How Gut Microbiota Supports Immunity, Growth and Development of  Preterm Infants: A Narrative Review

ABSTRACTBackground: Gut microbiota, a complex ecosystem consisting of abundant microorganisms, plays a role in preterm infants’ immunity, growth, and development. Dysbiosis or disruption of the gut microbiota can precipitate various diseases, such as allergy or autoimmune disorders in premature infants. Purpose: This study aimed to review gut microbiota in preterm infants and its role in supporting the infants’ immunity, growth, and development. Discussion: Bifidobactericeae is the predominant microbiota in GI tract of preterm infants. However, various factors can influence this gut microbiota e.g., genetics, lifestyle of the mothers (smoking, diet, use of antibiotic, obesity), birth mode, type of feeding, and environmental factors. Gut dysbiosis can result in impaired immune system which predisposes the preterm infants to infections, even fatal adverse event. Furthermore, the growth and development might be affected as well as lead to various neurodevelopmental and psychiatric disorders. Human milk is a prebiotic source which can stimulate the growth of Baifidobactericeae and Bacteroidetes. If the human milk is inadequate or unavailable, the recommended interventions for gut dysbiosis in premature infants are probiotics, prebiotics, or both supplementations (synbiotics). The administration of prebiotics and probiotics associates with lower morbidity and death rates in preterm infants, as well as shorter duration of hospital stay and duration to achieve full enteral feeding. Conclusions: Immunity as well as growth and development of preterm infants are affected greatly by gut microbiota The less diverse microbiota in preterm infants’ gut predispose them to various health problems. Hence, this problem should be managed properly, one of which is prebiotic and probiotic supplementation Keywords: Gastrointestinal Microbiome, Premature, Immunity, Growth, Development

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Feeding the feeble

10.1093/med/9780198854807.003.0038 ◽

2021 ◽

pp. 265-272

Author(s):

Michael Obladen

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Premature Infants ◽

Tube Feeding ◽

Theoretical Knowledge ◽

Air Inlet ◽

Nasogastric Tubes ◽

Nutritional Needs ◽

The 1960S

This chapter describes historic steps in feeding techniques and knowledge about the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920: tube feeding by gavage, medicine droppers and pipettes, feeding bottles with air inlet, and beaked spoons for nasal feeding. Indwelling nasogastric tubes were in use from 1951. For alleged safety concerns, postnatal feeding was postponed until a week of starvation was reached in the 1950s and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been known since 1919. However, nutritional practice lagged behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants fed formula than in those fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Compared to other aspects of neonatal medicine, there is little evidence on how to feed preterm infants.

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Growth and Development of Premature Infants Fed Predominantly Human Milk, Predominantly Premature Infant Formula, or a Combination of Human Milk and Premature Formula

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-200310000-00008 ◽

2003 ◽

Vol 37 (4) ◽

pp. 437-446 ◽

Cited By ~ 114

Author(s):

Deborah L. O'Connor ◽

Joan Jacobs ◽

Robert Hall ◽

David Adamkin ◽

Nancy Auestad ◽

...

Keyword(s):

Human Milk ◽

Premature Infant ◽

Infant Formula ◽

Premature Infants ◽

Growth And Development

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Tolerance in Preterm Infants Fed Exclusively with Human Milk. Prospective Analytic Study

Nursing and Health Care ◽

10.33805/2573.3877.145 ◽

2020 ◽

pp. 01-06

Author(s):

Pasqua Anna Quitadamo ◽

Chiara Cisternino ◽

Carmela Parente ◽

Paola Lurdo ◽

Massimiliano Copetti ◽

...

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Premature Infants ◽

Statistical Correlation ◽

Analytic Study ◽

Prospective Analysis ◽

Food Tolerance ◽

Donor Milk ◽

Total Percentage ◽

The Relationship

Human milk is the best feeding for premature infants. When Own Mother’s Milk (OMM) is insufficient or unavailable, the alternative is represented by the Donor Milk (DM). OMM and DM must be fortified to support the adequate growth. Objectives: Evaluation of the food tolerance on preterm fed exclusively with fortified Human Milk (HM). Materials and Methods: This prospective analysis has been performed on a sample of 48 preterm with GA ≤ 32 weeks. Gastric Residual (GR), Vomiting (V) and Feeding Suspension (FS) are the parameters performed. We identified two categories (OMM/DM) and 4 groups: newborns fed exclusively with OMM (EOMM), with prevalent OMM (POMM), with exclusively DM (EDM) and with prevalent DM (PDM). Results: The overall incidence of GRs was 18%, the incidence of bilious residuals was 4%, the incidence of Vs was 4.5%, there was no indication of blood in the stool, the total percentage of days of FS was 12.7%. There was no statistical correlation between the incidence of GR, V, FS in the two categories (OMM/DM). The relationship between the kind of feeding and the GA or the BW was not statistically significant. Conclusions: The study highlights the irreplaceability of the OMM in feeding the preterm and that the DM is a valid substitute of OMM.

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CLINICAL ACUMEN—FIFTY YEARS AGO!

PEDIATRICS ◽

10.1542/peds.63.3.442 ◽

1979 ◽

Vol 63 (3) ◽

pp. 442-442

Author(s):

Julius H. Hess

Keyword(s):

Human Milk ◽

Premature Infants ◽

Human Body ◽

Growth And Development ◽

Artificial Feeding ◽

Artificial Food ◽

Contagious Diseases ◽

The Dead ◽

Breast Fed

There can be no comparison between the results to be expected in feeding premature infants on human milk, and those to be obtained with artificial food. With human milk taken from a well-regulated department for wet-nurses, the milk can be obtained fresh, practically sterile; it is more digestible; its constituents are of the quality and in the proportions required for the growth and development of the human body; and it is live, and contains many of the immunity-comferring properties, as evidenced by the resistance of a breast-fed infant to infections and contagious diseases. Most of these properties and advantages are lacking in the dead foods used in artificial feeding.

