Oropharyngeal colostrum immunotherapy and nutrition in preterm newborns: meta-analysis

Ramos, Michelle de Santana Xavier; Martins, Camilla da Cruz; Souza, Elivan Silva; Vieira, Graciete Oliveira; Filho, Isaac Suzart Gomes; Figueiredo, Ana Cláudia Morais Godoy; Pereira, Maúrício Gomes; Cruz, Simone Seixas da

doi:10.11606/s1518-8787.2021055003051

Cited by 9 publications

(6 citation statements)

References 25 publications

(87 reference statements)

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“…Only one study has reported neurodevelopment at 6 months of corrected gestational age. 22 Although several meta-analyses were published on the use of OPCA in the last few years, 10,[36][37][38][39][40][41][42] we updated this meta-analysis as several recently published studies 11,[13][14][15]27 were not included in these meta-analyses. In the two recent meta-analyses, 37,40 there was evidence for a reduction in NEC Stage 2 or 3 and any sepsis, but not for culture-proven sepsis and mortality, though there was a trend towards reduction in these two critical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: A systematic review and meta‐analysis

Anne,

Kumar,

Kumar

et al. 2023

J. pediatr. gastroenterol. nutr.

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Various studies have shown that oropharyngeal colostrum application (OPCA) is beneficial to preterm neonates. We performed a systematic review and meta‐analysis to assess whether OPCA reduces the incidence of culture‐proven neonatal sepsis in preterm neonates. Randomized controlled trials comparing OPCA with placebo or standard care in preterm neonates were included. Medline, Embase, Web of Science, Cumulated Index to Nursing and Allied Health Literature, Scopus, and CENTRAL were searched for studies published up to June 15, 2023. We used the Cochrane Risk of Bias tool, version 2, for risk of bias assessment, the random‐effects model (RevMan 5.4) for meta‐analysis, and Gradepro software for assessing the certainty of evidence. Twenty‐one studies involving 2393 participants were included in this meta‐analysis. Four studies had a low risk of bias, whereas seven had a high risk. Oropharyngeal colostrum significantly reduced the incidence of culture‐proven sepsis (18 studies, 1990 neonates, risk ratio [RR]: 0.78, 95% confidence interval [95% CI]: 0.65, 0.94), mortality (18 studies, 2117 neonates, RR: 0.73, 95% CI: 0.59, 0.90), necrotizing enterocolitis (NEC) (17 studies, 1692 neonates, RR: 0.59, 95% CI: 0.43, 0.82), feeding intolerance episodes (four studies, 445 neonates, RR: 0.59, 95% CI: 0.38, 0.92), and the time to full enteral feeding (19 studies, 2142 neonates, mean difference: −2 to 21 days, 95% CI: −3.44, −0.99 days). There was no reduction in intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, ventilator‐associated pneumonia, neurodevelopmental abnormalities, hospital stay duration, time to full oral feeding, weight at discharge, pneumonia, and duration of antibiotic therapy. The certainty of the evidence was high for the outcomes of culture‐positive sepsis and mortality, moderate for NEC, low for time to full enteral feeding, and very low for feeding intolerance. OPCA reduces culture‐positive sepsis and mortality (high certainty), NEC (moderate certainty), and time to full enteral feeding (low certainty) in preterm neonates. However, scarcity of data from extremely premature infants limits the generalizability of these results to this population.

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Section: Discussionmentioning

confidence: 99%

Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: A systematic review and meta‐analysis

Anne,

Kumar,

Kumar

et al. 2023

J. pediatr. gastroenterol. nutr.

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“…Infants receiving colostrum reached full enteral feeding earlier, around 7.2 days, compared to 9.1 for the control group (p < 0.05) [ 28 ]. Numerous other studies have concluded that the effective full enteral feeding time was significantly reduced in pre-term infants receiving OAC compared to those in the control group [ 32 , 34 , 36 , 38 - 40 , 44 , 45 ]. Reaching full enteral nutrition sooner may improve the development of the digestive system of pre-term infants and reduces cytokine release.…”

