1982, Developmental profiles of urinary SIgA in newborns and the effect of blood transfusion., Immunology, 46, 329

Maia, 2011, Length of stay in a neonatal intensive care unit and its association with low rates of exclusive breastfeeding in very low birth weight infants., J Matern Fetal Neonatal Med, 24, 774, 10.3109/14767058.2010.520046

Goldblum, 1989, Human milk feeding enhances the urinary excretion of immunologic factors in low birth weight infants., Pediatr Res, 25, 184, 10.1203/00006450-198902000-00021

Hutchens, 1989, Purification and characterization of intact lactoferrin found in the urine of human milk-fed preterm infants., Clin Chem, 35, 1928, 10.1093/clinchem/35.9.1928

Hutchens, 1991, Origin of intact lactoferrin and its DNA-binding fragments found in the urine of human milk-fed preterm infants. Evaluation by stable isotopic enrichment., Pediatr Res, 29, 243, 10.1203/00006450-199103000-00005

Brandtzaeg, 2010, The mucosal immune system and its integration with the mammary glands., J Pediatr, 156, S8, 10.1016/j.jpeds.2009.11.014

English, 1988, Production of lymphotoxin and tumor necrosis factor by human neonatal mononuclear cells., Pediatr Res, 24, 717, 10.1203/00006450-198812000-00014

Lewis, 1991, Cellular and molecular mechanisms for reduced interleukin 4 and interferon-gamma production by neonatal T cells., J Clin Invest, 87, 194, 10.1172/JCI114970

Yachie, 1992, Defective production of interleukin-6 in very small premature infants in response to bacterial pathogens., Infect Immun, 60, 749, 10.1128/iai.60.3.749-753.1992

Chang, 1994, Transforming growth factor-beta 1, macrophage inflammatory protein-1 alpha, and interleukin-8 gene expression is lower in stimulated human neonatal compared with adult mononuclear cells., Blood, 84, 118, 10.1182/blood.V84.1.118.118

Chheda, 1996, Decreased interleukin-10 production by neonatal monocytes and T cells: relationship to decreased production and expression of tumor necrosis factor-alpha and its receptors., Pediatr Res, 40, 475, 10.1203/00006450-199609000-00018

Nanthakumar, 2011, The mechanism of excessive intestinal inflammation in necrotizing enterocolitis: an immature innate immune response., PLoS ONE, 6, e17776, 10.1371/journal.pone.0017776

Nanthakumar, 2000, Inflammation in the developing human intestine: a possible pathophysiologic contribution to necrotizing enterocolitis., Proc Natl Acad Sci U S A, 97, 6043, 10.1073/pnas.97.11.6043

Rautava, 2011, Breast milk-transforming growth factor-β2 specifically attenuates IL-1β-induced inflammatory responses in the immature human intestine via an SMAD6- and ERK-dependent mechanism., Neonatology, 99, 192, 10.1159/000314109

Rezaie, 2007, Study on the correlations among disease activity index and salivary transforming growth factor-beta 1 and nitric oxide in ulcerative colitis patients., Ann N Y Acad Sci, 1095, 305, 10.1196/annals.1397.034

Scarpa, 2009, TGF-beta1 and IGF-1 production and recurrence of Crohn’s disease after ileo-colonic resection., J Surg Res, 152, 26, 10.1016/j.jss.2008.04.014

Babyatsky, 1996, Expression of transforming growth factors alpha and beta in colonic mucosa in inflammatory bowel disease., Gastroenterology, 110, 975, 10.1053/gast.1996.v110.pm8613031

Walker, 2010, Breast milk as the gold standard for protective nutrients., J Pediatr, 156, S3, 10.1016/j.jpeds.2009.11.021

Claud, 2003, Modulation of human intestinal epithelial cell IL-8 secretion by human milk factors., Pediatr Res, 53, 419, 10.1203/01.PDR.0000050141.73528.AD

Håversen, 2002, Lactoferrin down-regulates the LPS-induced cytokine production in monocytic cells via NF-kappa B., Cell Immunol, 220, 83, 10.1016/S0008-8749(03)00006-6

Håversen, 2003, Anti-inflammatory activities of human lactoferrin in acute dextran sulphate-induced colitis in mice., Scand J Immunol, 57, 2, 10.1046/j.1365-3083.2003.01162.x

Thông tin
Thông tin xuất bản

American Academy of Pediatrics (AAP)

Tập 135 Số 2

e357-e366

Thông tin tác giả