Source of human milk (mother or donor) is more important than fortifier type (human or bovine) in shaping the preterm infant microbiome

Kumbhare, Shreyas V.; Jones, William-Diehl; Fast, Sharla; Bonner, Christine; Jong, Geert ’t; Domselaar, Gary Van; Graham, Morag; Narvey, Michael; Azad, Meghan B.

doi:10.1016/j.xcrm.2022.100712

Cited by 29 publications

(18 citation statements)

References 62 publications

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“… 40 Recent studies aimed at evaluating the role of MOM and EHMD in modifying gut microbial colonization, and later vascular aging and neurodevelopmental outcomes could possibly reaffirm the uniqueness of HM bioactivity. 5 , 41 , 42 Our study contributes to new information that specific bioactive properties lost or attenuated through the pasteurization of DHM could be reinstated through HMDF, and for MOM, the levels could be augmented offering potential benefits to ELBW infants. An improved understanding of how MOM designs, donates, and modulates the immunochemical components to offspring would be desirable to improve preventative approaches.…”

Section: Discussionmentioning

confidence: 86%

Exclusive Human Milk Diet for Extremely Premature Infants: A Novel Fortification Strategy That Enhances the Bioactive Properties of Fresh, Frozen, and Pasteurized Milk Specimens

Philip

Romeih

Bailie

et al. 2023

Breastfeeding Medicine

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Background: Human milk (HM) fortification has been recommended for the nutritional optimization of very low–birthweight infants. This study analyzed the bioactive components of HM and evaluated fortification choices that could accentuate or attenuate the concentration of such components, with special reference to human milk-derived fortifier (HMDF) offered to extremely premature infants as an exclusive human milk diet. Materials and Methods: An observational feasibility study analyzed the biochemical and immunochemical characteristics of mothers' own milk (MOM), both fresh and frozen, and pasteurized banked donor human milk (DHM), each supplemented with either HMDF or cow's milk-derived fortifier (CMDF). Gestation-specific specimens were analyzed for macronutrients, pH, total solids, antioxidant activity (AA), α -lactalbumin, lactoferrin, lysozyme, and α- and β -caseins. Data were analyzed for variance applying general linear model and Tukey's test for pairwise comparison. Results: DHM exhibited significantly lower ( p < 0.05) lactoferrin and α-lactalbumin concentrations than fresh and frozen MOM. HMDF reinstated lactoferrin and α-lactalbumin and exhibited higher protein, fat, and total solids ( p < 0.05) in comparison to unfortified and CMDF-supplemented specimens. HMDF had the highest ( p < 0.05) AA, suggesting the potential capability of HMDF to enhance oxidative scavenging. Conclusion: DHM, compared with MOM, has reduced bioactive properties, and CMDF conferred the least additional bioactive components. Reinstatement and further enhancement of bioactivity, which has been attenuated through pasteurization of DHM, is demonstrated through HMDF supplementation. Freshly expressed MOM fortified with HMDF and given early , enterally , and exclusively (3E) appears an optimal nutritional choice for extremely premature infants.

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Section: Discussionmentioning

confidence: 86%

Exclusive Human Milk Diet for Extremely Premature Infants: A Novel Fortification Strategy That Enhances the Bioactive Properties of Fresh, Frozen, and Pasteurized Milk Specimens

Philip

Romeih

Bailie

et al. 2023

Breastfeeding Medicine

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“… 153–155 Notably, two recent RCTs identified an association between human milk source (MOM vs. donor) and microbiome composition in very low birthweight infants (<1,500 g). 156 , 157 The effect of milk type on the microbiome was dose-dependent, 157 but inconsistent effects were reported for fortifiers (human vs. bovine). 156 , 157 These results were recapitulated in an observational study of probiotic use in preterm infants that included formula fed infants, which found MOM and fortifiers significantly influenced the microbiome, although to a lesser degree than probiotics.…”

Section: Clinical Considerations For Probiotic Supplementation In Pre...mentioning

confidence: 99%

“… 156 , 157 The effect of milk type on the microbiome was dose-dependent, 157 but inconsistent effects were reported for fortifiers (human vs. bovine). 156 , 157 These results were recapitulated in an observational study of probiotic use in preterm infants that included formula fed infants, which found MOM and fortifiers significantly influenced the microbiome, although to a lesser degree than probiotics. 36 Given these findings, the interactive effects of milk and fortifier types need to be considered in the context of probiotic supplementation and its influence on microbiome composition in preterm infants.…”

Section: Clinical Considerations For Probiotic Supplementation In Pre...mentioning

confidence: 99%

Probiotics to improve the gut microbiome in premature infants: are we there yet?

