The Importance of Human Milk for Immunity in Preterm Infants

Lewis, Erin D.; Richard, Caroline; Larsen, Bodil; Field, Catherine J.

doi:10.1016/j.clp.2016.11.008

Cited by 92 publications

(84 citation statements)

References 149 publications

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“…Human milk contains digestive enzymes, such as amylase, lipase and proteases, which enhance digestion . Growth hormones like epidermal growth factor, insulin‐like growth factor 1 and transforming growth factor act as intestinal trophic factors and promote immunologic tolerance and maturation of gastrointestinal cells . Human milk oligosaccharides enhance colonisation of commensal bacteria of the gut and inhibit pathogen binding .…”

Section: Discussionmentioning

confidence: 99%

“…Growth hormones like epidermal growth factor, insulin‐like growth factor 1 and transforming growth factor act as intestinal trophic factors and promote immunologic tolerance and maturation of gastrointestinal cells . Human milk oligosaccharides enhance colonisation of commensal bacteria of the gut and inhibit pathogen binding . Most of these factors persist after pasteurisation and are also present in donor milk .…”

Section: Discussionmentioning

confidence: 99%

“…In contrast to formula, human milk contains several components that are beneficial for preterm infants. Growth factors, like epidermal growth factor, leucocytes and antimicrobial proteins, and peptides, such as lactoferrin, cytokines, chemokines, nucleotides and oligosaccharides, are involved in the maturation of the gut and in the development of neonatal immune functions . The colonisation of the preterm gut is influenced by the type of diet and has a later impact on health and disease: human milk contains bioactive components and microorganisms that shape the development of the intestinal microbiota and, therefore, contribute to the protective effect of human milk feeding against necrotising enterocolitis (NEC) .…”

Section: Introductionmentioning

confidence: 99%

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Starting enteral nutrition with preterm single donor milk instead of formula affects time to full enteral feeding in very low birthweight infants

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Starting enteral nutrition with preterm single donor milk instead of formula affects time to full enteral feeding in very low birthweight infants

et al. 2017

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“…Thus, in preterm infants, human milk provides immunological benefits through two mechanisms: direct protection through components such as lactoferrin, lysozyme, defensine and other cytokines, and stimulating action on the growth of the immune system due to its high content of growth factors and nucleotides. 24 Despite the great scientific efforts made by pediatricians and neonatologists, there are still many difficulties in effectively promoting breastfeeding in Neonatal Intensive Care Units. In May 2016, in Italy, the Ministry of Health published a list of recommendations aiming to increase this practice (Table 3).…”

Section: Breast Milkmentioning

confidence: 99%

Feeding of preterm infants and fortification of breast milk

Mangili

Garzoli

2017

Pediatr Med Chir

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The administration of the adequate amount of nutrients helps to improve a correct short-term linear growth and long-term neurocognitive development. To reduce the extra-uterine growth delay in very low birth weight infants (VLBW) the best strategy of nutrition (parenteral or enteral) should be established rapidly, since the first day of life. In preterm infants, nutrition can be administered parenterally and enterally. Prematurity is the most frequent indication for parenteral nutritional support due to intestinal functional immune deficiency, deficiency of digestive enzymatic systems and reduced nutritional reserve of these infants. In terms of enteral nutrition, breast milk is the first choice. In case of preterm and VLBW infants, fortifiers are used to overcome breast milk's protein and mineral deficiencies. When breast milk is not available, specific infant formula is the alternative. IntroductionThe improvement of neonatal care has led to an increase in the survival rate of very low birth weight infants (VLBW) infants (<1500 g). Nonetheless, growth failure is still a very frequent issue with incidence that ranges from 43 to 97% among various neonatal units. Thus, more aggressive nutritional strategies have been developed: first the parenteral nutrition then the enteral nutrition. Parenteral nutrition is often the only source of nutrients that can be used during the period of clinical instability. 1 Enteral nutrition must be gradually introduced as soon as possible; in presence of a good enteral tolerance, the parenteral nutrition should be rapidly discontinued, thus reducing its related side effects. 2 Parenteral nutritionAssuring an adequate nutrition to preterm infants is a real challenge, especially during the first hours after birth, when a total parenteral nutrition (TPN) is needed to meet the high nutritional requirements but it is often complicated by glucose and lipids intolerance. 3 Parenteral nutrition (PN) is an intravenous nutritional therapy that includes the administration of fluids, electrolytes, glucose, proteins, lipids, minerals, vitamins and oligo-elements. 4 It should be started as soon as possible within the first 24 hours of life. It can be prescribed in individualized or standardized administration; PN is provided through a central catheter (umbilical vein catheter or percutaneous central catheter) or, temporarily, via a peripheral route in the case of partial parenteral solutions and low osmolar load (<600 mOsm/L). Fluids and electrolytesIn the first week of life changes occur in the extracellular and intracellular compartments, resulting in a redistribution of fluids. This is one of the reason that explains the weight loss (5-10% of birth weight) that usually takes place during the first days of life. The fluid intake in the newborn (VLBW) and very low birth weight (ELBW) starts with 80-90 mL/kg/day and then is gradually increased by 10-20 mL/kg/day up to 160-180 and 150-160 mL/kg/day, respectively. 2,5-8 Electrolytic supplementation usually begins on the third-fourth day of...

