From Mum to Bum: An Observational Study Protocol to Follow Digestion of Human Milk Oligosaccharides and Glycoproteins from Mother to Preterm Infant

The nutritional requirements of preterm infants are challenging to meet in neonatal care, yet crucial for their growth, development and health. Aberrant maturation of the gastrointestinal tract and the microbiota could affect the digestion of human milk and its nutritional value considerably. Therefore, the main objective of the proposed research is to investigate how the intestinal microbiota of preterm and full-term infants differ in their ability to extract energy and nutrients from oligosaccharides and glycoproteins in human milk. This pilot study will be an observational, single-center study performed at the Neonatal Intensive Care Unit at Isala Women and Children’s Hospital (Zwolle, The Netherlands). A cohort of thirty mother–infant pairs (preterm ≤30 weeks of gestation, n = 15; full-term 37–42 weeks of gestation, n = 15) will be followed during the first six postnatal weeks with follow-up at three- and six-months postnatal age. We will collect human milk of all mothers, gastric aspirates of preterm infants and fecal samples of all infants. A combination of 16S rRNA amplicon sequencing, proteomics, peptidomics, carbohydrate analysis and calorimetric measurements will be performed. The role of the microbiota in infant growth and development is often overlooked yet offers opportunities to advance neonatal care. The ‘From Mum to Bum’ study is the first study in which the effect of a preterm gut microbiota composition on its metabolic capacity and subsequent infant growth and development is investigated. By collecting human milk of all mothers, gastric aspirates of preterm infants and fecal samples of all infants at each timepoint, we can follow digestion of human milk from the breast of the mother throughout the gastrointestinal tract of the infant, or ‘From Mum to Bum’.

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Platelets in the neonatal period: developmental differences in platelet production, function, and hemostasis and the potential impact of therapies

Hematology ◽

10.1182/asheducation.v2012.1.506.3798532 ◽

2012 ◽

Vol 2012 (1) ◽

pp. 506-511 ◽

Cited By ~ 46

Author(s):

Martha Sola-Visner

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Developmental Differences ◽

Full Term ◽

Term Infants ◽

Platelet Production ◽

Primary Hemostasis ◽

Wall Interaction ◽

And Function

Abstract Thrombocytopenia is a common problem among sick neonates admitted to the neonatal intensive care unit. Frequently, platelet transfusions are given to thrombocytopenic infants in an attempt to decrease the incidence or severity of hemorrhage, which is often intracranial. Whereas there is very limited evidence to guide platelet transfusion practices in this population, preterm infants in the first week of life (the highest risk period for bleeding) are nearly universally transfused at higher platelet counts than older infants or children. To a large extent, this practice has been influenced by the observation that neonatal platelets are hyporeactive in response to multiple agonists in vitro, although full-term infants exhibit normal to increased primary hemostasis. This apparently paradoxical finding is due to factors in the neonatal blood that enhance the platelet-vessel wall interaction and counteract the platelet hyporeactivity. Relatively few studies have evaluated the platelet function and primary hemostasis of preterm infants, the subset of neonates at highest risk of bleeding and those most frequently transfused. Current understanding of platelet production and function in preterm and full-term neonates, how these factors affect their response to thrombocytopenia and their primary hemostasis, and the implications of these developmental differences to transfusion medicine are reviewed herein.

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Anxiety, Dysphoria, and Depression Symptoms in Mothers of Preterm Infants

Psychological Reports ◽

10.2466/pr0.104.2.667-679 ◽

2009 ◽

Vol 104 (2) ◽

pp. 667-679 ◽

Cited By ~ 20

Author(s):

Flávia Helena Pereira Padovani ◽

Ana Emília Vita Carvalho ◽

Geraldo Duarte ◽

Francisco Eulogio Martinez ◽

Maria Beatriz Martins Linhares

Keyword(s):

Preterm Infants ◽

State Anxiety ◽

Neonatal Intensive Care ◽

Clinical Symptoms ◽

Clinical Status ◽

Full Term ◽

Depression Symptoms ◽

Health Staff ◽

Term Infants ◽

Mothers Of Preterm Infants

To compare presence and severity of clinical symptoms of anxiety, dysphoria, and depression in mothers of preterm and of full-term infants and to observe changes in symptoms of mothers of preterm infants during hospitalization of the infants and after discharge, 50 mothers of preterm infants and 25 mothers of full-term infants completed the State-Trait Anxiety Inventory and the Beck Depression Inventory. The mothers with preterm infants had significantly higher clinical symptoms of State Anxiety during hospitalization than the group with full-term infants, but the clinical symptoms of anxiety in mothers of preterm infants decreased significantly after discharge. The health staff in a neonatal intensive care unit should not only be aware of infants' clinical status but also of the mothers' emotional state.

