Radiographic Imaging to Evaluate Food Passage Rate in Preterm Piglets as a Model for Preterm Infants

Abstract

Objectives and study: Gut motility in infants mature with increasing post-menstrual age and is affected by numerous hormonal, immunological and nutritional factors. However, it remains unclear how age and diet influence gut motility and its relation to feeding intolerance and gastric residuals in preterm neonates. Using preterm piglets as a model for infants, we investigated if contrast passage rate, as determined by X-ray contrast imaging, is affected by gestational age at birth, advancing postnatal age and different milk diets.Methods: Contrast passage rate was evaluated using serial abdominal X-ray imaging on postnatal day 4 and 18 in preterm and near-term piglets fed infant formula, colostrum or intact bovine milk, with or without added fortifier (total n = 140).Results: Preterm piglets had a faster small intestinal passage rate of contrast solution at day 4 of life than near-term piglets (SIEmpty, hazard ratio (HR): 0.52, 95%CI [0.15, 0.88], p < 0.01). Formula fed piglets at day 4 had a faster passage rate of contrast to caecum (ToCecum, HR: 0.61, 95%CI [0.25,0.96], p = 0.03), and through the colon region (CaecumToRectum, p < 0.05, day 4) than colostrum fed preterm piglets. The time for contrast to leave the stomach, and passage through the colon in day 4 preterm piglets were slower than in older piglets at day 18 (both, p < 0.05). Adding a nutrient fortifier increased body growth, gastric residuals, intestinal length and weight, but did not affect any of the observed passage rates of the contrast solution.Conclusion: Serial X-ray contrast imaging is a feasible method to assess food passage rate in preterm piglets. Contrast passage rate through different gut segments is affected by gestational age at birth, postnatal age, and milk diet. The preterm piglet could be a good model to investigate clinical and dietary factors that support maturation of gut motility and thereby feeding tolerance and gut health in preterm infants.

A Randomized, Controlled Study to Investigate How Bovine Colostrum Fortification of Human Milk Affects Bowel Habits in Preterm Infants (FortiColos Study)

“…Statistically, the presence of GR (regardless of volume) had no negative effect on the following feeding volume, indicating that neither BC nor CF increased FI. Infants fortified with BC had a lower stomach appearance score, potentially reflecting a more mature gut, including improved motility and digestive function, as suggested by preterm piglets fortified with BC [47,48].…”

Preterm pigs for preterm birth research: reasonably feasible

“…To choose the best food supply during the crucial newborn period, studies on physiological adaptation in preterm pigs are helpful (Sangild et al, 2013;Baek et al, 2019;Ahnfeldt et al, 2020). Therefore, preterm pigs are a good model to research the effects of preterm feeding tolerance, GIT maturation, microbial colonization, immunological activation, and growth (Obelitz-Ryom et al, 2018;Kappel et al, 2020). Using preterm pig models, the researchers found that pasteurization improved the digestion of formula milk powder and decreased bacterial adhesion in the mucosa of the proximal small intestine of piglets (Navis et al, 2020).…”

Potential Benefits of Bovine Colostrum in Pediatric Nutrition and Health

“…However, neither casein supplementation to whey-based formula nor rapid advancement of a diet with casein (intact or hydrolyzed) increased the NEC sensitivity in preterm pigs [ 304 , 308 ]. In fact, a moderate BC-induced retention of digesta in the stomach may promote digestion and gut maturation, relative to whey-based formulas, as indicated from food transit studies in preterm pigs [ 309 ].…”