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Nutrients
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Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis
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Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Immunology".

Deadline for manuscript submissions: closed (31 January 2020) | Viewed by 99250

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Dr. Misty Good

E-Mail Website
Guest Editor
Washington University School of Medicine in St. Louis, USA
Interests: necrotizing enterocolitis, gut mucosal immunology, breast milk, donor milk, nutrition, innate immunity, prematurity, intestine, inflammation, neonatal

Special Issue Information

Dear Colleagues,

Nutrients is planning a Special Issue focusing on neonatal nutritional advances for inflammatory disorders such as necrotizing enterocolitis (NEC). Nutrition can impact the development of diseases that afflict infants. This Special Issue aims to bring together the latest research on the role of nutrition in preventing or impacting neonatal disorders. Specifically, this Special Issue will focus on the role of breast milk or donor breast milk and the various components in milk that have been demonstrated to protect against NEC and other inflammatory diseases. In addition, the impacts of nutrition on the microbiome and the microbial impact on diseases affecting the neonate will be included. This issue seeks to provide a comprehensive composite of the advances in nutritional strategies that can modulate or prevent neonatal intestinal disorders.

Dr. Misty Good
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • necrotizing enterocolitis
  • breast milk
  • donor milk
  • nutrition
  • innate immunity
  • prematurity
  • intestine
  • inflammation
  • neonatal

Published Papers (15 papers)

