Effects on Gastroesophageal Reflux of Donkey Milk-Derived Human Milk Fortifier Versus Standard Fortifier in Preterm Newborns: Additional Data from the FortiLat Study

Cresi, Francesco; Maggiora, Elena; Pirra, Alice; Tonetto, Paola; Rubino, Carlotta; Cavallarin, Laura; Giribaldi, Marzia; Moro, Guido; Peila, Chiara; Coscia, Alessandra

doi:10.3390/nu12072142

Cited by 16 publications

(4 citation statements)

References 27 publications

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“…Nevertheless, this last point has been intentionally avoided due to the vulnerability of preterm infants in neonatal intensive care units, that requires the preferential use of non-invasive methods of analysis. The main strengths of this study are: (i) a good match between the neonatal characteristics of the two groups, including a similar prevalence of twins in each group, that were randomly assigned either separately to each arm of the study, or to the same arm; (ii) the overall organization of the trial, that provided substantial evidence of a higher tolerability of D-HMF with respect to B-HMF infants, as supported by the different investigated parameters [18,41]; (iii) the detailed knowledge of the experimental product based on donkey milk, including the processing and manufacturing, performed by the authors specifically for the clinical trial; and (iv) the use of a balanced fortification strategy, isocaloric and isoproteic, thus limiting the effect of nutrient imbalance on the present findings.…”

Section: Discussionmentioning

confidence: 99%

Urinary Metabolomic Profile of Preterm Infants Receiving Human Milk with Either Bovine or Donkey Milk-Based Fortifiers

Giribaldi¹,

Peila

Coscia

et al. 2020

Nutrients

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Fortification of human milk (HM) for preterm and very low-birth weight (VLBW) infants is a standard practice in most neonatal intensive care units. The optimal fortification strategy and the most suitable protein source for achieving better tolerance and growth rates for fortified infants are still being investigated. In a previous clinical trial, preterm and VLBW infants receiving supplementation of HM with experimental donkey milk-based fortifiers (D-HMF) showed decreased signs of feeding intolerance, including feeding interruptions, bilious gastric residuals and vomiting, with respect to infants receiving bovine milk-based fortifiers (B-HMF). In the present ancillary study, the urinary metabolome of infants fed B-HMF (n = 27) and D-HMF (n = 27) for 21 days was analyzed by 1H NMR spectroscopy at the beginning (T0) and at the end (T1) of the observation period. Results showed that most temporal changes in the metabolic responses were common in the two groups, providing indications of postnatal adaptation. The significantly higher excretion of galactose in D-HMF and of carnitine, choline, lysine and leucine in B-HMF at T1 were likely due to different formulations. In conclusion, isocaloric and isoproteic HM fortification may result in different metabolic patterns, as a consequence of the different quality of the nutrients provided by the fortifiers.

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Section: Discussionmentioning

confidence: 99%

Urinary Metabolomic Profile of Preterm Infants Receiving Human Milk with Either Bovine or Donkey Milk-Based Fortifiers

Giribaldi¹,

Peila

Coscia

et al. 2020

Nutrients

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“…Among diet modifications, the utility of GERD recommendations, such as thickening feeds or avoiding cow’s milk protein, remains undemonstrated in P-LPR regarding the lack of studies including infants or children with a positive diagnostic at the HEMII-pH. Similar observations may be made regarding the influence of type of milk on the occurrence of pharyngeal reflux events, because previous studies included GERD patients [ 95 , 96 , 97 ]. Smaller and frequent meals as well as sleep positioning (elevating the head of the bed) may provide benefit to infants with GERD and ‘reflux extension’ into the upper aerodigestive tract [ 6 , 98 ], but the utility of these approaches is still not demonstrated in children with only P-LPR [ 4 ].…”

