Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives

Rodriguez, Nancy A.; Meier, Paula P.; Groër, Maureen; Zeller, Janice M.

doi:10.1038/jp.2008.130

Cited by 104 publications

(117 citation statements)

References 70 publications

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“…12 Despite the theoretical advantages, providing maternal colostrum to extremely premature infants in the early postnatal period presents a variety of challenges. During this time, enteral feedings are frequently disturbed by immature gastrointestinal function and comorbidities that compromise splanchnic perfusion, such as patent ductus arteriosus, umbilical catheterization, or hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…The colostrum group had less clinical sepsis (50% vs 92%, P = .003) and shorter total antibiotic duration (6 [IQR: 3.8-8.5] vs 9.5 [IQR: [7][8][9][10][11][12][13][14][15][16][17][18][19]] days, P = .014), but no difference in cultureproven sepsis (46% vs 58%, P = .56) ( Table 2). The significant effect of colostrum administration on clinical sepsis was also validated in a regression analysis with all possible confounders, including mechanical ventilation, H2 blocker use, probiotic use, postnatal steroid use, feeding status and types (exp[B] = 67.3, 95% confidence interval: 3.8-1186.9, P = .004).…”

Section: Figurementioning

confidence: 99%

“…During this intervention, a small amount of colostrum is placed directly onto the oropharyngeal mucosa in the buccal cavity for absorption. 12 In theory, the abundant immune factors in colostrum interact with lymphoid tissues in the oropharynx and stimulate the immature neonatal immune system when administered via the oropharyngeal route. 11,13 Although theoretical and preclinical support for this practice exists, there is insufficient evidence that oropharyngeal administration of colostrum is beneficial to date.…”

Section: What This Study Addsmentioning

confidence: 99%

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Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT

et al. 2015

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To determine the immunologic effects of oropharyngeal colostrum administration in extremely premature infants. METHODS:We conducted a double-blind, randomized, placebo-controlled trial involving 48 preterm infants born before 28 weeks' gestation. Subjects received 0.2 mL of their mother's colostrum or sterile water via oropharyngeal route every 3 hours for 3 days beginning at 48 to 96 hours of life. To measure concentrations of secretory immunoglobulin A, lactoferrin, and several immune substances, urine and saliva were obtained during the first 24 hours of life and at 8 and 15 days. Clinical data during hospitalization were collected.RESULTS: Urinary levels of secretory immunoglobulin A at 1 week (71.4 vs 26.5 ng/g creatinine, P = .04) and 2 weeks (233.8 vs 48.3 ng/g creatinine, P = .006), and lactoferrin at 1 week (3.5 vs 0.9 mg/g creatinine, P = .01) were significantly higher in colostrum group. Urine interleukin-1b level was significantly lower in colostrum group at 2 weeks (55.3 vs 91.8 mg/g creatinine, P = .01). Salivary transforming growth factor-b1 (39.2 vs 69.7 mg/mL, P = .03) and interleukin-8 (1.2 vs 4.9 ng/mL, P = .04) were significantly lower at 2 weeks in colostrum group. A significant reduction in the incidence of clinical sepsis was noted in colostrum group (50% vs 92%, P = .003).CONCLUSIONS: This study suggests that oropharyngeal administration of colostrum may decrease clinical sepsis, inhibit secretion of pro-inflammatory cytokines, and increase levels of circulating immune-protective factors in extremely premature infants. Larger studies to confirm these findings are warranted. WHAT'S KNOWN ON THIS SUBJECT:Immunerelated bioactive proteins are highly concentrated in the colostrum of mothers who deliver preterm infants. Oropharyngeal administration was proposed as a safe and feasible alternative method of providing colostrum to immunocompromised premature infants. WHAT THIS STUDY ADDS:Oropharyngeally administered colostrum during the first few days of life increased urinary secretory immunoglobulin A and lactoferrin, decreased urinary interleukin-1b, reduced salivary transforming growth factor-b1 and interleukin-8, and reduced the occurrence of clinical sepsis in extremely premature infants.