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Maturation of the preterm gastrointestinal tract can be defined by host and microbial markers for digestion and barrier defense

Scientific Reports ◽

10.1038/s41598-021-92222-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jannie G. E. Henderickx ◽

Romy D. Zwittink ◽

Ingrid B. Renes ◽

Richard A. van Lingen ◽

Diny van Zoeren-Grobben ◽

...

Keyword(s):

Enzyme Activity ◽

Gastrointestinal Tract ◽

Preterm Infants ◽

Early Life ◽

Growth And Development ◽

Stress Proteins ◽

Term Infants ◽

Gastrointestinal Barrier ◽

Related Proteins ◽

Single Center Observational Study

AbstractFunctionality of the gastrointestinal tract is essential for growth and development of newborns. Preterm infants have an immature gastrointestinal tract, which is a major challenge in neonatal care. This study aims to improve the understanding of gastrointestinal functionality and maturation during the early life of preterm infants by means of gastrointestinal enzyme activity assays and metaproteomics. In this single-center, observational study, preterm infants born between 24 and 33 weeks (n = 40) and term infants born between 37 and 42 weeks (n = 3), who were admitted to Isala (Zwolle, the Netherlands), were studied. Enzyme activity analyses identified active proteases in gastric aspirates of preterm infants. Metaproteomics revealed human milk, digestive and immunological proteins in gastric aspirates of preterm infants and feces of preterm and term infants. The fecal proteome of preterm infants was deprived of gastrointestinal barrier-related proteins during the first six postnatal weeks compared to term infants. In preterm infants, bacterial oxidative stress proteins were increased compared to term infants and higher birth weight correlated to higher relative abundance of bifidobacterial proteins in postnatal week 3 to 6. Our findings indicate that gastrointestinal and beneficial microbial proteins involved in gastrointestinal maturity are associated with gestational and postnatal age.

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Infant–Father Attachment in Infants Born Preterm - A Brief Report

International Journal of Developmental Science ◽

10.3233/dev-200299 ◽

2021 ◽

pp. 1-6

Author(s):

Ruediger Kissgen ◽

Sebastian Franke ◽

Nino Jorjadze ◽

Bernhard Roth ◽

Angela Kribs

Keyword(s):

Preterm Infants ◽

Full Term ◽

Strange Situation ◽

Term Infants ◽

Attachment Quality ◽

Attachment Research ◽

Neurodevelopmental Problems ◽

Strange Situation Procedure ◽

Father Attachment

This study examines the infant–father attachment in infants born preterm (< 1500 g at birth and/or < 37 weeks gestation) in comparison to full-term infants. The infant–father attachment was assessed using the Strange Situation Procedure at a (corrected) age of 15 months. We found at least half of preterm and full-term infants (50.0% and 56.5 % respectively) securely attached to their fathers, and no significant overall difference was observed concerning the distribution of attachment quality comparing the two groups. In light of the fact that preterm infants tend to have numerous neurodevelopmental problems, it is encouraging that significant differences were not found in the distribution of the attachment quality among the groups. Therefore, from the perspective of attachment research, it would be highly beneficial to include fathers in the care of their preterm infants.

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Longitudinal Changes in the Concentration of Major Human Milk Proteins in the First Six Months of Lactation and Their Effects on Infant Growth

Nutrients ◽

10.3390/nu13051476 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1476

Author(s):

Jian Zhang ◽

Ai Zhao ◽

Shiyun Lai ◽

Qingbin Yuan ◽

Xiaojiang Jia ◽

...

