An Exclusively Human Milk-Based Diet Is Associated with a Lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products

Sullivan, Sandra; Schanler, Richard J.; Kim, Jae; Patel, Aloka L.; Trawöger, Rudolf; Kiechl‐Kohlendorfer, Ursula; Chan, Gary M.; Blanco, Cynthia L.; Abrams, Steven A.; Cotten, C. Michael; Laroia, Nirupama; Ehrenkranz, Richard A.; Dudell, Golde G.; Cristofalo, Elizabeth; Meier, Paula P.; Lee, Martin L.; Rechtman, David J.; Lucas, Alan

doi:10.1016/j.jpeds.2009.10.040

Cited by 832 publications

(758 citation statements)

References 22 publications

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“…Many studies in both industrialized and developing countries have shown that nursing infants are less vulnerable to infections during their first months of life, including gastroenteritis, respiratory infections, otitis media, urinary tract infections, and necrotizing enterocolitis in premature infants (3,(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%

“…The immune system in human milk includes secretory immunoglobulin A (sIgA), immunoglobulin G, free fatty acids, monoglycerides, proteins such as lactoferrin, lactalbumin, glycans, nonabsorbed oligosaccharides, exosomes, immunomodulators such as cytokines, nucleic acids, antioxidants, and immune cells such as macrophages, neutrophils, and lymphocytes (1,4,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). All these immunologic milk constituents interact together and with the newborn's gut directly or indirectly (e.g., by changing the gut flora) to increase immunity against infection, and probably also contribute to the maturation and efficiency of the newborn immune system (5,6).Many studies in both industrialized and developing countries have shown that nursing infants are less vulnerable to infections during their first months of life, including gastroenteritis, respiratory infections, otitis media, urinary tract infections, and necrotizing enterocolitis in premature infants (3,(18)(19)(20)(21)(22)(23)(24)(25).The mechanisms involved in the immunity provided by human milk to the nursing infant are not fully understood. Until recently, it was believed that the changes in immunological constituents of breast milk were mostly related to the time that elapsed from delivery or, in some cases, were also related to the mother's nutritional state.…”

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confidence: 99%

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Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant

et al. 2011

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INTRODUCTION:To investigate whether immunologic factors in breast milk change in response to nursing infants' infection. RESULTS: Total cD45 leukocyte count dropped from 5,655 (median and interquartile range: 1,911; 16,871) in the acute phase to 2,122 (672; 6,819) cells/ml milk after recovery with macrophage count decreasing from 1,220 (236; 3,973) to 300 (122; 945) cells/ml. Tumor necrosis factor-α (TNFα) levels decreased from 3.66 ± 1.68 to 2.91 ± 1.51 pg/ml. The decrease in lactoferrin levels was of borderline statistical significance. such differences were not recorded in samples of the controls. Interleukin-10 levels decreased in the sick infants' breast milk after recovery, but also in the healthy controls, requiring further investigation. secretory immunoglobulin a levels did not change significantly in the study or control group. DISCUSSION: During active infection in nursing infants, the total number of white blood cells, specifically the number of macrophages, and TNFα levels increase in their mothers' breast milk. These results may support the dynamic nature of the immune defense provided by breastfeeding sick infants. METHODS: Breast milk from mothers of 31 infants, up to 3 months of age, who were hospitalized with fever, was sampled during active illness and recovery. Milk from mothers of 20 healthy infants served as controls.T he increased sensitivity of the newborn infant to infections originates from the immaturity of the immune system (1). In addition to transfer of immunoglobulin G to the fetus through the placenta, breastfeeding constitutes an important immunological support that the mammalian mother can provide to her relatively immunocompromised offspring against infections during the first months of life (2-6). The immune system in human milk includes secretory immunoglobulin A (sIgA), immunoglobulin G, free fatty acids, monoglycerides, proteins such as lactoferrin, lactalbumin, glycans, nonabsorbed oligosaccharides, exosomes, immunomodulators such as cytokines, nucleic acids, antioxidants, and immune cells such as macrophages, neutrophils, and lymphocytes (1,4,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). All these immunologic milk constituents interact together and with the newborn's gut directly or indirectly (e.g., by changing the gut flora) to increase immunity against infection, and probably also contribute to the maturation and efficiency of the newborn immune system (5,6).Many studies in both industrialized and developing countries have shown that nursing infants are less vulnerable to infections during their first months of life, including gastroenteritis, respiratory infections, otitis media, urinary tract infections, and necrotizing enterocolitis in premature infants (3,(18)(19)(20)(21)(22)(23)(24)(25).The mechanisms involved in the immunity provided by human milk to the nursing infant are not fully understood. Until recently, it was believed that the changes in immunological constituents of breast milk were mostly related to the time that elapsed from delivery or, in some cases,...

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant

et al. 2011

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“…The many benefits of human milk versus formula include nutritional, immunologic, developmental, psychological, social, and economic. Feeding human milk to very-low-birth-weight infants has been associated with reductions in morbidity and mortality specifically related to prevention of sepsis and necrotizing enterocolitis (NEC) [2][3][4][5][6][7]. Long-term benefits for VLBW infants from human milk include improved cognitive performance.…”

Section: Introductionmentioning

confidence: 99%

“…Mother's own milk, fresh or frozen, should be the primary diet, and it should be fortified appropriately for the infant weighing less than 1.5 kg. If own mother's milk is unavailable despite significant lactation support, pasteurized donor milk should be used [7,15]. Quality control of pasteurized donor milk is important and should be monitored [1].…”

Section: Introductionmentioning

confidence: 99%

Donor Human Milk: No Longer A Place For Formula in the Neonatal Intensive Care Unit?

Adamkin

Radmacher

2014

Curr Pediatr Rep

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Human milk is the best food for human infants, including those born preterm. Human milk feeding benefits the preterm infant by improving mental and motor development, decreasing the risk of necrotizing enterocolitis, sepsis, and retinopathy of prematurity during the postnatal period spent in the Neonatal Intensive Care Unit. In order to support the increased nutrient requirements of these infants, human milk must be fortified. In the absence of a mother's own milk, donor human milk is becoming a more commonly used replacement for bovine-based formula, especially in the tiniest patients. While donor human milk has been shown to convey many of the benefits of mother's own milk, it is generally lower in protein and calories than preterm milk and may require fortification in different proportions. This report discusses the evidence for donor human milk in the nutritional support of the preterm infant.

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“…A striking fact is that infants fed with human breast milk (HBM) have a significant reduced incidence of NEC, reaching a ratio of up to 1:10 when compared to infants fed milk formula (5)(6)(7)(8). The reason why HBM exerts such a protective effect finally avoiding NEC development remains to be determined.…”

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confidence: 99%

TIMP-1 inhibition of occludin degradation in Caco-2 intestinal cells: a potential protective role in necrotizing enterocolitis

et al. 2015

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An Exclusively Human Milk-Based Diet Is Associated with a Lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products

Cited by 832 publications

References 22 publications

Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant

Changes in immunomodulatory constituents of human milk in response to active infection in the nursing infant

Donor Human Milk: No Longer A Place For Formula in the Neonatal Intensive Care Unit?

TIMP-1 inhibition of occludin degradation in Caco-2 intestinal cells: a potential protective role in necrotizing enterocolitis

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