Human milk and necrotizing enterocolitis
Section snippets
Objectives
- 1.
To review the known and potential protective factors in human milk that may reduce NEC
- 2.
To review the data that support a protective benefit of mother’s own milk, pasteurized donor human milk, and an “all-human” diet
- 3.
To review evidence for practical implementation of human milk in the NICU
The known and potential protective factors in human milk that may reduce NEC
The intestinal tract of a preterm infant is particularly vulnerable to injury and inflammation due to factors related to immaturity (Table 1). Enteral nutrition is a key factor in the development of NEC as it rarely occurs in preterm infants before enteral feeds begin. Also, enteral feeds impact the risk of NEC with reduced NEC rates associated with HM feedings in contrast to formula feedings.11, 12 Human and animal studies have demonstrated that bovine-based formula increases intestinal
MOM
Multiple clinical studies have demonstrated a dose-dependent relationship between MOM feeding and significant reductions in NEC. The MOM dose received during the first 14 days demonstrated increased survival time free of NEC with each 10% increase in MOM (Figure 1).11 Over the first 14 days, exclusive HM feedings, MOM and/or DHM, for the first 7 days47 and exclusive MOM for the first 14 days of life12 have been associated with significantly reduced odds of developing NEC. Two other thresholds
Evidence for feasibility of increasing utilization of human milk in the NICU
Increasing utilization of human milk in the NICU presents an important challenge. Expanding on the beneficial effects of the Baby Friendly Hospital Initiative in encouraging mothers of healthy term infants to breastfeed more, many institutions have been able to begin incorporating similar basic steps in the NICU to encourage a stronger culture for the use of human milk, MOM, and DHM.61, 62, 63 Multiple guidelines and examples have been published describing best practices to implement HM in the
Summary
Human milk contains numerous bioactive components that reduce the incidence and severity of NEC. MOM feedings supported with HMF compared to preterm formula provides the optimal nutrition for preterm infants that are associated with the lowest risk for NEC. Substitution of formula with DHM has been associated with reduction in risk of NEC, but since DHM differs significantly from MOM the emphasis on maximizing MOM is the best practice. Human milk-based HMF may add further to this protection
References (82)
- et al.
A critical question for NEC researchers: can we create a consensus definition of NEC that facilitates research progress?
Semin Perinatol
(2017) - et al.
Reducing incidence of necrotizing enterocolitis
Clin Perinatol
(2017) Necrotizing enterocolitis: the road to zero
Semin Fetal Neonatal Med
(2014)- et al.
Donor human milk update: evidence, mechanisms, and priorities for research and practice
J Pediatr
(2017) - et al.
Using quality improvement to increase human milk use for preterm infants
Semin Perinatol
(2017) - et al.
Early enteral feeding in very low birth weight infants
Early Hum Dev
(2014) - et al.
At the dawn of a new discovery: the potential of breast milk stem cells
Adv Nutr
(2014) Bioactive proteins in human milk: mechanisms of action
J Pediatr
(2010)- et al.
Human milk components modulate toll-like receptor-mediated inflammation
Adv Nutr
(2016) - et al.
Human-milk glycans that inhibit pathogen binding protect breast-feeding infants against infectious diarrhea
J Nutr
(2005)
Variation of metabolite and hormone contents in human milk
Clin Perinatol
Improving human milk and breastfeeding practices in the NICU
J Obstet Gynecol Neonatal Nurs
Improving the use of human milk during and after the NICU stay
Clin Perinatol
Challenges in the practice of human milk nutrition in the neonatal intensive care unit
Early Hum Dev
Quality initiatives related to moderately preterm, late preterm, and early term births
Clin Perinatol
Nutritional and physiologic significance of human milk proteins
Am J Clin Nutr
Bioactive proteins in human milk: health, nutrition, and implications for infant formulas
J Pediatr
Human milk composition: nutrients and bioactive factors
Pediatr Clin North Am
Necrotizing enterocolitis
N Engl J Med
Intestinal microbiota and its relationship with necrotizing enterocolitis
Pediatr Res
Can a national dataset generate a nomogram for necrotizing enterocolitis onset?
J Perinatol
The impact of a regional care bundle on maternal breast milk use in preterm infants: outcomes of the east of England quality improvement programme
Arch Dis Child Fetal Neonatal Ed
Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death
J Perinatol
Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants
Neonatology
Suppressive effects of breast milk on oxidative DNA damage in very low birthweight infants
Arch Dis Child Fetal Neonatal Ed
Digested formula but not digested fresh human milk causes death of intestinal cells in vitro: implications for necrotizing enterocolitis
Pediatr Res
Longitudinal study of cytokine expression, lipid profile and neuronal growth factors in human breast milk from term and preterm deliveries
Nutrients
Concentrations of epidermal growth factor and transforming growth factor-alpha in preterm milk
Adv Exp Med Biol
Innate recognition of bacteria in human milk is mediated by a milk-derived highly expressed pattern recognition receptor, soluble CD14
J Exp Med
Human milk oligosaccharides in premature infants: absorption, excretion, and influence on the intestinal microbiota
Pediatr Res
The role of immunonutrients in the prevention of necrotizing enterocolitis in preterm very low birth weight infants
Nutrients
Human milk: a source of more life than we imagine
Benef Microbes
Immune markers in breast milk and fetal and maternal body fluids: a systematic review of perinatal concentrations
J Hum Lact
Lactoferrin levels in term and preterm milk
J Am Coll Nutr
Longitudinal changes in lactoferrin concentrations in human milk: a global systematic review
Crit Rev Food Sci Nutr
Inhibitory effects of bovine lactoferrin and lactoferricin B on enterobacter sakazakii
Biocontrol Sci
Bactericidal activity of human lactoferrin: influence of physical conditions and metabolic state of the target microorganism
Infect Immun
Killing of gram-negative bacteria by lactoferrin and lysozyme
J Clin Invest
Benefits of lactoferrin, osteopontin and milk fat globule membranes for infants
Nutrients
Enteral lactoferrin supplementation for prevention of sepsis and necrotizing enterocolitis in preterm infants
Cochrane Database Syst Rev
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