Mercer

Arrieta

2023

Gut Microbes

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Gut microbiome maturation in infants born prematurely is uniquely influenced by the physiological, clinical, and environmental factors surrounding preterm birth and early life, leading to altered patterns of microbial succession relative to term infants during the first months of life. These differences in microbiome composition are implicated in acute clinical conditions that disproportionately affect preterm infants, including necrotizing enterocolitis (NEC) and late-onset sepsis (LOS). Probiotic supplementation initiated early in life is an effective prophylactic measure for preventing NEC, LOS, and other clinical concerns relevant to preterm infants. In parallel, reported benefits of probiotics on the preterm gut microbiome, metabolome, and immune function are beginning to emerge. This review summarizes the current literature on the influence of probiotics on the gut microbiome of preterm infants, outlines potential mechanisms by which these effects are exerted, and highlights important clinical considerations for determining the best practices for probiotic use in premature infants.

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“…59 Studies have characterized the gastrointestinal microbiome 60 of preterm populations, revealing frequent dysbiosis driven by exposure to infant formula, antibiotics, and delivery mode (ie, cesarean section) that could contribute to NEC. 61 Interestingly, two 2022 RCTs 62,63 examining infant fortifiers highlight the crucial role of MHM in positively shaping the preterm gastrointestinal microbiome, with Kumbhare et al 62 identifying volume of MHM as the strongest predictor of the preterm infant's gut microbiota.…”

Section: Potential Mechanismsmentioning

confidence: 99%

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

Elgersma

Wolfson

Fulkerson

et al. 2023

Preprint

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Background: Infants with single ventricle (SV) congenital heart disease (CHD) undergo three staged surgeries/interventions, with risk for morbidity and mortality. We estimated the effect of human milk (HM) and direct breastfeeding (BF) on outcomes including necrotizing enterocolitis (NEC), infection-related complications, length of stay (LOS), and mortality. Methods: We analyzed the National Pediatric Cardiology Quality Improvement Collaborative registry (2016?2021), examining HM/BF groups during stage 1 (S1P) and stage 2 (S2P) palliations. We calculated propensity scores for feeding exposures, then fitted Poisson and logistic regression models to compare outcomes between propensity-matched cohorts. Results: Participants included 2491 infants (68 sites). Estimates for all outcomes were better in HM/BF groups. Infants fed exclusive HM before S1P had lower odds of preoperative NEC (OR=0.37, 95% CI=0.17?0.84, p=0.017) and shorter S1P LOS (RR=0.87, 0.78?0.98, p=0.027). During the S1P hospitalization, infants with high HM had lower odds of postoperative NEC (OR=0.28, 0.15?0.50, p<0.001) and sepsis (0.29, 0.13?0.65, p=0.003), and shorter S1P LOS (RR=0.75, 0.66?0.86, p<0.001). At S2P, infants with any HM (0.82, 0.69?0.97, p=0.018) and any BF (0.71, 0.57?0.89, p=0.003) experienced shorter LOS. Conclusions: Infants with SV CHD in high HM and BF groups experienced multiple significantly better outcomes. Given our findings of improved health, strategies to increase the rates of HM/BF in these patients should be implemented. Future research should replicate these findings with granular feeding data and in broader CHD populations, and should examine mechanisms (eg, HM components; microbiome) by which HM/BF benefits these infants.

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Source of human milk (mother or donor) is more important than fortifier type (human or bovine) in shaping the preterm infant microbiome

Cited by 29 publications

References 62 publications

Exclusive Human Milk Diet for Extremely Premature Infants: A Novel Fortification Strategy That Enhances the Bioactive Properties of Fresh, Frozen, and Pasteurized Milk Specimens

Exclusive Human Milk Diet for Extremely Premature Infants: A Novel Fortification Strategy That Enhances the Bioactive Properties of Fresh, Frozen, and Pasteurized Milk Specimens

Probiotics to improve the gut microbiome in premature infants: are we there yet?

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

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