Intestinal Permeability in Preterm Infants by Feeding Type: Mother's Milk Versus Formula

Abstract

Background and Objective: Intestinal permeability in preterm infants represents a critical balance between absorption of nutritional agents and protection from dangerous pathogens. This study identified the relationship between feeding type (human milk and formula) and intestinal permeability as measured by lactulose to mannitol ratio in preterm infants in the first postnatal month. Study Design: Sixty-two preterm (Յ32 weeks of gestation) infants had assessment of feeding type and evaluation with enteral lactulose and mannitol administration and urinary measurement at three time points in the first postnatal month. Results: Infants who received the majority of feeding as human milk (Ͼ75%) demonstrated significantly lower intestinal permeability when compared to infants receiving minimal or no human milk (Ͻ25% or none) at postnatal days 7, 14, and 30 (p ϭ 0.02, 0.02, and 0.047, respectively). When infants receiving any human milk were compared to infants receiving formula only, a significant difference existed at day 7 and day 14 but not for day 30 (p ϭ 0.04, 0.02, and 0.15, respectively). With evaluation over the complete study period, exclusively formulafed infants demonstrated a 2.8-fold higher composite median lactulose/mannitol ratio when compared with those who received any human milk. Infants who received Ͼ75% of enteral feeding as mother's milk demonstrated a 3.8-fold lower composite median ratio when compared to infants receiving Ͻ25% or no mother's milk. Conclusion: Preterm infant intestinal permeability was significantly decreased for those receiving human milk versus formula in a dose-related manner in the first postnatal month.

The Role of Intestinal Barrier Function in Early Life in the Development of Colitis

“…Since the intestinal barrier is underdeveloped in pre-term babies, the influence of breast milk is particularly important. A study on pre-term infants in the first month post-birth found that those predominately fed human milk demonstrated lower intestinal permeability when compared with those fed minimal or no human milk (Taylor et al, 2009). A similar effect of breast feeding on intestinal permeability has also been reported for full-term babies (Catassi et al, 1995).…”

Evaluation of changes in oral drug absorption in preterm and term neonates for Biopharmaceutics Classification System (BCS) class I and II compounds

“…For example, it has been shown that intestinal permeability decreases faster in breast-fed newborns compared with formula-fed babies [24,25]. A study by Taylor et al investigating the effect of breast milk volume on intestinal permeability in preterm infants (≤ 32 weeks) showed that breast milk promotes intestinal closure earlier and in a more consistent manner than formula fed babies during the first post-natal month and that breast milk doses greater than 25% of total feeds appear to play a role in the low intestinal permeability at the end of the first post-natal month compared with the group of infants who received minimal or no breast milk [52]. In addition, there are also findings that indicate that enteral feeding induces an increase in intestinal barrier function [26].…”

Early maternal separation induces alterations of colonic epithelial permeability and morphology

“…Various studies have indicated that breast milk could decrease intestinal permeability [13][14][15]. A study on pre-term infants during the first month of life indicated that those predominantly breastfed have Fig.…”

“…4 Ex vivo intestinal resistance in mouse colon (a) and ileum (b). Transepithelial resistance (Rte) in colon and ileum (a, b) is determined by amplitude of voltage deflection generated by short intermittent current pulses and the exposed tissue surface area Intestinal permeability is expressed as the mean of basolateral concentration of FD4 (lg/ml/cm 2 /min) lower intestinal permeability when compared to those fed with minimal or no breast milk [14].…”