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Iron Deficiency and Iron Homeostasis in Low Birth Weight Preterm Infants: A Systematic Review

Nutrients ◽

10.3390/nu11051090 ◽

2019 ◽

Vol 11 (5) ◽

pp. 1090 ◽

Cited By ~ 5

Author(s):

Jorge Moreno-Fernandez ◽

Julio J. Ochoa ◽

Gladys O. Latunde-Dada ◽

Javier Diaz-Castro

Keyword(s):

Birth Weight ◽

Iron Deficiency ◽

Low Birth Weight ◽

Preterm Infants ◽

Premature Infants ◽

Systematic Reviews ◽

Growth And Development ◽

Iron Status ◽

Deficiency Anemia ◽

The Impact

Iron is an essential micronutrient that is involved in many functions in humans, as it plays a critical role in the growth and development of the central nervous system, among others. Premature and low birth weight infants have higher iron requirements due to increased postnatal growth compared to that of term infants and are, therefore, susceptible to a higher risk of developing iron deficiency or iron deficiency anemia. Notwithstanding, excess iron could affect organ development during the postnatal period, particularly in premature infants that have an immature and undeveloped antioxidant system. It is important, therefore, to perform a review and analyze the effects of iron status on the growth of premature infants. This is a transversal descriptive study of retrieved reports in the scientific literature by a systematic technique. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adapted for the review strategy. The inclusion criteria for the studies were made using the PICO (population, intervention, comparison, outcome) model. Consequently, the systematic reviews that included studies published between 2008–2018 were evaluated based on the impact of iron status on parameters of growth and development in preterm infants.

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Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu8080471 ◽

2016 ◽

Vol 8 (8) ◽

pp. 471 ◽

Cited By ~ 20

Author(s):

Arianna Aceti ◽

Davide Gori ◽

Giovanni Barone ◽

Maria Callegari ◽

Maria Fantini ◽

...

Keyword(s):

Systematic Review ◽

Human Milk ◽

Preterm Infants ◽

Enteral Feeding ◽

Meta Analysis ◽

Full Enteral Feeding

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Feeding the feeble: steps towards nourishing preterm infants

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0054 ◽

2015 ◽

Vol 43 (5) ◽

Cited By ~ 1

Author(s):

Michael Obladen

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Premature Infants ◽

Tube Feeding ◽

Theoretical Knowledge ◽

Air Inlet ◽

Nutritional Needs ◽

The 1960S ◽

Feeding Techniques

AbstractThis paper describes historic steps in feeding techniques and knowledge on the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920, including tube feeding by gavage, medicine droppers and pipettes, feeding bottles with an air inlet, and beaked spoons for nasal feeding. Indwelling nastrogastric tubes were in use from 1951. For alleged safety concerns in the 1950s, postnatal feeding was postponed until a week of starvation was reached, and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been established since 1919. However, these remained controversial, and nutritional practices continued to lag behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants who were fed formula than in those who were fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Nevertheless, compared with other aspects of neonatal medicine, there is still remarkably little evidence on how to feed preterm infants.

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Faculty Opinions recommendation of Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726622667.793555376 ◽

2019 ◽

Author(s):

Agostino Pierro

Keyword(s):

Systematic Review ◽

Human Milk ◽

Preterm Infants ◽

Enteral Feeding ◽

Meta Analysis ◽

Full Enteral Feeding

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Growth and Development in Preterm Infants: What is The Long-Term Risk?

Amerta Nutrition ◽

10.20473/amnt.v5i1sp.2021.27-33 ◽

2021 ◽

Vol 5 (1SP) ◽

pp. 27

Author(s):

Bernie Endyarni Medise

Keyword(s):

Immune System ◽

Birth Weight ◽

Gut Microbiota ◽

Preterm Infants ◽

Growth And Development ◽

Adequate Nutrition ◽

Nutrition Supplementation ◽

Catch Up ◽

The Impact

ABSTRACT Background: Indonesia comes in the fifth for the greatest number of preterm births. Preterm infants may inflict various complication as the result of underdeveloped immunity, affecting their growth and development in the long run until they reach adult phase. Such complications could be prevented through adequate nutrition fulfillment. Purpose: This article aimed to elaborate the characteristics of growth and development of premature babies, long term effect on the development and the impact of immunity and gut health of preterm infants in supporting their growth and development. Methods: References cited in this article were obtained from the latest primary literature within the last 10 years. Discussion: The rate and ability of infants to perform catch-up growth depends on the birth weight and gestation age, at which the lower birth weight and lower gestational age had slower rate. Brain structures that of preterm infants differ compared to the term, and these changes give rise to various clinical outcomes, including long term emotional, behavioral changes, cognitive and executive functioning. Immature immune system in preterm infants reduces the protective ability by innate and adaptive immunity in overcoming pathogens compared to term infants, including gut microbiota prematurity which affects nutrition absorption and growth and development catch up ability. Appropriate and adequate nutrition supplementation has shown beneficial effects in promoting the growth of normal gut flora, which allow better absorption of nutrition and therefore enhancing growth rate and supporting the development of preterm infants. Conclusions: Optimal growth and development of preterm infants are supported by sufficient nutrition supplementation to support the growth of gut microbiota, facilitating the catch-up growth and development of premature infants and immune system maturity.

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