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Section: Discussionmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

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Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT

et al. 2015

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“…Although the average number of PICC line days was not significantly different in the Before and After groups, a significant decrease in the variability of PICC line days was evident. Colostrum administration, which began with the new feeding protocol and has anti-infective and immune-priming properties, 30,31 may also have contributed to the decreased sepsis and NEC rates.…”

Section: Discussionmentioning

confidence: 99%

Improved outcomes with a standardized feeding protocol for very low birth weight infants

et al. 2011

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Objective: The objective of this study was to evaluate the impact of a standardized enteral feeding protocol for very low birth weight (VLBW) infants on nutritional, clinical and growth outcomes.Study Design: Retrospective analysis of VLBW cohorts 9 months before and after initiation of a standardized feeding protocol consisting of 6-8 days of trophic feedings, followed by an increase of 20 ml/kg/day. The primary outcome was days to reach full enteral feeds defined as 160 ml/ kg/day. Secondary outcomes included rates of necrotizing enterocolitis and culture-proven sepsis, days of parenteral nutrition and growth end points.Result: Data were analyzed on 147 VLBW infants who received enteral feedings, 83 before ('Before') and 64 subsequent to ('After') feeding protocol initiation. Extremely low birth weight (ELBW) infants in the After group attained enteral volumes of 120 ml/kg/day (43.9 days Before vs 32.8 days After, P ¼ 0.02) and 160 ml/kg/day (48.5 days Before vs 35.8 days After, P ¼ 0.02) significantly faster and received significantly fewer days of parenteral nutrition (46.2 days Before vs 31.3 days After, P ¼ 0.01). Necrotizing enterocolitis decreased in the After group among VLBW (15/83, 18% Before vs 2/64, 3% After, P ¼ 0.005) and ELBW infants (11/31, 35% Before vs 2/26, 8% After, P ¼ 0.01). Late-onset sepsis decreased significantly in the After group (26/83, 31% Before vs 6/64, 9% After, P ¼ 0.001). Excluding those with weight <3rd percentile at birth, the proportion with weight <3rd percentile at discharge decreased significantly after protocol initiation (35% Before vs 17% After, P ¼ 0.03).Conclusion: These data suggest that implementation of a standardized feeding protocol for VLBW infants results in earlier successful enteral feeding without increased rates of major morbidities.

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“…La mayor supervivencia de los niños prematuros en los últimos años gracias al desarrollo de la neonatología, en edades gestacionales y pesos cada vez menores, hace que estos pacientes tengan largos periodos de ingreso en las Unidades de Cuidados Neonatales. La inmadurez del tracto gastrointestinal de estos recién nacidos y la presencia de comorbilidades asociadas, que pudieran provocar una hipoperfusión intestinal, contraindican en ocasiones la nutrición enteral (2).…”

Section: Introductionunclassified

Efectos de la administración de calostro orofaríngeo en recién nacidos prematuros sobre los niveles de inmunoglobulina A

Álvarez¹,

Cabanillas²,

Peña‐Caballero³

et al. 2016

Nutr Hosp

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Introducción: el recién nacido prematuro de muy bajo peso (RNMBP) es inmunológicamente inmaduro y además presenta una alteración de las barreras naturales de defensa. Objetivo: evaluar los efectos que pueda tener la administración de calostro orofaríngeo, administrado durante los primeros 15 días posnatales, sobre los niveles de inmunoglobulina A (IgA) sérica en recién nacidos prematuros de muy bajo peso durante el primer mes de vida. Material y métodos: se desarrolló un estudio de intervención no aleatorizado con grupo control, en el que se incluyeron 38 recién nacidos con ≤ 32 + 6 semanas de gestación y/o menores de 1.500 g de peso. Los sujetos recibieron 0,2 ml de calostro de su madre cada 4 h, iniciándose el procedimiento en las primeras 24 h de vida hasta el 15.o día postnatal. Se midieron los niveles de IgA en la sangre al nacimiento, 3. er , 15.o y 30.o días de vida. Se registraron datos perinatales al nacimiento y durante el periodo de seguimiento. Resultados: IgA sérica aumentó de forma estadísticamente significativa en el grupo de intervención (M1 15,84 μg/ml, M2 20,07 μg/ml, M3 23,65 μg/ml, M4 30,34 μg/ml, p 0,001) y en el grupo control (M1 12,48 μg/ml, M2 16,48 μg/ml, p 0,018; M3 19,41 μg/ml, M4 22,48 μg/ml, p 0,001). Al mes de vida, los niveles de IgA sérica fueron significativamente mayores en el grupo de intervención que en el grupo control (p 0,026). Conclusiones: este estudio sugiere que la administración de calostro orofarínge

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Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives

Cited by 104 publications

References 70 publications

Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT

Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT

Improved outcomes with a standardized feeding protocol for very low birth weight infants

Efectos de la administración de calostro orofaríngeo en recién nacidos prematuros sobre los niveles de inmunoglobulina A

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