Enteral administration of hematopoietic growth factors in the neonatal intensive care unit

Abstract

Calhoun DA. Enteral administration of hematopoietic growth factors in the neonatal intensive care unit. Acta Paediatr 2002; Suppl 438: 43-53. Stockholm. ISSN 0803-5326 By 20 wk of gestation, the human fetal gastrointestinal (GI) tract morphologically resembles that of the term infant, but functional development is limited before 26 wk. By 30 wk of gestation, the fetus has the capacity for limited digestion and enteral absorption. GI growth and development continue postnatally. Trophic factors, including nutrients, peptides, hormones and growth factors, are recognized as having important in uences on the morphology and histology of the developing GI tract. Other trophic factors are important in adaptation and repair following injury. Many such factors are provided in utero via amniotic uid swallowing and later by human colostrum and milk.Conclusion: This review discusses cytokines with known GI trophic effects, either in vitro or in vivo, and focuses on those cytokines that have been used in the neonatal intensive care unit.

The role of gut microbiota in programming the immune phenotype

“…95 We know from other studies that trophic factors in amniotic fluid bathing the fetal intestine during the third trimester of pregnancy are needed to produce a profound maturational effect on the intestine's ability to appropriately respond to colonizing bacteria. 96 For example, mature enterocytes interacting with colonizing bacteria can distinguish between commensal bacteria and potential pathogens. The enterocyte responds to pathogen interaction with a selflimited inflammatory response to prevent penetration, leading to gastroenteritis or sepsis.…”

Tolerance of an Enterally Administered Simulated Amniotic Fluid-Like Solution by Neonates Recovering from Surgery for Congenital Bowel Abnormalities

“…Amniotic fluid contains intestinal growth factors that, when swallowed by the fetus, bind to receptors on the luminal surface of villous enterocytes. 3,4 We postulated that it is the lack of such binding that results in the dysmorphic mucosa we observed 2 and that a limitation in amniotic fluid swallowing could constitute at least part of the explanation for postoperative feeding intolerance.…”

“…It was once thought that the critical factor was the volume of liquid swallowed, but experimentation showed that it is the growth factors in amniotic fluid that are critical to small bowel villous development. 4,12 Amniotic fluid contains multiple intestinal growth factors that have cognate receptors on the luminal surface of developing villous enterocytes. 3,4,12 The precise action of each factor remains to be defined.…”

“…4,12 Amniotic fluid contains multiple intestinal growth factors that have cognate receptors on the luminal surface of developing villous enterocytes. 3,4,12 The precise action of each factor remains to be defined. Erythropoietin and granulocyte colony-stimulating factor are two such facors that have the practical advantage of being available as sterile human recombinant factors in quantities sufficient to use in clinical trials.…”

“…Erythropoietin and granulocyte colony-stimulating factor are two such facors that have the practical advantage of being available as sterile human recombinant factors in quantities sufficient to use in clinical trials. 4 Obviously, large multicentered, randomized trials are needed to test the approach of enterally providing growth factors to neonates after bowel surgery in order to restore villous structure and function and thereby reduce feeding intolerance. However, before any such trials can be designed, basic information is needed regarding whether neonates following intestinal surgery can even tolerate such a solution for the period preceding and during the time milk feedings are introduced and advanced.…”