Keyword(s):

Human Milk ◽

Maternal Education ◽

Mode Of Delivery ◽

Milk Proteins ◽

Protein Composition ◽

Infant Growth ◽

Term Infants ◽

Longitudinal Changes ◽

Milk Samples ◽

The Impact

Our knowledge related to human milk proteins is still limited. The present study determined the changes in multiple human milk proteins during the first six months of lactation, investigated the influencing factors of milk proteins, and explored the impact of milk proteins on infant growth. A total of 105 lactating women and their full-term infants from China were prospectively surveyed in this research. Milk samples were collected at 1–5 days, 8–14 days, 1 month, and 6 months postpartum. Concentrations of total protein and α-lactalbumin were measured in all milk samples, and concentrations of lactoferrin, osteopontin, total casein, β-casein, αs−1 casein, and κ-casein were measured in milk from 51 individuals using ultra performance liquid chromatography coupled with mass spectrometry. The concentration of measured proteins in the milk decreased during the first six months of postpartum (p-trend < 0.001). Maternal age, mode of delivery, maternal education, and income impacted the longitudinal changes in milk proteins (p-interaction < 0.05). Concentrations of αs−1 casein in milk were inversely associated with the weight-for-age Z-scores of the infants (1 m: r −0.29, p 0.038; 6 m: r −0.33, p 0.020). In conclusion, the concentration of proteins in milk decreased over the first six months postpartum, potentially influenced by maternal demographic and delivery factors. Milk protein composition may influence infant weights.

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WEIGHT GAINS IN THE FIRST FOUR WEEKS OF INFANCY: A COMPARISON OF THREE DIETS

PEDIATRICS ◽

10.1542/peds.18.3.362 ◽

1956 ◽

Vol 18 (3) ◽

pp. 362-368

Author(s):

Ruth T. Gross ◽

Lincoln E. Moses

Keyword(s):

Human Milk ◽

Statistical Methods ◽

Full Term ◽

Clinical Judgement ◽

Careful Selection ◽

Term Infants ◽

Weight Gains ◽

The Many ◽

Selection Of

Four hundred seven healthy, full-term infants were divided into three groups and fed, respectively, a formula of evaporated milk and water with 5% carbohydrate; human milk; and a special modified evaporated milk designed to simulate human milk. No other foods were added to the diet. A comparison of the three groups was made, based on weight gains from birth to the end of the first 4 weeks. The conclusions refer only to weight gains; no attempt was made to determine the superiority of any particular diet. The data show no significant differences in the 4-week weight gains among the three groups of infants, although sensitive statistical methods could be validly applied to the problem. These methods are explained. The authors wish to emphasize the many variables which must be taken into account in a study of this sort; the necessity for careful selection of valid statistical methods; the importance of critical clinical judgement in the evaluation of the results.

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Reduction in Obstructive Breathing Events During Body Rocking: A Controlled Polygraphic Study in Preterm and Full-Term Infants

PEDIATRICS ◽

10.1542/peds.96.1.64 ◽

1995 ◽

Vol 96 (1) ◽

pp. 64-68

Author(s):

J. Groswasser ◽

M. Sottiaux ◽

E. Rebuffat ◽

T. Simon ◽

M. Vandeweyer ◽

...

Keyword(s):