Section: Therapeutic Strategiesmentioning

confidence: 98%

Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review

Lechien

2023

Children

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Purpose: Pediatric laryngopharyngeal reflux (P-LPR) is associated with the development of common otolaryngological symptoms and findings. In the present study, the findings about epidemiology, clinical presentation, diagnostic and therapeutic outcomes of pediatric population were reviewed. Methods: A PubMed, Cochrane Library, and Scopus literature search was conducted about evidence-based findings in epidemiology, clinical presentation, diagnostic and therapeutic outcomes of P-LPR. Findings: The prevalence of LPR remains unknown in infant and child populations. The clinical presentation depends on age. Infants with LPR symptoms commonly have both gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux and related digestive, respiratory and ear, nose and throat symptoms. The GERD prevalence appears to decrease over the growth, and the clinical picture is increasingly associated with LPR symptoms and findings without GERD. The prevalence of LPR and proximal acid and nonacid esophageal reflux events may be high in some prevalent otolaryngological conditions (chronic otitis media, laryngolomalacia and apnea). However, the lack of use of hypopharyngeal–esophageal multichannel intraluminal impedance pH monitoring (HEMII-pH) limits the establishment of etiological associations. Proton pump inhibitors are less effective in P-LPR patients compared to GERD populations, which may be related to the high prevalence of weakly or nonacid reflux events. Conclusions: Many gray areas persist in P-LPR and should be not resolved without the establishment of diagnostic criteria (guidelines) based on HEMII-pH. The unavailability of HEMII-pH and the poor acid-suppressive therapeutic response are all issues requiring future investigations. Future controlled studies using HEMII-pH and enzyme measurements in ear, nose or throat fluids may clarify the epidemiology of P-LPR according to age and its association with many otolaryngological conditions.

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“…Moreover, DF reduced the occurrence of episodes of feeding intolerance, feeding interruptions, bilious gastric residuals and vomiting [25]. In an ancillary study, the use of DF reduced also the gastroesophageal reflux frequency in infants showing infants with clinical signs of gastroesophageal reflux and cardiorespiratory symptoms associated with feeding intolerance [27]. A recent urinary metabolomics investigation revealed that the different quality of the nutrients provided by isocaloric and isoproteic fortification with either DF and BF resulted in different urinary metabolic patterns [28].…”

Section: Introductionmentioning

confidence: 98%

The “Fortilat” Randomized Clinical Trial Follow-Up: Auxological Outcome at 18 Months of Age

et al. 2020

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Human milk fortification is a routine clinical practice for feeding preterm infants. We hypothesized that donkey milk can be a suitable basis for developing an innovative human milk fortifier. Our randomized controlled single-blind clinical trial, named “Fortilat”, evaluated the feeding tolerance, growth and clinical short-term outcomes in a population of preterm infants fed with a novel multi-component fortifier and a protein concentrate derived from donkey milk. The aim of the current study is to extend the previous findings and to evaluate the auxological outcomes of the infants enrolled in the “Fortilat” trial at 18 months of age. In the previous trial “Fortilat”, the fortification protocol followed was the same for the two groups, and the two diets were designed to be isoproteic and isocaloric. All infants enrolled in the trial were included in a premature infant developmental evaluation program consisting of hospital visits at 40 ± 1 weeks of postmenstrual age, and at 6, 12 and 18 months of corrected age. Weight, head circumference and length were expressed in z-score using neonatal Intergrowth21st and INeS charts at birth, and WHO 0–5 years growth charts at 18 months. 122 children (Bovine-arm = 62, Donkey-arm = 60) were included in this study. All the observations were recorded in the interval of 18 ± 3 months of the correct age. The two groups did not differ for head circumference, length or weight at 18 months of age. Our data show that fortifiers derived from donkey milk had not different long term auxological outcomes of standard bovine-derived fortifier, but the new donkey milk fortifier was well tolerated in our population.

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Effects on Gastroesophageal Reflux of Donkey Milk-Derived Human Milk Fortifier Versus Standard Fortifier in Preterm Newborns: Additional Data from the FortiLat Study

Cited by 16 publications

References 27 publications

Urinary Metabolomic Profile of Preterm Infants Receiving Human Milk with Either Bovine or Donkey Milk-Based Fortifiers

Urinary Metabolomic Profile of Preterm Infants Receiving Human Milk with Either Bovine or Donkey Milk-Based Fortifiers

Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review

The “Fortilat” Randomized Clinical Trial Follow-Up: Auxological Outcome at 18 Months of Age

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