scholarly journals The Role of Dietary Fats in the Development and Prevention of Necrotizing Enterocolitis

Nutrients ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 145
Author(s):  
Belal N. Alshaikh ◽  
Adriana Reyes Loredo ◽  
Megan Knauff ◽  
Sarfaraz Momin ◽  
Shirin Moossavi
Keyword(s):  
Fatty Acids ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Postnatal Period ◽  
Dietary Fats ◽  
Microbial Colonization ◽  
Intestinal Development ◽  
Limited Effect ◽  
Mortality And Morbidity

Necrotizing enterocolitis (NEC) is a significant cause of mortality and morbidity in preterm infants. The pathogenesis of NEC is not completely understood; however, intestinal immaturity and excessive immunoreactivity of intestinal mucosa to intraluminal microbes and nutrients appear to have critical roles. Dietary fats are not only the main source of energy for preterm infants, but also exert potent effects on intestinal development, intestinal microbial colonization, immune function, and inflammatory response. Preterm infants have a relatively low capacity to digest and absorb triglyceride fat. Fat may thereby accumulate in the ileum and contribute to the development of NEC by inducing oxidative stress and inflammation. Some fat components, such as long-chain polyunsaturated fatty acids (LC-PUFAs), also exert immunomodulatory roles during the early postnatal period when the immune system is rapidly developing. LC-PUFAs may have the ability to modulate the inflammatory process of NEC, particularly when the balance between n3 and n6 LC-PUFAs derivatives is maintained. Supplementation with n3 LC-PUFAs alone may have limited effect on NEC prevention. In this review, we describe how various fatty acids play different roles in the pathogenesis of NEC in preterm infants.

scholarly journals Old and new adventures with fatty acids and their oxylipins: The road towards personalised clinical nutrition

OCL ◽  
2021 ◽  
Vol 28 ◽  
pp. 49
Author(s):  
Robert Gibson
Keyword(s):  
Fatty Acids ◽  
Preterm Birth ◽  
Cognitive Development ◽  
Preterm Infants ◽  
Dietary Fats ◽  
World Health ◽  
Blood Levels ◽  
Omega 3 Fatty Acids ◽  
Omega 3

After paying homage to the work of E. Chevreul, Prof. Robert Gibson went on in a lighthearted way to find similarities in the way they both approached their respective fields of research, as well as their way of life. Prof. Robert Gibson, who was awarded the 2021 Chevreul Medal, reported that “his huge delight was to witness the massive growth of lipid research and to have played a role in elucidating the role of dietary fats in the health of mothers and their babies”. Prof. Gibson highlighted some of the major results he collected from Australian clinical studies conducted on the role of omega-3 fatty acids on the health outcomes of mothers and their infants. He first discussed the role of fish oil on visual acuity of babies and demonstrated that infant formulas supplying more than 1% of linolenic acid (ALA) seemed adequate to ensure optimal visual and cognitive development of term infants. However, in preterm infants, whether there is a specific need for DHA above the benefit provided by ALA, still needs to be clarified. He reported a small beneficial impact on the cognitive development of preterm infants receiving DHA enriched breast milk of their mothers (1% of total fatty acids). He then discussed data from his large randomised clinical trials conducted on pregnant women receiving a DHA dietary treatment (800 mg/d DHA) or placebo, that suggested that DHA may decrease the risk of preterm birth (DOMInO trial, 2400 women). This effect was confirmed in the ORIP trial (5400 women) which found that preterm birth could be prevented by a DHA supplement treatment mainly in women with a singleton pregnancy who had a low omega-3 status in the first trimester. In the last part of his review, Robert Gibson described the use of a new low cost, rapid and efficient method to monitor changes in blood levels of omega-3 fatty acids with clinical outcomes: the Dried Blood Spots (DBS) technology. The validation of this technique has been demonstrated in large trials like N3RO and ORIP involving large cohorts of women, which could not have been obtained easily by classical analysis of lipids. He went on to point out that free fatty acids (generally not explored despite their importance in many metabolic disorders) and oxylipins, are both stable and easily identified when they are preserved in a dry state on a paper matrix (DBS), thus opening new fields of research. To conclude, the major impact of Prof. Robert Gibson’s work was identifying and overcoming one of the causes of early preterm birth (omega-3 deficiency), developing a tool to rapidly assess omega-3 status (the DBS technique) that together is close to being implemented into the world health system.

