Oral colostrum priming shortens hospitalization without changing the immunomicrobial milieu

Abstract

Background Oral colostrum priming (OCP) after birth in preterm infants is associated with improved weight gain and modification of the oral immuno-microbial environment. We hypothesized OCP would modify salivary immune peptides and the oral microbiota in preterm infants. Methods We conducted a prospective, randomized clinical trial to determine the effects of OCP on salivary immune peptide representation in preterm infants (<32 weeks completed gestation at birth). Saliva samples were collected prior to and after OCP. Salivary immune peptide representation was determined via mass spectroscopy. Oral microbiota representation was determined via sequencing of 16S rRNA gene. Results Neonates that received OCP (n = 48) had a 16-day reduction in the median length of hospitalization as compared to infants that did not receive OCP (n = 51). No differences in salivary immune peptide sequence representation prior to OCP between groups were found. Longitudinal changes in peptides were detected (lysozyme C, immunoglobulin A, lactoferrin) but were limited to a single peptide difference (alpha defensin 1) between primed and unprimed infants after OCP. We found no difference in microbial diversity between treatment groups at any time point, but diversity decreased significantly over time in both groups. OCP treatment marginally modified oral taxa with a decline in abundance of Streptococci in the OCP group at 30 days of life. Conclusions OCP had neither an effect on the salivary peptides we examined nor on overall oral bacterial diversity and composition. Infants that received OCP had a reduced length of hospitalization and warrants further investigation.

Role of Oropharyngeal Administration of Colostrum in Very Low Birth Weight Infants for Reducing Necrotizing Enterocolitis: A Randomized Controlled Trial

“…Similarly, earlier conducted study did not show any significant reduction in the incidence of NEC with OAC. 29,31,32 Similar to the earlier published studies, there was no significant reduction in the incidence of neonatal sepsis in the study population, 29,31,32 but Lee et al showed significant reduction in clinical sepsis in the intervention arm. This difference can be because of difference in the study population of both the trials as neonates of Lee et al trial were more premature and were lighter in weight, compared with our study population.…”

“…33 Similar to Romano-Keeler et al, we reported significant reduction in the duration of hospital stay in the intervention arm. 31 This reduction can be explained by decrease in the incidence of early onset, late onset, and VAP in the intervention arm, although the differences were not statistically significant.…”

Early provision of oropharyngeal colostrum leads to sustained breast milk feedings in preterm infants

“…In part, our result likely reflects the recent change in NICU culture to start trophic feeds as early as possible. 33 In a recent study, Romano-Keeler et al 17 also observed no difference in the time to initiate enteral feeds (median age of 2 days) between groups, further validating this cultural shift. Similar to Lee et al 27 we also found no difference in the time it took for infants to regain their birth weight and no difference in time to reach full enteral feeds.…”

“…16 In the immediate postnatal period for very low birth weight (VLWB) infants, enteral feedings are not always possible and oral feedings are not practical because of developmental immaturity. 17 To bridge the gap to the introduction of enteral breast milk, the practice of early application of oropharyngeal colostrum (OC) was proposed as a protective strategy. 18 This application of OC in this early neonatal period is feasible and safe for VLBW infants that are not yet able to receive enteral feeds.…”

Human and Bovine Colostrum for Prevention of Necrotizing Enterocolitis: A Meta-analysis

“…We included 8 RCTs that proved eligible, enrolling 394 individuals. The intervention in 6 studies 13,14,16,[26][27][28] was human colostrum, and in 2 studies the intervention was bovine colostrum. 29,30 In 2 studies, researchers enrolled preterm infants with a birth weight of ≤1.0 kg or gestational age <28 weeks.…”