Eye Movement ◽

Preterm Infants ◽

Upper Airway ◽

Periodic Breathing ◽

Full Term ◽

Rapid Eye Movement ◽

Term Infants ◽

Obstructive Sleep ◽

Significant Difference ◽

Obstructive Sleep Apneas

Objective. To investigate the effect of body rocking on infant respiratory behavior during sleep. Methods. Eighteen infants with documented obstructive sleep apneas were studied. There were eight premature infants with persistent bradycardias and 10 infants born full-term, admitted after an idiopathic apparent life-threatening event. No cause for the obstructive apneas was found. The infants were recorded with polygraphic techniques during two successive nights. They were randomly assigned to a rocking or a nonrocking mattress. The conditions were reversed the following night, in a crossover design. Results. In both groups of infants, no significant difference was seen between the two consecutive nights for most of the variables studied: total sleep time, the proportion of non-rapid-eye-movement and rapid-eye-movement sleep, the number of arousals, the number and maximal duration of central apneas, the frequency of periodic breathing, the level of oxygen saturation, and heart rate. During the nonrocking nights, all infants had repeated obstructive breathing events. In seven of the eight preterm infants and in nine of the 10 full-term subjects, body rocking was associated with a significant decrease in the frequency of obstructive events. During rocking, in the preterm infants the obstructions fell from a median of 2.5 to 1.8 episodes per hour (P = .034). In the full-term infants, rocking reduced the obstructive events from a median of 1.5 obstructions per hour to 0.7 (P = .005). No difference was seen for the duration of the obstructive episodes. Conclusion. In preterm and full-term infants prone to obstructive sleep apneas, gentle side-to-side body rocking is associated with a significant decrease in the frequency of upper-airway obstructions.

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Vaccinations in Infants Born Preterm: An Update

Current Pediatric Reviews ◽

10.2174/157339631666620011609445 ◽

2020 ◽

Vol 16 (2) ◽

pp. 148-155

Author(s):

Areti Aphrodite Sioriki ◽

Despoina Gkentzi ◽

Evangelia Papadimitriou ◽

Gabriel Dimitriou ◽

Ageliki Karatza

Keyword(s):

Preterm Infants ◽

Vaccine Safety ◽

Full Term ◽

Morbidity And Mortality ◽

Term Infants ◽

Safety And Efficacy ◽

Vaccine Preventable Diseases ◽

Increased Risk ◽

Protective Antibodies

Infants born prematurely (before completion of 37 weeks of gestation) are at increased risk of morbidity and mortality due to vaccine preventable diseases, mostly because of their immunological immaturity and failure of transfer of maternal protective antibodies. Despite their great need of being vaccinated, concerns on vaccine safety and efficacy, constitute the main reasons for which vaccinations are often delayed in this group. In this review we summarize the latest evidence on vaccine safety, efficacy and immunogenicity in preterm infants which is similar to full-term infants. Therefore there is no reason for delaying vaccination in this population.

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

Amerta Nutrition ◽

10.20473/amnt.v5i1sp.2021.14-20 ◽

2021 ◽

Vol 5 (1SP) ◽

pp. 14

Author(s):

Ariani Dewi Widodo

Keyword(s):

Gut Microbiota ◽

Human Milk ◽

Preterm Infants ◽

Premature Infants ◽

Growth And Development ◽

Gastrointestinal Microbiome ◽

Gut Dysbiosis ◽

Complex Ecosystem ◽

Full Enteral Feeding ◽

Lower Morbidity

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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Commentary on Breast-Feeding and Infant Formulas, Including Proposed Standards for Formulas

PEDIATRICS ◽

10.1542/peds.57.2.278 ◽

1976 ◽

Vol 57 (2) ◽

pp. 278-285

Author(s):

Lewis A. Barness ◽

Alvin M. Mauer ◽

Malcolm A. Holliday ◽

Arnold S. Anderson ◽

Peter R. Dallman ◽

...

Keyword(s):

Human Milk ◽

Breast Feeding ◽

Growth And Development ◽

Good Growth ◽

Infant Formulas ◽

Special Group ◽

Term Infants ◽

Excess Lead ◽

Milk Substitute ◽

Mineral Levels

This statement proposes recommendations toward increasing the practice of breast feeding. Specific recommendations made for standards of infant formulas as to calorie, protein, fat, vitamin, and mineral levels apply to both milk-based and milk-substitute infant formulas. Such formulas, when used in place of breast-feeding, must supply most or all of the nutrients infants require during the first weeks or months of life. The minimum levels of nutrients per 100 kcal recommended for formulas provide good growth and development in healthy, full-term infants; distinct hazards may be encountered at levels below these. However, no significant advantage is to be gained by providing levels in excess of these minima in normal infants. Recommendations for maximum levels are made only where quantities in excess lead to toxicity; generally, levels near the minima recommended are most desirable because they are the most likely to reflect the composition of human milk, and the least likely to result in any undesirable nutrient to nutrient interaction. The recommendations also can be used as reference standards for formulas for special dietary uses of "medical" formulas. The Committee recommends that "medical" formulas be classified by FDA into a special group under the paragraph dealing with infant formulas.

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