Allergic diseases among very preterm infants according to nutrition after hospital discharge

Abstract

To determine whether a cow's milk-based human milk fortifier (HMF) added to mother's milk while breastfeeding or a cow's milk-based preterm formula compared to exclusively mother's milk after hospital discharge, increases the incidence of developing allergic diseases among very preterm infants (VPI) during the first year of life. Of a cohort of 324 VPI (gestational age 24-32 wk), the exclusively breastfed VPI were shortly before discharge randomized to breastfeeding without fortification or supplementing with a fortifier. Those not breastfed were fed a preterm formula. The intervention period was from discharge until 4 months corrected age (CA). Follow-up was performed at 4 and 12 months CA including specific IgE to a panel of allergens at 4 months CA. The incidence during and prevalence at 12 months CA of recurrent wheezing (RW) was 39.2% and 32.7%, while atopic dermatitis (AD) was 18.0% and 12.1%, respectively. Predisposition to allergic disease increased the risk of developing AD (p=0.04) [OR 2.6 (95% CI 1.0-6.4)] and the risk of developing RW (p=0.02) [OR 2.7 (95% CI 1.2-6.3)]. Boys had an increased risk of developing RW (p=0.003) [OR 3.1 (95% CI 1.5-6.5)]. No difference was found between nutrition groups. None developed food allergy. Compared to exclusively breastfed, VPI supplemented with HMF or fed exclusively a preterm formula for 4 months did not have an increased risk of developing allergic diseases during the first year of life.

Association between Caesarean Delivery and Isolated Doses of Formula Feeding in Cow Milk Allergy

“…The relevant fact is that only 4.3% of patients with CMA were premature, and this figure is much lower than the proportion in the general population (13.2% in the control group). This fact has already been pointed out by Zachariassen et al [29] who, when studying the incidence of allergic disease in a cohort of extremely premature infants, did not find a single case of food allergy. The explanation for this is possibly immunological: the premature patient's immune system is most likely not developed enough to generate IgE-mediated reactions to allergens through the digestive tract, a fact that was already observed in a study published in 1975 by Rieger and Rothberg [42] in which it was found that up until 35-36 weeks newborns exposed to CMP are not able to generate specific IgE antibodies.…”

“…Other factors that have been studied are caesarean delivery [19,20,21,22,23] and perinatal exposure to small amounts of CMP [24,25,26,27], though the results are conflicting. Other factors such as duration of BF [14,28,29], prematurity, threatened premature delivery, preeclampsia [30], hypertension, gestational diabetes [31], and antibiotics [21] during labor have been much less studied. The purpose of this study is to analyze the impact different perinatal factors may have on the development of IgE-mediated CMA.…”

Human Milk for the Premature Infant

“…There do not appear to be consistent benefits of human milk in premature infants in relation to feeding tolerance, 19 time to full enteral feeding, 24 or allergic/atopic outcomes. 40 Providing human milk has been postulated to decrease parental anxiety, increase skin-to-skin contact and parent-infant bonding, but data to support these hypotheses are limited. The provision of human colostrum in the form of oral care for intubated premature infants has been proposed as a method of stimulating the oropharyngeal-associated lymphatic tissue and altering the oral microbiota, but data to support this intervention are lacking.…”

Improved lung function at age 6 in children born very preterm and fed extra protein post‐discharge

“…In preterm‐born infants with BPD, no influence of increased intake of energy on respiratory outcomes has been found . Among non‐BPD preterm‐born infants, wheezing at 1 year of age was not associated with post‐discharge nutrition …”

“…18 Among non-BPD preterm-born infants, wheezing at 1 year of age was not associated with postdischarge nutrition. 19 Measurement of fractional exhaled nitric oxide (FeNO) is a noninvasive method to screen for airway inflammation in asthma. FeNO is synthesised and expressed by airway epithelial cells as an inflammatory response, and the value can be increased twofold-threefold in patients with asthma.…”