Bioactive Components of Breast Milk as Enteral Supplements for Preterm Infants

Human breast milk is well known as the ideal source of nutrition during early life, ensuring optimal growth during infancy and early childhood. Breast milk is also the source of many unique and dynamic bioactive components that play a key role in the development of the immune system. These bioactive components include essential microbes, human milk oligosaccharides (HMOs), immunoglobulins, lactoferrin and dietary polyunsaturated fatty acids. These factors all interact with intestinal commensal bacteria and/or immune cells, playing a critical role in establishment of the intestinal microbiome and ultimately influencing intestinal inflammation and gut health during early life. Exposure to breast milk has been associated with a decreased incidence and severity of necrotizing enterocolitis (NEC), a devastating disease characterized by overwhelming intestinal inflammation and high morbidity among preterm infants. For this reason, breast milk is considered a protective factor against NEC and aberrant intestinal inflammation common in preterm infants. In this review, we will describe the key microbial, immunological, and metabolic components of breast milk that have been shown to play a role in the mechanisms of intestinal inflammation and/or NEC prevention.

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Lipid Composition, Digestion, and Absorption Differences among Neonatal Feeding Strategies: Potential Implications for Intestinal Inflammation in Preterm Infants

Nutrients ◽

10.3390/nu13020550 ◽

2021 ◽

Vol 13 (2) ◽

pp. 550

Author(s):

Kathryn Burge ◽

Frederico Vieira ◽

Jeffrey Eckert ◽

Hala Chaaban

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Lipid Composition ◽

Intestinal Inflammation ◽

Digestive Enzyme ◽

Feeding Strategies ◽

Bioactive Components ◽

Fat Digestion ◽

The Many ◽

Neonatal Population

Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality in the neonatal population. Formula feeding is among the many risk factors for developing the condition, a practice often required in the cohort most often afflicted with NEC, preterm infants. While the virtues of many bioactive components of breast milk have been extolled, the ability to digest and assimilate the nutritional components of breast milk is often overlooked. The structure of formula differs from that of breast milk, both in lipid composition and chemical configuration. In addition, formula lacks a critical digestive enzyme produced by the mammary gland, bile salt-stimulated lipase (BSSL). The gastrointestinal system of premature infants is often incapable of secreting sufficient pancreatic enzymes for fat digestion, and pasteurization of donor milk (DM) has been shown to inactivate BSSL, among other important compounds. Incompletely digested lipids may oxidize and accumulate in the distal gut. These lipid fragments are thought to induce intestinal inflammation in the neonate, potentially hastening the development of diseases such as NEC. In this review, differences in breast milk, pasteurized DM, and formula lipids are highlighted, with a focus on the ability of those lipids to be digested and subsequently absorbed by neonates, especially those born prematurely and at risk for NEC.

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BREAST MILK AND NEURODEVELOPMENTAL OUTCOMES IN EXTREMELY PRETERM INFANTS

Journal of Paediatrics and Child Health ◽

10.1111/jpc.14409_71 ◽

2019 ◽

Vol 55 (S1) ◽

pp. 29-29

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Neurodevelopmental Outcomes ◽

Extremely Preterm ◽

Extremely Preterm Infants

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Tube Feeding Practices and Transition to Breastfeeding Experiences of Mothers of Preterm Infants at a Kangaroo Mother Care Unit of a Tertiary Hospital in South Africa

Global Pediatric Health ◽

10.1177/2333794x211037032 ◽

2021 ◽

Vol 8 ◽

pp. 2333794X2110370

Author(s):

Sphiwe Madiba ◽

Malmsey Sengane

Keyword(s):

South Africa ◽

Breast Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Tube Feeding ◽

Feeding Practices ◽

Tertiary Hospital ◽

Very Preterm Infants ◽

Mothers Of Preterm Infants ◽

Group Interviews

To receive human milk, most preterm infants initially receive the mothers’ expressed milk through a nasogastric tube. However, breast milk feeding the preterm infant and making the transition to direct breast-feeding come with significant challenges. The study explored and described the experiences of mothers of preterm infants regarding initiation and expressing breast milk, tube feeding practices, and transition to breastfeeding during the infants’ stay in a kangaroo care unit (KMC) of an academic hospital in South Africa. Using a qualitative design, focus group interviews were conducted with 38 mothers of preterm infants after discharge from the neonatal intensive care unit (NICU). We analyzed transcripts following the 5 steps for qualitative thematic data analysis. Tube feeding and breastfeeding preterm infants was challenging and exhausting for the mothers. Many described their experiences of initiating expression and sustaining milk supply as negative. They had constant concerns about their ability to produce adequate milk volumes to feed their infants. They had immense dislike of expressing, which they described as physically exhausting, stressful, and painful. Those who had initiated breastfeeding were highly motivated to breastfeed their preterm infants. They described breastfeeding as a positive bonding experience that they derived pleasure from. The mothers’ dislike of expressing was overshadowed by their emotional obligation toward their preterm infants. Although the KMC unit promotes breastfeeding, mothers encountered problems and struggled to initiate expression and sustain milk production. Mothers of extreme and very preterm infants need support to continue with milk expression during the long NICU and KMC stay.