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Research

Jump to: Review

19 pages, 3961 KiB  
Article
Feeding Formula Eliminates the Necessity of Bacterial Dysbiosis and Induces Inflammation and Injury in the Paneth Cell Disruption Murine NEC Model in an Osmolality-Dependent Manner
by Shiloh R Lueschow, Stacy L Kern, Huiyu Gong, Justin L Grobe, Jeffrey L Segar, Susan J Carlson and Steven J McElroy
Nutrients 2020, 12(4), 900; https://doi.org/10.3390/nu12040900 - 26 Mar 2020
Cited by 10 | Viewed by 2999
Abstract
Necrotizing enterocolitis (NEC) remains a significant cause of morbidity and mortality in preterm infants. Formula feeding is a risk factor for NEC and osmolality, which is increased by the fortification that is required for adequate growth of the infant, has been suggested as [...] Read more.
Necrotizing enterocolitis (NEC) remains a significant cause of morbidity and mortality in preterm infants. Formula feeding is a risk factor for NEC and osmolality, which is increased by the fortification that is required for adequate growth of the infant, has been suggested as a potential cause. Our laboratory has shown that Paneth cell disruption followed by induction of dysbiosis can induce NEC-like pathology in the absence of feeds. We hypothesized adding formula feeds to the model would exacerbate intestinal injury and inflammation in an osmolality-dependent manner. NEC-like injury was induced in 14–16 day-old C57Bl/6J mice by Paneth cell disruption with dithizone or diphtheria toxin, followed by feeding rodent milk substitute with varying osmolality (250–1491 mOsm/kg H2O). Animal weight, serum cytokines and osmolality, small intestinal injury, and cecal microbial composition were quantified. Paneth cell-disrupted mice fed formula had significant NEC scores compared to controls and no longer required induction of bacterial dysbiosis. Significant increases in serum inflammatory markers, small intestinal damage, and overall mortality were osmolality-dependent and not related to microbial changes. Overall, formula feeding in combination with Paneth cell disruption induced NEC-like injury in an osmolality-dependent manner, emphasizing the importance of vigilance in designing preterm infant feeds. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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9 pages, 521 KiB  
Article
Parent and Provider Perspectives on the Imprecise Label of “Human Milk Fortifier” in the NICU
by Jennifer Canvasser, Amy B. Hair, Jae H. Kim and Sarah N. Taylor
Nutrients 2020, 12(3), 720; https://doi.org/10.3390/nu12030720 - 9 Mar 2020
Cited by 4 | Viewed by 4985
Abstract
In the critical care of preterm infants, feeding is complex and potentially harmful to an immature gastrointestinal system. Parents have expressed the desire to be fully informed about what is being fed to their child, as this places them in the best position [...] Read more.
In the critical care of preterm infants, feeding is complex and potentially harmful to an immature gastrointestinal system. Parents have expressed the desire to be fully informed about what is being fed to their child, as this places them in the best position to nurture their child’s health. In the parent-engaged setting of the Necrotizing Enterocolitis Symposium, NICU parents expressed concern and confusion about how cow’s milk product and donor human milk product both carry the label “Human Milk Fortifier” (HMF). Accordingly, two online surveys were developed to characterize how the label HMF is used and interpreted in the NICU by parents and providers. Of 774 United States participants, only 21.9% of providers reported consistently describing the source of HMF to parents, and only 20.6% of parents whose child received an HMF product report knowing the source. Parents expressed that they were “not given information” regarding HMF, while both parents and healthcare providers expressed that “the label (HMF) is misleading”. This study documents the ambiguity around the label HMF as well as the need for more specific language and clearer communication. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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9 pages, 209 KiB  
Article
Supplementation of Mother’s Own Milk with Donor Milk in Infants with Gastroschisis or Intestinal Atresia: A Retrospective Study
by Rebecca Hoban, Supriya Khatri, Aloka Patel and Sharon L. Unger
Nutrients 2020, 12(2), 589; https://doi.org/10.3390/nu12020589 - 24 Feb 2020
Cited by 20 | Viewed by 3558
Abstract
Background: Mother’s own milk (MOM) improves in-hospital outcomes for preterm infants. If unavailable, donor milk (DM) is often substituted. It is unclear if DM vs. formula to supplement MOM is associated with improved in-hospital outcomes in term/late preterm surgical infants with gastroschisis or [...] Read more.
Background: Mother’s own milk (MOM) improves in-hospital outcomes for preterm infants. If unavailable, donor milk (DM) is often substituted. It is unclear if DM vs. formula to supplement MOM is associated with improved in-hospital outcomes in term/late preterm surgical infants with gastroschisis or intestinal atresia. Methods: This retrospective study included infants born ≥33 weeks gestational age (GA) with a birth weight of >1500 g who were admitted to a quaternary neonatal intensive care unit (NICU). Using Chi square and Mann-Whitney u testing, we compared hospital outcomes (length of stay, parenteral nutrition and central line days) before and after a clinical practice change to offer DM instead of formula in this surgical population. Results: Baseline characteristics were similar between eras for the 140 infants (median GA 37 weeks). Fewer infants in DM era were receiving formula at discharge (50.0% vs. 31.4%, p = 0.03). In sub-analyses including only small bowel atresia and gastroschisis infants, the median length of stay (35 vs. 25, p < 0.01) and the central line days (28 vs. 20, p < 0.01) were lower in the DM era. Conclusion: In this retrospective study, offering DM instead of formula was associated with less formula feeding at discharge, and in infants with gastroschisis or small bowel atresia, shorter length of stay and central line days. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
