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Human Milk Fortification with Bovine Colostrum Is Superior to Formula-Based Fortifiers to Prevent Gut Dysfunction, Necrotizing Enterocolitis, and Systemic Infection in Preterm Pigs

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  1. Gut and immune effects of bioactive milk factors in preterm pigs exposed to prenatal inflammation

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  2. Pathogenesis and biomarkers for necrotizing enterocolitis: Getting any closer?

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • Jing Sun
  • Yanqi Li
  • Xiaoyu Pan
  • Duc Ninh Nguyen
  • Anders Brunse
  • Anders M Bojesen
  • Silvia Rudloff
  • Martin S Mortensen
  • Douglas G Burrin
  • Per T Sangild
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BACKGROUND: Fortification of donor human milk (DHM) is required for optimal growth of very preterm infants, but there are concerns of more gut dysfunction and necrotizing enterocolitis (NEC) when using formula-based fortifiers (FFs), especially soon after birth. Intact bovine colostrum (BC) is rich in nutrients and bioactive factors, and protects against NEC in preterm pigs. We hypothesized that fortification of DHM with BC is superior to FFs to prevent gut dysfunction and infections when provided shortly after preterm birth.

METHODS: Two FF products, Enfamil (ENF; intact protein, vegetable oil) and PreNAN+Nutrilon (NAN; extensively hydrolyzed protein, maltodextrin), were compared with BC as fortifier to DHM fed to preterm pigs for 5 days.

RESULTS: Relative to the DHM+BC group, DHM+FF groups had higher diarrhea score and lower hexose uptake and lactase activity, and specifically the DHM+NAN group showed higher gut permeability, NEC score, more mucosa-adherent bacteria with altered gut microbiota structure (ie, lower diversity, increased Enterococcus, decreased Staphylococcus abundance). Both DHM+FF groups showed higher expression of intestinal cytokine and inflammation-related genes, more gut-derived bacteria in the bone marrow, lower density of mucin-containing goblet cells, and slightly higher colon lactate, stomach pH and acetate, and blood neutrophil-to-lymphocyte levels than the DHM+BC group.

CONCLUSIONS: Used as a fortifier to DHM, BC is superior to FFs to support gut function, nutrient absorption, and bacterial defense mechanisms in preterm pigs. It is important to optimize the composition of nutrient fortifiers for preterm infants fed human milk.

OriginalsprogEngelsk
TidsskriftJournal of Parenteral and Enteral Nutrition
Vol/bind43
Udgave nummer2
Sider (fra-til)252-262
Antal sider11
ISSN0148-6071
DOI
StatusUdgivet - feb. 2019

Bibliografisk note

© 2018 American Society for Parenteral and Enteral Nutrition.

ID: 59423528