Glucocorticosteroids effects on brain development in the preterm infants: a role for microglia?

2021 ◽  
Vol 19 ◽  
Author(s):  
Zinni Manuela ◽  
Pansiot Julien ◽  
Elodie Billion ◽  
Baud Olivier ◽  
Mairesse Jérôme
Keyword(s):  
Brain Development ◽  
Preterm Infants ◽  
Adverse Outcomes ◽  
Mortality And Morbidity ◽  
Respiratory Problems ◽  
Neurodevelopmental Impairment ◽  
Short And Long Term ◽  
Abnormal Brain

: Prematurity, observed in 15 million births worldwide each year, is a clinical condition that is a major cause of neonatal mortality and morbidity in short and long term. Preterm infants are at high risk for developing respiratory problems, sepsis, and other morbidities leading to neurodevelopmental impairment and neurobehavioral disorders. Perinatal glucocorticosteroids have been widely used for the prevention and treatment of adverse outcomes linked to prematurity. However, despite their shortterm benefits due to their maturational properties, some clinical trials have shown an association between steroids exposure and abnormal brain development in infants born preterm. Neuroinflammation has emerged as a preeminent factor for brain injury in preterm infants, and the major role of microglia, the brain resident immune cells, has been recently highlighted. Considering the role of microglia in the modulation of brain development, the aim of this review is to summarize the effects of endogenous and exogenous glucocorticosteroids on brain development and discuss the possible role of microglia as a mediator of these effects.

scholarly journals The Role of Human Milk Oligosaccharides and Probiotics on the Neonatal Microbiome and Risk of Necrotizing Enterocolitis: A Narrative Review

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3052
Author(s):  
Lila S. Nolan ◽  
Jamie M. Rimer ◽  
Misty Good
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Mode Of Delivery ◽  
Intestinal Barrier ◽  
Vulnerable Population ◽  
Human Milk Oligosaccharides ◽  
Milk Oligosaccharides ◽  
Intestinal Homeostasis

Preterm infants are a vulnerable population at risk of intestinal dysbiosis. The newborn microbiome is dominated by Bifidobacterium species, though abnormal microbial colonization can occur by exogenous factors such as mode of delivery, formula feeding, and exposure to antibiotics. Therefore, preterm infants are predisposed to sepsis and necrotizing enterocolitis (NEC), a fatal gastrointestinal disorder, due to an impaired intestinal barrier, immature immunity, and a dysbiotic gut microbiome. Properties of human milk serve as protection in the prevention of NEC. Human milk oligosaccharides (HMOs) and the microbiome of breast milk are immunomodulatory components that provide intestinal homeostasis through regulation of the microbiome and protection of the intestinal barrier. Enteral probiotic supplements have been trialed to evaluate their impact on establishing intestinal homeostasis. Here, we review the protective role of HMOs, probiotics, and synbiotic combinations in protecting a vulnerable population from the pathogenic features associated with necrotizing enterocolitis.

scholarly journals Incomplete antenatal steroid therapy can enhance outcomes in preterm infants with emergency conditions

2019 ◽  
pp. 1
Author(s):  
Sebnem Calkavur ◽  
Senem Alkan Özdemir ◽  
Ruya Colak ◽  
Ezgi Yangin Ergon ◽  
Ferit Kulali ◽  
...  
Keyword(s):  
Single Dose ◽  
Preterm Infants ◽  
Steroid Therapy ◽  
Statistical Difference ◽  
Prospective Observational Study ◽  
Mortality And Morbidity ◽  
Antenatal Steroid ◽  
One Year ◽  
The One

<p><strong>Objective</strong>: We aimed to investigate the role of incomplete  of antenatal steroid therapy by comparing with no and complete steroid exposure on mortality and morbidity in preterm infants.</p><p><strong>Methods:</strong>This is a prospective,observational study which includes preterm infants of 32 weeks of gestation and/or≤1500 grams who were referred to Izmir Dr.Behçet Uz Children's Hospital NICU during the one year period. Infants were divided into three groups according to the administration of antenatal steroid as those who received incomplete-dose antenatal steroid, complete dose steroid therapy  and those with no steroid exposure. Intubation at delivery room, surfactant requirement,the inotropic requirement in the first 72 hours and morbidities associated with prematurity were determined as the primary results. Mortality and bronchopulmonary dysplasia at discharge and stage ≥2 retinopathy were analyzed as secondary outcomes.<strong></strong></p><p><strong>Results:</strong> We found that 54 infants were born with a incomplete dose, 55 infants with complete dose and 38 infants with no steroid therapy. Surfactant requirement, ,intubation requirement,inotropic requirement and hsPDA were lower in the steroid  group leading to a statistical difference (p&lt;0.05).Also it was found that mortality and BPD were lower in the single-dose group,leading to a statistical difference (p&lt;0.05).</p><p><strong><em>Conclusion</em></strong><em>:</em>We speculate that even single-dose steroid may reduce mortality by reducing RDS.</p>