Section: Reviewmentioning

confidence: 99%

Colostrum and Preterm Babies: A Systematic Review

Slouha,

Anderson,

Ankrah

et al. 2023

Cureus

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Colostrum from mothers is rich in immunomodulating bio-factors such as immunoglobulins (IgA), lactoferrin, and oligosaccharides and supports gut microbial and inflammatory processes. The support in these processes may provide some relief for infants who are born pre-term. Pre-term infants are more likely to develop necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and ventilator-acquired/associated pneumonia (VAP). Due to the components of colostrum, there may be incentives towards early administration for preterm infants. An extensive literature review was done using ProQuest, ScienceDirect, and PubMed. Only meta-analyses and experimental studies were used. The search included the keywords ‘colostrum and preterm’ and ‘colostrum and necrotizing enterocolitis’. The initial search generated 13,543 articles and was narrowed to 25 articles through comprehensive inclusion and exclusion criteria. There were significantly higher levels of Lactobacillus and Bifidobacterium in pre-term infants given colostrum and a decrease in Moraxellaceae and Staphylococcaceae . Salivary secretory IgA increased following oral colostrum administration in pre-term infants along with downregulation of interleukin (IL)-1b and IL-8. It was also observed that tumor necrosis factor (TNF)-a, and interferon-gamma (IFN-g) were significantly higher in the control group. There was no significant difference in the incidence of LOS, NEC, or VAP between pre-term infants receiving colostrum and those who did not. Secondary outcomes such as time to full enteral feeding were improved in pre-term infants receiving oral colostrum in addition to reduced hospital stays. Lastly, there was no difference in mortality between pre-term infants that received colostrum compared to those who did not.

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“…Because of limited sample size and inconsistent OAC measures, among other reasons, there is no sufficient evidence to prove that OAC can reduce the incidence of NEC, LOS and death [ 40 ]. But OAC can promote intestinal maturation and rapidly achieve total enteral feeding [ 41 , 42 ]. However, the mechanism by which OAC promotes intestinal maturation by changing intestinal microbiota and metabolites remains elusive, which is the significant contribution of our study.…”

Section: Introductionmentioning

confidence: 99%

Oropharyngeal administration of colostrum targeting gut microbiota and metabolites in very preterm infants: protocol for a multicenter randomized controlled trial

Wang,

Zhang,

et al. 2023

BMC Pediatr

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Background Oropharyngeal administration of colostrum (OAC) has an immune-stimulating effect on oropharyngeal-associated lymphoid tissue, and can promote the maturation of the gastrointestinal tract. However, how OAC promotes intestinal maturation in preterm infants by altering gut microbiota remains unclear. We aim to assess changes in gut microbiota and metabolites after OAC in very preterm infants. Methods A multicenter, double-blind, randomized controlled trial will be conducted in three large neonatal intensive care units in Shenzhen, China, with preterm infants with gestational age less than 32 weeks at birth and birth weight less than 1500 g. It is estimated that 320 preterm infants will be enrolled in this study within one year. The intervention group will receive oropharyngeal administration of 0.2 ml colostrum every 3 h, starting between the first 48 to 72 h and continued for 5 consecutive days. Following a similar administration scheme, the control group will receive oropharyngeal administration of sterile water. Stool samples will be collected at the first defecation, as well as on the 7th, 14th, 21st and 28th days after birth for analysis of effect of OAC on gut microbiota and metabolites through 16sRNA gene sequencing and liquid chromatography-mass spectrometry. Discussion This proposal advocates for the promotion of OAC as a safe and relatively beneficial protocol in neonatal intensive care units, which may contribute to the establishment of a dominant intestinal flora. Findings of this study may help improve the health outcomes of preterm infants by establishment of targeted gut microbiota in future studies. Trial registration NCT05481866 (registered July 30, 2022 on ClinicalTrials.gov).

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Oropharyngeal colostrum immunotherapy and nutrition in preterm newborns: meta-analysis

Cited by 9 publications

References 25 publications

Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: A systematic review and meta‐analysis

Effect of oropharyngeal colostrum therapy on neonatal sepsis in preterm neonates: A systematic review and meta‐analysis

Colostrum and Preterm Babies: A Systematic Review

Oropharyngeal administration of colostrum targeting gut microbiota and metabolites in very preterm infants: protocol for a multicenter randomized controlled trial

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