Allergen Shedding in Human Milk from Mothers of Preterm Infants: Proteomic and Peptidomic Feasibility and Pilot Analysis

Rationale: There is little information regarding the allergen content of milk feeds in the preterm population. Previous studies have evaluated specific proteins/peptides via ELISA, but no studies have performed a broad analysis of the allergenic peptide content and protease activity of milk feeds in this population. Preterm infants spend a critical window of time for immune development in the Newborn Intensive Care Unit (NICU), and may receive fortified donor milk, maternal milk or formula feeds via nasogastric tube or bottle instead of fresh breastmilk via breastfeeding. Methods: To evaluate feasibility, we initially performed mass spectrometry on four human milk samples (two term and two preterm) from the Mommy’s Milk Human Milk Biorepository (HMB) which included maternal surveys of diet and environmental exposures. We analyzed the results against the University of Nebraska FASTA database and UniProt for a total of 2211 protein sequences. We then further analyzed 5 samples from the Microbiome, Atopy and Prematurity (MAP) pilot study along with formula and human milk fortifier controls and performed not only mass spectrometry, but also peptidomic and protease activity analysis. Results: Each HMB sample had between 806 and 1007 proteins, with 37 to 44 non-human proteins/sample encompassing 26 plant and animal species. Bovine proteins were the most numerous; seven unique Bos taurus proteins were found in all four samples, and three contained Bos d 5. Cat, dog, mosquito, salmon, and crab were detected in all four samples. All donors ingested fish, shellfish and tree nuts, and all had salmon and crab proteins in their milk samples; two almond proteins were detected in three samples. Aeroallergens, including dust mite (Der f 28, Der f 25) and mold (Cla h 4) were identified in all samples. Two samples contained allergens to latex (Hev b 9) and chicken (Gal d 10). One sample contained several unique proteins, including carrot, two molds (including Pen c 19) and Der f 33-like protein. In the preterm MAP samples, 784 digested non-human proteins were identified, 30 were non-bovine in origin. Proteins from 23 different species including aeroallergens, food, and contact allergens were identified. Protease activity was highest in human milk samples without human milk fortifier and lowest in preterm formula. Conclusions: These findings represent the first preterm milk feed mass spectrometry and protease analysis with identification of known allergenic proteins to food, contact and aeroallergens. The varying degree of protein detection may reflect variable individual secretion and augmentation of feeds. This raises questions of whether the composition of milk feeds in the NICU impact the development of atopic disease in the preterm population and whether the complex interaction between allergens, proteases, and other human milk components can serve to induce sensitization or tolerance to allergens in infants.

Peningkatan Pertumbuhan Bayi Kurang Bulan dengan Pemberian Human Milk Fortifier

Latar belakang. Bayi kurang bulan (BKB) mempunyai beberapa permasalahan yang berkaitan dengan proses metabolisme dan perkembangan fungsi oromotor yang belum matang sehingga berisiko terjadi kekurangan gizi. Pemberian human milk fortifier (HMF) menyediakan tambahan protein, mineral, dan vitamin untuk mengejar pertumbuhan.Tujuan. Menganalisis peningkatan pertumbuhan BKB sesuai masa kehamilan (SMK) dan kecil masa kehamilan (KMK) dengan pemberian HMF.Metode. Penelitian observasional dengan 30 BKB SMK dan 23 BKB KMK di RSDK pada Januari 2019-2020. Kriteria inklusi adalah bayi dengan berat lahir <1500 gram yang pemberian enteral telah mencapai 100 ml/kg/hari, SMK atau KMK. Data yang diambil berat badan (BB) setelah 7, 14, 21, dan 28 hari diberi HMF; panjang badan (PB) dan lingkar kepala (LK) setelah 28 hari diberi HMF, dianalisis dengan nilai p<0,05 adalah bermakna.Hasil. Setelah pemberian HMF yang sesuai dengan target pencapaian peningkatan pada PB dan LK, BKB lebih banyak pada kelompok SMK, pada BB lebih banyak pada kelompok KMK. Pencapaian peningkatan pertumbuhan BKB SMK dibandingkan KMK setelah diberi HMF tidak terdapat perbedaan yang bermakna.Kesimpulan. Bayi kurang bulan SMK dan KMK yang diberi HMF telah sesuai dengan target pencapaian peningkatan BB, PB, dan LK.

Effect of the Addition of Human Milk Fortifier to Breast Milk on the Early Recovery of Infants After Congenital Cardiac Surgery

Objective: This article studied the effect of breast milk supplemented with human milk fortifier (HMF) on the early recovery of infants after congenital cardiac surgery.Methods: Infants undergoing congenital cardiac surgery were randomly divided into an intervention group (n = 27) and a control group (n = 27). Infants in the intervention group received HMF, and those in the control group were exclusively breastfed. The nutritional indicators at discharge, the postoperative recovery status, and nutritional-related complications were recorded.Results: Compared with the control group at the time of discharge, the weight and albumin and prealbumin levels of the intervention group were significantly increased (P &lt; 0.05). The length of hospital stay of the intervention group was significantly reduced compared with that of the control group (P &lt; 0.05). Although the length of ICU stay for the intervention group was shorter than that of the control group, the difference was not significant (P &gt; 0.05). No significant difference in the incidence of postoperative nutrition-related complications was noted between the two groups (P &gt; 0.05).Conclusion: Compared with breastfeeding alone, with HMF can improve postoperative weight gains, reduce the length of stay, and promote infants' early recovery after congenital cardiac surgery.

Comparison of Very Low Birth Weight Preterm Infants with And Without Experienced Target Weight Gain on The Administration of Human Milk Fortifier

Background: Human milk fortifier (HMF) is defined as a supplement added to breastmilk to increase calories, proteins, vitamins, and various nutrition of breastmilk. The purpose of HMF administration is to increase the concentration of breastmilk nutrients to improve the weight of very low birth weight preterm infants. The administration of HMF is insufficient to fulfill protein needs in 20-40% very low birth weight babies, thus the weight gain did not meet the expected target.Objective: To analyze characteristic differences between very low birth weight preterm infants who experienced weight gain according to the target and not according to the target on the administration of HMF.Methods: An analytical study with a case-control approach comparing case and control group, which was observed to determine characteristic differences between both groups. The samples were 52 very low birth weight preterm infants obtained by consecutive sampling. Data analysis includes descriptive analysis and hypothesis testing. Results: Data were obtained from medical records and consisted of 52 participants, including 26 very low birth weight premature infants who experienced weight gain according to the target and 26 who experienced weight gain not according to the target. There was no characteristic difference of cyanosis clinical symptoms (OR 2.3; 95% CI 0.51-10.4), chest retraction (OR 1.0; 95% CI 0.32-3.1), apnea of prematurity comorbid (OR 1.0; 95% CI 0.25-3.9), neonatal infections (OR 0.62; 95% CI 0.21-1.9), starting age of HMF administration (OR 0.62; 95% CI 0.21-1.89), bloating (OR 0.57; 95% CI 0.17-1.9), and vomiting (OR 1.18; 95% CI 0.38-3.7) in both groups.Conclusion: There was no characteristic difference between very low birth weight preterm infants who experienced weight gain according to the target and not according to the target on the administration of HMF.