The Importance of Human Milk in Preterm Infants. Almerinda Barroso Pereira. Hospital de Braga

Transcription

1 The Importance of Human Milk in Preterm Infants Almerinda Barroso Pereira Hospital de Braga

2 The Importance of Human Milk in Preterm Infants Premature infants have great nutritional needs to achieve optimal growth in the neonatal period. Infants born at the beginning of the third trimester of pregnancy often are growth-restricted because of decreased intrauterine nutrient deposition. Medical conditions: hypotension, hypoxia, acidosis, infection, surgery, increase metabolic energy requirements and nutrient needs. Additional impediments to growth are physiologic immaturity of the gastrointestinal tract including decreased gastrointestinal motility and reduced intestinal enzyme activity.

3 The Importance of Human Milk in Preterm Infants Nutritional support helps to correct growth restriction at birth and to achieve an appropriate rate of weight gain. Enteral nutrition must be provided to premature infants with human milk as the preferred feeding for all infants. Pediatrics. 2012;129(3):e827

4 ADVANTAGES OF HUMAN MILK Improved gastrointestinal function, digestion, absorption of nutrients. Promotes more rapid attainment of full enteral feeds. Improved host defence with reduced rates of infection. Enhanced maternal psychological well-being and maternal-infant bonding. Shorter duration of hospitalization in premature infants. Improved cognitive and visual development. Breastfeeding is associated with long-term benefits, infant and mother. (October 2008)

5 Human Milk Clinical Direct Benefits: Improvement in Gastrointestinal Function Host Defence - Anti-microbial Components Long Term Benefits: Reduction of Acute Illnesses Decreased Risk of Chronic Diseases Improved Neurodevelopment Outcome

6 Human Milk and Gastrointestinal Function Components of human milk stimulate gastrointestinal growth and motility, which enhance the maturity of the gastrointestinal tract: Cortisol, somatomedin-c, insulin-like growth factors, insulin, and thyroid hormone may affect intestinal growth and mucosal function. Growth factors (nerve growth factor) may play a role in the innervation of the intestinal tract. Gastrointestinal mediators (neurotensin and motilin) may affect gastrointestinal motility. Free amino acids may be trophic for intestinal growth (taurine) and may stimulate enterocyte growth (glutamine). Clin Perinatol. 1999;26(2):335.

7 Human Milk and Gastrointestinal Function Components of human milk are protective and decrease the risk of infections: Growth factors (epidermal growth factor) affect development of the intestinal tract and may be protective against invasive disease. Human milk is associated with neonatal intestinal colonization by the beneficial microbes of the Bifidobacteria and Lactobacilli species rather than potential enteropathogenic bacteria. Anti-inflammatory agents, Enzymes, Immunoglobulins IgA and IgG, protective agents.. Am J Physiol Gastrointest Liver Physiol. 2005;288(4):G755. Acta Paediatr. 2004;93(11):1496. Arch Dis Child Fetal Neonatal Ed. 2011;96(3):F160

8 Compared to formula, human milk has been shown to: Increase the rate of gastric emptying. Increase the intestinal lactase activity in premature infants. Decrease the risk of NEC in premature infants.

9 Human Milk Improved Host Defense - Reduced Rates Infection Presence of maternal antibodies ([IgG] [siga]) in breast milk provided by the enteromammary immune system. Mothers exposed to their own infants by skin-to-skin contact may also make specific antibodies to nosocomial pathogens. Human milk feeding may result in fecal flora comprised of less pathogenic microorganisms than nursery-acquired pathogens.

10 Human Milk Anti-microbial Components Human milk contains a variety of heterogeneous agents that possess antimicrobial activity: Protein: lactoferrin, lysozyme, serum immunoglobulin A. Lipid: free fatty acids and monoglycerides, lipase. Carbohydrate: oligosaccharides. White blood cells: neutrophils and macrophages, lymphocytes in human milk may contribute to cytokine production (T-cells) or Ig A production (B-cells). JAMA. 2009;302(13):1421 Pediatr Res. 2006;59(3):377.

11 Human Milk - Reduce Acute Illnesses A study of former premature infants demonstrated that infants who received human milk had fewer days of upper respiratory symptoms compared to those who were formula-fed during the first seven months of life (17.6 vs 38 days). The incidence of sepsis is reduced in premature infants receiving human milk. J Perinatol. 2002;22(5):354.

12 Human Milk - Decrease Risk of Chronic Diseases Adult Cardiovascular Disease In a randomized trial, adolescents born preterm who received human milk compared to those who received formula had a lower serum C-reactive protein (CRP) and a lower ratio of low density lipoprotein (LDL) to high density lipoprotein (HDL) cholesterol, indicative of a lower risk for cardio vascular disease. Lancet. 2004;363(9421):1571.

13 Neurodevelopment Outcome Improved long-term cognitive development in premature infants has been reported with the receipt of human milk during hospitalization, including extremely low birth weight (ELBW) infants. Breastfeeding is associated with improved cognitive development, particularly in children born preterm. The benefit of breastfeeding upon cognitive function is modulated by variations of a gene involved in the control of fatty acid metabolism. (FADSE2 gene) Pediatrics. 2007;120(4):e953. Proc Natl Acad Sci U S A. 2007;104(47):18860 J Pediatr. 2012;160(1):25...

14 Visual function Several studies have indicated that human milk-fed term and premature infants have improved visual function compared to formula-fed infants. This benefit has been attributed to docosahexaenoic acid (DHA), which is a component of phospholipids found in brain, retina, and red cell membranes. The severity and incidence of retinopathy of prematurity are decreased among breastfed compared to formula fed infants. This association may relate to the substantial antioxidant capacity of human milk compared with formula. Pediatr Int. 2007;49(6):894. J Pediatr. 2008;152(3):356.

15 Hearing function Infants fed breast milk have faster brainstem maturation, compared with infants fed formula, based on the rate of maturation of brainstem auditory-evoked responses in preterm infants. This effect may be attributable to the constituent composition of breast milk, compared with synthetic formulas. Pediatrics. 2000;106(2 Pt 1):318

16 Stress Reduction There appears to be an analgesic effect of breastfeeding, which may be due to the enhanced maternal-infant bonding. Breastfed infants experience less stress during painful procedures than formula fed infants. The lactation hormones, oxytocin and prolactin, are important components of the stress axis and have a positive impact on social behaviors, including maternal-infant bonding. Another possible explanation for the analgesic effect of breastfeeding is a higher cortisol level in breast-fed compared to formula-fed infants. Improved bonding may reduce infant stress. BMJ. 2003;326(7379):13. J Pediatr. 2009;154(3):452

17 Human Milk is strongly supported because of its acknowledged direct benefits to nutrition, gastrointestinal function, host defense, and psychological well-being. There is increasing evidence that human milk has long-term benefits beyond the period of breastfeeding. These include continued protection against acute illnesses, and reported reduction of specific chronic diseases. Human Milk also may have improved neurodevelopmental outcome compared to those who were formula-fed.

18 Human Milk is the Best in Preterm Infants