A Pilot Study to Determine the Safety and Feasibility of Oropharyngeal Administration of Own Mother's Colostrum to Extremely Low-Birth-Weight Infants

Abstract

Purpose-To determine the safety of oropharyngeal administration of own mother's colostrum to ELBW infants in first days of life. A secondary purpose was to investigate the feasibility of (1) delivering this intervention to ELBW infants in the first days of life, and (2) measuring concentrations of secretory immunoglobulin A (sIgA) and lactoferrin in tracheal aspirate secretions and urine of these infants.Subjects-Five ELBW infants (mean BW and gestational age = 657 grams and 25.5 weeks, respectively).Design-Quasi experimental, one group, pretest-posttest design.Methods-Subjects received 0.2 mL of OMC administered oropharyngeally every two hours for 48 consecutive hours, beginning at 48 hours of life. Concentrations of sIgA and lactoferrin were measured in tracheal aspirates and urine of each subject at baseline, at the completion of the intervention and again 2 weeks later.Results-All infants completed the entire treatment protocol, each receiving 24 treatments. A total of 15 urine specimens were collected and 14 were sufficient in volume for analysis. A total of 15 tracheal aspirates were collected, but only 7 specimens (47%) were sufficient in volume for analysis. There was wide variation in concentrations of sIgA and lactoferrin in urine and tracheal aspirates among the five infants; however several results were outside the limits of assay detection. All infants began to suck on the endotracheal tube during the administration of colostrum drops. Oxygen saturation measures remained stable or increased slightly during each of the treatment sessions. There were no episodes of apnea, bradycardia, hypotension or other adverse effects associated with the administration of colostrum.Conclusions-Oropharyngeal administration of OMC is easy, inexpensive, and well-tolerated by even the smallest and sickest ELBW infants. Future research should continue to examine the optimal procedure for measuring the direct immune effects of this therapy, as well as the clinical outcomes such as infections, particularly ventilator-associated pneumonia (VAP). of infants born at 24 weeks of gestation will survive to discharge, compared to 50% just 15 years ago. 1 However, the survival of these infants is associated with significant short and long-term morbidity, including nosocomial infection, 2, 3 necrotizing enterocolitis, 4 intraventricular hemorrhage, 4,5 periventricular leukomalacia 6 and adverse long-term neurodevelopmental sequelae including cognitive and motor disabilities, visual and/or hearing impairment, and cerebral palsy. [7][8][9] Nosocomial infection, an acquired infection after 48 hours of hospital admission, is particularly important because of its high prevalence and its association with other morbidities including poor growth, 10, 11 adverse long-term neurological sequelae, 10 increased length of hospital stay, 12 and a substantial cost 12 to families, hospitals, and society. The risk of acquiring a nosocomial infection is inversely related to birth weight and gestational age, and directly related to the severi...

Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT

“…The colostrum group had less clinical sepsis (50% vs 92%, P = .003) and shorter total antibiotic duration (6 [IQR: 3.8-8.5] vs 9.5 [IQR: [7][8][9][10][11][12][13][14][15][16][17][18][19]] days, P = .014), but no difference in cultureproven sepsis (46% vs 58%, P = .56) ( Table 2). The significant effect of colostrum administration on clinical sepsis was also validated in a regression analysis with all possible confounders, including mechanical ventilation, H2 blocker use, probiotic use, postnatal steroid use, feeding status and types (exp[B] = 67.3, 95% confidence interval: 3.8-1186.9, P = .004).…”

“…11,13 Although theoretical and preclinical support for this practice exists, there is insufficient evidence that oropharyngeal administration of colostrum is beneficial to date. [13][14][15][16] We aimed to evaluate the immunologic effects of oropharyngeal colostrum administration in extremely premature infants.…”

Efectos de la administración de calostro orofaríngeo en recién nacidos prematuros sobre los niveles de inmunoglobulina A

“…Recientemente se han publicado varios trabajos (2,(14)(15)(16) en los que se ha sugerido que la absorción del calostro a nivel orofaríngeo durante los primeros días de vida podría mejorar la función del sistema inmune de estos recién nacidos enfermos, a través del estímulo del tejido linfoide asociado a mucosas, proporcionando una barrera de protección local y cambiando los niveles de los factores inmunológicos derivados, como IgA secretora (IgAs) y la lactoferrina, en los fluidos corporales. La administración por vía orofaríngea no equivale a la administración oral, sino que consiste en colocar pequeñas cantidades de calostro (0,2 ml) directamente en la mucosa oral con la expectativa de que el líquido, o cualquiera de sus componentes, sea absorbido por la mucosa orofaríngea.…”

“…La administración por vía orofaríngea no equivale a la administración oral, sino que consiste en colocar pequeñas cantidades de calostro (0,2 ml) directamente en la mucosa oral con la expectativa de que el líquido, o cualquiera de sus componentes, sea absorbido por la mucosa orofaríngea. Los estudios demuestran que es una práctica segura, factible y bien tolerada incluso por los bebés prematuros más pequeños (14,17). La administración orofaríngea del calostro sería considerada un complemento y no un sustituto de la nutrición enteral trófica.…”

Early docosahexaenoic and arachidonic acid supplementation in extremely-low-birth-weight infants

“…This would also account for immature pancreatic function and diminished intestinal absorption (10). Oropharyngeal application of small volumes of breast milk for nonnutritive purposes has been incorporated into some clinical practices, can occur independent of feeding status, and results in systemic absorption of bioactive factors (11,12). In addition, fatty acids have been safely applied and absorbed topically and to buccal and rectal mucosa as effective drug adjuvants (13)(14)(15)(16)(17)(18).…”