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“…The combined effects of cesarean delivery, exposure to hospital flora instead of maternal flora, and the use of broad‐spectrum antibiotics lead to the colonization of pathogenic bacteria and a predisposition to bacterial translocation and a proinflammatory state in the gut. Several immune active molecules, immune cells, and probiotic bacteria present in HM help overcome these pathological conditions . The earlier the HM is given, the more likely it is to be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Employing a Nutrition Nurse in Neonatal Intensive Care Unit Improved Nutrition and Growth Outcomes in Preterm Neonates

et al. 2018

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Background: Nutrition nurses are clinical nurse specialists with knowledge and experience in nutrition support. We aimed to investigate the nutrition and growth outcomes after employment of a nutrition nurse in our level III neonatal intensive care unit (NICU). Methods: A retrospective cohort study including preterm neonates < 34 weeks and < 2000 g were conducted. Nutrition and growth outcomes of infants in pre-nutrition-nurse and post-nutrition-nurse periods were compared. Primary outcome was presence of postnatal growth retardation (PGR) at term-equivalent age (body weight < 10 percentile at 40 weeks postmenstrual age). Results: Infants in pre-nutrition-nurse (n = 38) and post-nutrition-nurse (n = 40) periods were similar with regard to gestational age, birth weight, gender, and perinatal characteristics. The initiation of parenteral nutrition after admission to NICU (30.8 ± 24.1 vs 6.7 ± 7.6 hours, P < 0,001) and attainment of full enteral feedings (27.3 ±18.1 vs 18.7 ± 11.3 days, P = 0.034) were earlier in post-nutrition-nurse period. First feeds were more commonly started with breast milk (29% vs 75%, P < 0.001); breastfeeding was more common at discharge (79% vs 95%, P = 0.045) and longer in duration (6.1 ± 7.3 vs 8.4 ± 6.3 months, P = 0.008) in postnutrition-nurse period. Primary outcome PGR at term-equivalent age was lower in post-nutrition-nurse period (57.9% vs 27.5%, P = 0.007). Conclusion: Employing a nutrition nurse improved quality of nutrition support, increased breastfeeding, and decreased PGR in preterm neonates. Further prospective evaluation of outcomes in the presence of a nutrition nurse is needed to generalize these findings to other NICUs. (Nutr Clin Pract. 2019;34:616-622)

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The Importance of Human Milk for Immunity in Preterm Infants

Cited by 92 publications

References 149 publications

Starting enteral nutrition with preterm single donor milk instead of formula affects time to full enteral feeding in very low birthweight infants

Starting enteral nutrition with preterm single donor milk instead of formula affects time to full enteral feeding in very low birthweight infants

Feeding of preterm infants and fortification of breast milk

Employing a Nutrition Nurse in Neonatal Intensive Care Unit Improved Nutrition and Growth Outcomes in Preterm Neonates

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