Nutritional interventions to reduce rates of infection, necrotizing enterocolitis and mortality in very preterm infants

Bührer, Christoph; Fischer, Hendrik; Wellmann, Sven

doi:10.1038/s41390-019-0630-2

Cited by 27 publications

(19 citation statements)

References 72 publications

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“…There are a number of products available for fortifying human milk for preterm babies which differ by the origin of milk used (bovine, human, or donkey), and by nutrient composition. In the clinical setting, feeding preterm infants with a mother's own milk or HDM reduces the incidence of NEC when compared to formula-fed infants but no differences emerged between infants receiving human or bovine milk-based fortifiers [40]. New knowledge about bioactive peptides could contribute to a targeted functional supplementation of human milk with specific peptides [12].…”

Section: Discussionmentioning

confidence: 99%

Impact of Storage Conditions on the Breast Milk Peptidome

et al. 2020

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Human donor milk (HDM) provides appropriate nutrition and offers protective functions in preterm infants. The aim of the study is to examine the impact of different storage conditions on the stability of the human breast milk peptidome. HDM was directly frozen at −80 °C or stored at −20 °C (120 h), 4 °C (6 h), or room temperature (RT for 6 or 24 h). The milk peptidome was profiled by mass spectrometry after peptide collection by ultrafiltration. Profiling of the peptidome covered 3587 peptides corresponding to 212 proteins. The variance of the peptidome increased with storage temperature and time and varied for different peptides. The highest impact was observed when samples were stored at RT. Smaller but significant effects were still observed in samples stored at 4 °C, while samples showed highest similarity to those immediately frozen at −80 °C when stored at −20 °C. Peptide structures after storage at RT for 24 h point to the increased activity of thrombin and other proteases cleaving proteins at lysine/arginine. The results point to an ongoing protein degradation/peptide production by milk-derived proteases. They underline the need for immediate freezing of HDM at −20 °C or −80 °C to prevent degradation of peptides and enable reproducible investigation of prospectively collected samples.

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Section: Discussionmentioning

confidence: 99%

Impact of Storage Conditions on the Breast Milk Peptidome

et al. 2020

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“…In recent years, the rapid development of perinatal science and neonatal intensive care treatment technology have significantly improved the survival of low birth weight or premature infants [8] . Although the symptoms of NEC can be relieved through conservative treatments such as fasting, parenteral nutrition, fluid resuscitation, antibiotics, and maintaining acid-base balance, there are still a considerable number of children with NEC that require surgical treatment [9,10] . Therefore, it is necessary to further explore the clinical features and influencing factors of NEC in low birth weight infants, and provide evidence support for the prevention and treatment of clinical NEC.…”

Section: Introductionmentioning

confidence: 99%

The predictors of necrotizing enterocolitis in newborns with low birth weight

Tan¹,

Zhou²,

Xu³

et al. 2022

Medicine

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There are needs to investigate the influencing factors of necrotizing enterocolitis (NEC) in low birth weight (LBW) newborns, to provide insights into the clinical management of NEC.This study was a retrospective cohort study. Infants admitted to our hospital from January 1, 2019 to June 30, 2021 were selected. The clinical characteristics of NEC and no-NEC infants were evaluated. Logistic regression analyses were conducted to assess the risk factors of NEC in LBW infants.A total of 192 LBW infants were included, the incidence of NEC in LBW infants was 35.42%. There were significant differences in the congenital heart disease, sepsis, breastfeeding, blood transfusion and probiotics feeding between NEC and no-NEC group (all P < .05), and there were no significant differences in birth weight, gestational age, mother's pregnancy-induced hypertension, premature rupture of fetal membrane, amniotic fluid pollution, fetal asphyxia, neonatal respiratory distress syndrome and mechanical ventilation between NEC and no-NEC group (all P > .05). Congenital heart disease (OR: 2.128, 95% CI: 1.103–3.511), sepsis (OR: 1.630, 95% CI: 1.022–2.549), and blood transfusion (OR: 1.451, 95% CI: 1.014–2.085) were the independent risk factors for NEC in LBW infants, and breastfeeding (OR: 0.494, 95% CI: 0.023–0.928), probiotics feeding (OR: 0.816, 95% CI: 0.782–0.982) were the protective factors for the NEC in LBW infants. The prognosis of NEC infants undergone surgery treatment was better than that of infants undergone conservative treatments (P = .043).The incidence of NEC in LBW is high, which is affected by many factors, and comprehensive interventions targeted on the risk and protective factors should be made to improve the prognosis of LBW infants.

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“…A critical limitation of research efforts to date is the focus on a limited number of oligosaccharide structures ( 7 ), thus negating the potential benefits of the wide variety of HMOs structures in existence. HMOs are produced as complex mixtures with possible synergistic mechanisms of action against NEC and infection ( 65 ). There is also a risk that supplementing feeds with just one or two of the many HMOs may cause an unwanted effect on the balance of the gut microbiome population and/or the immune system, with potential long-term implications.…”

Section: Discussionmentioning

confidence: 99%

Tailoring Human Milk Oligosaccharides to Prevent Necrotising Enterocolitis Among Preterm Infants

et al. 2021

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Necrotising enterocolitis (NEC) is a devastating disease affecting preterm infants, with little improvement in mortality rates and treatment strategies in the last 30 years. Human milk oligosaccharides (HMOs) are emerging as a potential preventive therapy, with multiple protective functions postulated. Our aim is to summarise the evidence concerning the role of HMOs in NEC development and emerging strategies to tailor the delivery of HMOs to preterm infants. Most research efforts to date have focused on supplementing preterm infants with simple oligosaccharides, which are structurally different to HMOs and derived mainly from plants. Clinical trials demonstrate limited benefits for NEC prevention arising from the use of these supplements. Alternative strategies under investigation include optimising HMOs for infants receiving donor human milk, concentrating oligosaccharides from donor human milk and from animal milks, as well as more sophisticated synthetic oligosaccharide production strategies. Critically, high quality evidence to support implementation of any of these approaches in the neonatal unit is lacking. Whether it is a specific HMO alone or a combination of HMOs that exert protective effects remains to be elucidated. Further challenges include how best to manufacture and administer oligosaccharides whilst retaining bioactivity and safety, including evaluation of the long-term effects of altering the balance of HMOs and gut microbiota in preterm infants. While several human clinical trials are underway, further research is needed to understand whether a tailored approach to oligosaccharide supplementation is beneficial for preterm infants.

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Nutritional interventions to reduce rates of infection, necrotizing enterocolitis and mortality in very preterm infants

Cited by 27 publications

References 72 publications

Impact of Storage Conditions on the Breast Milk Peptidome

Impact of Storage Conditions on the Breast Milk Peptidome

The predictors of necrotizing enterocolitis in newborns with low birth weight

Tailoring Human Milk Oligosaccharides to Prevent Necrotising Enterocolitis Among Preterm Infants

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