The Role of Probiotics in the Prevention of Necrotizing Enterocolitis

2019 ◽  
Vol 15 (2) ◽  
pp. 88-91 ◽  
Author(s):  
Ivana Trivić ◽  
Ana Savić Mlakar ◽  
Iva Hojsak
Keyword(s):  
Gastrointestinal Tract ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Preventive Strategies ◽  
Life Threatening ◽  
Probiotic Strains ◽  
Considerable Benefit ◽  
Nutritional Strategies

Necrotizing enterocolitis (NEC) is a frequent and severe life-threatening disease affecting the gastrointestinal tract of preterm infants. Given that NEC occurs in a well-defined population of patients, there might be a considerable benefit in identifying specific pharmacological and nutritional preventive strategies, that could reduce the incidence of NEC. Amongst nutritional strategies emphasis has been put on the use of probiotics. Therefore, the aim of this review is to summarize currently available evidence on the role of probiotics in general, as well as the role of specific probiotic strains or their combinations, in the prevention of NEC.

scholarly journals Parenteral lipid emulsions induce unique ileal fatty acid and metabolomic profiles but do not increase the risk of necrotizing enterocolitis in preterm pigs

2020 ◽  
Author(s):  
William Yakah ◽  
Pratibha Singh ◽  
Joanne Brown ◽  
Barbara Stoll ◽  
Douglas G. Burrin ◽  
...  
Keyword(s):  
Fatty Acid ◽  
Fish Oil ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Tissue Injury ◽  
Fatty Acid Analysis ◽  
Postnatal Period ◽  
Distal Ileum ◽  
Lipid Emulsions ◽  
Fatty Acid Profiles

Background: Necrotizing enterocolitis (NEC) is a manifestation of maladaptive intestinal responses in preterm infants centrally medicated by unattenuated inflammation. Early in the postnatal period, preterm infants develop a deficit in arachidonic and docosahexaenoic acid, both potent regulators of inflammation. We hypothesized that the fatty acid composition of parenteral lipid emulsions uniquely induces blood and intestinal fatty acid profiles which, in turn, modifies the risk of NEC development. Methods: 42 preterm pigs were randomized to receive one of three lipid emulsions containing 100% soybean oil (SO), 15% fish oil (MO15), or 100% fish oil (FO100) with enteral feedings over an 8-day protocol. Blood and distal ileum tissue were collected for fatty acid analysis. The distal ileum underwent histologic, proteomic, and metabolomic analyses. Results: Eight pigs (3/14 SO (21 %), 3/14 MO15 (21%), and 2/14 FO100 (14%)) developed NEC. No differences in NEC risk were evident between groups despite differences in induced fatty acid profiles in blood and ileal tissue. Metabolomic analysis of NEC vs no NEC tissue revealed differences in tryptophan metabolism and arachidonic acid-containing glycerophospholipids. Proteomic analysis demonstrated no differences by lipid group; however, 15 proteins differentiated NEC vs no NEC in the domains of tissue injury, glucose uptake and chemokine signaling. Conclusions: Exposure to parenteral lipid emulsions induces unique intestinal fatty acid and metabolomic profiles, however, these profiles are not linked to a difference in NEC development. Metabolomic and proteomic analyses of NEC vs no NEC intestinal tissue provide mechanistic insights into the pathogenesis of NEC in preterm infants.

scholarly journals Probiotics, Prebiotics, and Synbiotics for the Prevention of Necrotizing Enterocolitis

2021 ◽  
Vol 8 ◽  
Author(s):  
Kiera Murphy ◽  
R. Paul Ross ◽  
C. Anthony Ryan ◽  
Eugene M. Dempsey ◽  
Catherine Stanton
Keyword(s):  
Gut Microbiota ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Early Life ◽  
Observational Studies ◽  
Meta Analysis ◽  
Randomized Controlled ◽  
Routine Administration ◽  
Gut Microbiota Composition

Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in preterm infants. The exact mechanism by which NEC develops is poorly understood however there is growing evidence to suggest that perturbations in the early-life gut microbiota composition increase the risk for NEC. Modulation of the gut microbiota with probiotics, prebiotics, or in combination (synbiotics) is an area which has attracted intense interest in recent years. In this narrative review, we present an overview of the role of the gut microbiota in the pathogenesis of NEC. We also examine the evidence currently available from randomized controlled trials, observational studies, systematic reviews, and meta-analysis examining the role of probiotics, prebiotics, and synbiotics in reducing the risk of or preventing NEC. Current clinical practice guidelines with recommendations on the routine administration of probiotics to preterm infants for NEC are also explored.

scholarly journals Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 192
Author(s):  
Isadora Beghetti ◽  
Davide Panizza ◽  
Jacopo Lenzi ◽  
Davide Gori ◽  
Silvia Martini ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Relative Effect ◽  
Outcome Data ◽  
Feeding Type ◽  
Credible Intervals ◽  
Meta Analyses

Background: Recent evidence supports a role of probiotics in preventing necrotizing enterocolitis (NEC) in preterm infants. Methods: A systematic review and network meta-analysis of randomized controlled trials (RCTs) on the role of probiotics in preventing NEC in preterm infants, focusing on the differential effect of type of feeding, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used; a subgroup analysis on exclusively human milk (HM)-fed infants vs. infants receiving formula (alone or with HM) was performed. Results: Fifty-one trials were included (10,664 infants, 29 probiotic interventions); 31 studies (19 different probiotic regimens) were suitable for subgroup analysis according to feeding. In the overall analysis, Lactobacillus acidophilus LB revealed the most promising effect for reducing NEC risk (odds ratio (OR), 0.03; 95% credible intervals (CrIs), 0.00–0.21). The subgroup analysis showed that Bifidobacterium lactis Bb-12/B94 was associated with a reduced risk of NEC stage ≥2 in both feeding type populations, with a discrepancy in the relative effect size in favour of exclusively HM-fed infants (OR 0.04; 95% CrIs <0.01–0.49 vs. OR 0.32; 95% CrIs 0.10–0.36). Conclusions: B. lactis Bb-12/B94 could reduce NEC risk with a different size effect according to feeding type. Of note, most probiotic strains are evaluated in few trials and relatively small populations, and outcome data according to feeding type are not available for all RCTs. Further trials are needed to confirm the present findings.

scholarly journals Breast Milk Lipids and Fatty Acids in Regulating Neonatal Intestinal Development and Protecting against Intestinal Injury

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 534 ◽  
Author(s):  
David Ramiro-Cortijo ◽  
Pratibha Singh ◽  
Yan Liu ◽  
Esli Medina-Morales ◽  
William Yakah ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Breast Milk ◽  
Human Milk ◽  
Preterm Infants ◽  
Gastrointestinal Disease ◽  
Essential Fatty Acids ◽  
Intestinal Injury ◽  
Human Breast Milk ◽  
Intestinal Development ◽  
Human Breast

Human breast milk is the optimal source of nutrition for infant growth and development. Breast milk fats and their downstream derivatives of fatty acids and fatty acid-derived terminal mediators not only provide an energy source but also are important regulators of development, immune function, and metabolism. The composition of the lipids and fatty acids determines the nutritional and physicochemical properties of human milk fat. Essential fatty acids, including long-chain polyunsaturated fatty acids (LCPUFAs) and specialized pro-resolving mediators, are critical for growth, organogenesis, and regulation of inflammation. Combined data including in vitro, in vivo, and human cohort studies support the beneficial effects of human breast milk in intestinal development and in reducing the risk of intestinal injury. Human milk has been shown to reduce the occurrence of necrotizing enterocolitis (NEC), a common gastrointestinal disease in preterm infants. Preterm infants fed human breast milk are less likely to develop NEC compared to preterm infants receiving infant formula. Intestinal development and its physiological functions are highly adaptive to changes in nutritional status influencing the susceptibility towards intestinal injury in response to pathological challenges. In this review, we focus on lipids and fatty acids present in breast milk and their impact on neonatal gut development and the risk of disease.

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