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Olfactory Stimulation of Preterm Infants with Breast Milk

Clinical Nursing Research ◽

10.1177/10547738211018913 ◽

2021 ◽

pp. 105477382110189

Author(s):

Woon Ae Lee ◽

Jin Suk Ra

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Repeated Measures ◽

Physiological Responses ◽

Nursing Intervention ◽

Olfactory Stimulation ◽

Control Group ◽

Repeated Measures Analysis ◽

Equivalent Control ◽

Experimental Group

Maintaining stable physiological responses may be important for the growth and development of preterm infants. The purpose of our study was to evaluate the effects of olfactory stimulation with maternal breast milk on the occurrence of abnormal physiological responses in preterm infants. With a non-equivalent control group pretest-posttest design, 13 preterm infants in the experimental group and 18 preterm infants in the control group completed the intervention. The intervention was implemented three times a day for 5 days in a row with 2 hours of administration per intervention. The frequency of abnormal physiological responses was assessed over 6 days (one day before intervention administration and 5 days during intervention administration). With repeated-measures analysis of variance, the experimental group showed a significantly lower frequency of apnea than the control group ( p = .021). Olfactory stimulation with maternal breast milk may be an effective nursing intervention for reducing apnea episodes in preterm infants.

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Human milk feeding and cognitive outcome in preterm infants: the role of infection and NEC reduction

Pediatric Research ◽

10.1038/s41390-021-01367-z ◽

2021 ◽

Author(s):

Winok Lapidaire ◽

Alan Lucas ◽

Jonathan D. Clayden ◽

Chris Clark ◽

Mary S. Fewtrell

Keyword(s):

Breast Milk ◽

Human Milk ◽

Preterm Infants ◽

Neonatal Infection ◽

Necrotising Enterocolitis ◽

Cognitive Outcome ◽

Standard Diet ◽

Risk Of Infection ◽

Verbal Iq

Abstract Background Breast milk has been associated with lower risk of infection and necrotising enterocolitis (NEC) and improved long-term cognitive outcomes in preterm infants but, if unsupplemented, does not meet the nutritional requirements of preterm infants. Methods Preterm infants were randomised to receive a high nutrient intervention diet: preterm formula (PTF) or the standard diet: term formula (TF) or banked donor breast milk (BBM), either as their sole diet or as supplement to maternal breast milk (MBM). IQ tests were performed at ages 7, 15, 20, and 30 years. Results An increase in MBM and BBM intake was associated with a lower chance of neonatal infection/NEC. Neonatal infection/NEC was associated with lower Full Scale IQ (FSIQ) and Performance IQ (PIQ) score at ages 7 and 30 years. The relationship between higher intake of MBM and PIQ at age 7 years was partly mediated by neonatal infection/NEC. The intervention diet was associated with higher Verbal IQ (VIQ) scores compared to the standard diet. There was no evidence that these effects changed from childhood through to adulthood. Conclusions Neonatal diet is an important modifiable factor that can affect long-term cognitive outcome through a ‘human milk’ factor, protecting against infection/NEC, and a ‘nutrient content’ factor. Impact This is the first study to demonstrate the effects of neonatal infection/necrotising enterocolitis (NEC) on IQ in the same cohort in childhood and adulthood. Diet can be a key factor in long-term cognitive outcome in people born preterm by preventing neonatal infection/NEC and providing adequate nutrients. Human milk, whether MBM or BBM, is associated with a reduced risk of infection/NEC. A higher nutrient diet is associated with better cognitive outcome in childhood. Performance IQ is particularly vulnerable to the effects of infection/NEC and verbal IQ to the quantity of (macro)nutrients in the diet.

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The Effect of Individualized Developmental Care Practices in Preterm Infants

Complementary Medicine Research ◽

10.1159/000504357 ◽

2019 ◽

Vol 27 (2) ◽

pp. 97-104

Author(s):

Dilek Küçük Alemdar ◽

Sevil İnal

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Oral Feeding ◽

Control Group ◽

Developmental Care ◽

Significant Difference ◽

Care Practices ◽

Maternal Voice

Background: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. Methods: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. Results: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. Conclusion: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.

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Effects of oral stimulation with breast milk in preterm infants oral feeding: a randomized clinical trial

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0282 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Qiong Le ◽

Sheng-hua Zheng ◽

Lan Zhang ◽

Li-fen Wu ◽

Feng-juan Zhou ◽

...

Keyword(s):

Clinical Trial ◽

Breast Milk ◽

Premature Infant ◽

Preterm Infants ◽

Oral Feeding ◽

Transition Time ◽

Control Group ◽

Oral Motor ◽

Oral Stimulation ◽

Nutritive Sucking

Abstract Objectives This study was performed to evaluate the effect of oral stimulation with breast milk for preterm infants. Methods A total of 68 subjects form neonatal intensive care unit were randomly assigned into control group (n=20), premature infant oral motor intervention (PIOMI) group (n=25) and premature infant oral motor intervention with breast milk (BM-PIOMI) group (n=23). Results BM-PIOMI group had significant shorter initiation of oral feeding (IOF) time compared to PIOMI group (2.95 days, 95% CI [0.42–5.48]) or control group (9.79 days, 95% CI [7.07–12.51]). BM-PIOMI group had significant sooner transition time from IOF to full oral feeding (FOF) compared to control group (6.68 days, 95% CI [2.2–11.16]), but not to PIOMI group (2.09 days, 95% CI [−2.07 to 6.25]). Length of hospital stay (LOS) did not show statistical different between three groups (control 38.85 ± 14.40 vs. PIOMI 38.48 ± 11.76 vs. BM-PIOMI 38.04 ± 12.2). Growth mixture model identified improvement in non-nutritive sucking (NNS) score in BM-PIOMI group compared to control and PIOMI group (0.8293, p<0.0001, and 0.8296, p<0.0001, respectively). Conclusions Oral stimulation with breast milk can better promotes the oral feeding process of premature infants than the simple oral stimulation, by shorten IOF time and improve early NNS score, but does not shorten transition time from IOF to FOF and LOS. Trial registration The trial identification number is ChiCTR1800019134 (Chinese Clinical Trial Registry http://www.who.int/ictrp/network/chictr2/en/)

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