12 pages, 865 KiB  
Article
Oropharyngeal Colostrum Positively Modulates the Inflammatory Response in Preterm Neonates
by Estefanía Martín-Álvarez, Javier Diaz-Castro, Manuela Peña-Caballero, Laura Serrano-López, Jorge Moreno-Fernández, Belen Sánchez-Martínez, Francisca Martín-Peregrina, Mercedes Alonso-Moya, José Maldonado-Lozano, Jose A. Hurtado-Suazo and Julio J. Ochoa
Nutrients 2020, 12(2), 413; https://doi.org/10.3390/nu12020413 - 5 Feb 2020
Cited by 22 | Viewed by 4054
Abstract
During the first days of life, premature infants have physiological difficulties swallowing, thereby missing out on the benefits of breastfeeding. The aim of this study is to assess the effects of oropharyngeal mother’s milk administration in the inflammatory signaling of extremely premature infants. [...] Read more.
During the first days of life, premature infants have physiological difficulties swallowing, thereby missing out on the benefits of breastfeeding. The aim of this study is to assess the effects of oropharyngeal mother’s milk administration in the inflammatory signaling of extremely premature infants. Neonates (n = 100) (<32 week’s gestation and/or <1500 g) were divided into two groups: mother’s milk group (n = 48), receiving 0.2 mL of oropharyngeal mother’s milk every 4 h for the first 15 days of life, and a control group (n = 52), not receiving oropharyngeal mother’s milk. Serum concentrations of interleukin (IL) IL-6, IL-8, IL-10, IL-1ra, tumor necrosis factor alpha (TNF-α), and interferón gamma (IFN-γ) were assessed at 1, 3, 15, and 30 days of postnatal life. Maternal and neonatal outcomes were collected. The rate of common neonatal morbidities in both groups was similar. The mother’s milk group achieved full enteral feeding earlier, and showed a decrease in Il-6 on days 15 and 30, in IL-8 on day 30, and in TNF-α and INF-γ on day 15, as well as an increase in IL-1ra on days 3 and 15 and in IL-10 on day 30. Oropharyngeal mother’s milk administration for 15 days decreases the pro-inflammatory state of preterm neonates and provides full enteral nutrition earlier, which could have a positive influence on the development of the immune system and inflammatory response, thereby positively influencing other developmental outcomes. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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12 pages, 752 KiB  
Article
Availability of Donor Milk for Very Preterm Infants Decreased the Risk of Necrotizing Enterocolitis without Adversely Impacting Growth or Rates of Breastfeeding
by Débora Cañizo Vázquez, Sandra Salas García, Montserrat Izquierdo Renau and Isabel Iglesias-Platas
Nutrients 2019, 11(8), 1895; https://doi.org/10.3390/nu11081895 - 14 Aug 2019
Cited by 25 | Viewed by 6050
Abstract
Human milk contains non-nutritional factors that promote intestinal maturation and protect against infectious and inflammatory conditions. In the Neonatal Intensive Care Unit (NICU) setting, donor milk (DM) is recommended when availability of own mother’s milk (OMM) is not enough. Our aim was to [...] Read more.
Human milk contains non-nutritional factors that promote intestinal maturation and protect against infectious and inflammatory conditions. In the Neonatal Intensive Care Unit (NICU) setting, donor milk (DM) is recommended when availability of own mother’s milk (OMM) is not enough. Our aim was to compare the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in very preterm infants (VPI) after the introduction of DM. Growth and breastfeeding rates were examined as secondary outcomes. Single center, observational and retrospective cohort study comparing 227 VPI admitted to our neonatal unit before (Group 1, n = 99) and after (Group 2, n = 128) DM introduction. Enteral nutrition was started earlier after DM availability (2.6 ± 1.1 vs. 2.1 ± 1 days, p = 0.001). Incidence of NEC decreased in group 2 (9.1% vs. 3.4%, p = 0.055), especially in those born between 28 and 32 weeks (5.4 vs. 0.0%, p = 0.044). Surgical NEC was also less frequent. Suffering NEC was 4 times more likely in group 1 (multivariate analysis). Availability of DM did not impact breastfeeding rates or preterm growth. Our findings support the protective role of DM against NEC, particularly in non-extreme VPI, a group less frequently included in clinical guidelines and research studies on the use of DM. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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11 pages, 1221 KiB  
Article
Macronutrient Analysis of Target-Pooled Donor Breast Milk and Corresponding Growth in Very Low Birth Weight Infants
by Ting Ting Fu, Paige E. Schroder and Brenda B. Poindexter
Nutrients 2019, 11(8), 1884; https://doi.org/10.3390/nu11081884 - 13 Aug 2019
Cited by 21 | Viewed by 3655
Abstract
The macronutrient composition of target-pooled donor breast milk (DBM) (milk combined strategically to provide 20 kcal/oz) and growth patterns of preterm infants receiving it have not been characterized. Caloric target-pooled DBM samples were analyzed by near-infrared spectroscopy. Weekly growth velocities and anthropometric z-scores [...] Read more.
The macronutrient composition of target-pooled donor breast milk (DBM) (milk combined strategically to provide 20 kcal/oz) and growth patterns of preterm infants receiving it have not been characterized. Caloric target-pooled DBM samples were analyzed by near-infrared spectroscopy. Weekly growth velocities and anthropometric z-scores were calculated for the first 30 days and at 36 weeks corrected gestational age (CGA) for 69 very low birthweight (VLBW) infants receiving minimum one week of DBM. Samples contained mean 18.70 kcal/oz, 0.91 g/dL protein, 3.11 g/dL fat, 7.71 g/dL carbohydrate (n = 96), less than labeled values by 2.43 kcal/oz and 0.11 g/dL protein (p < 0.001). By week 3, growth reached 16.58 g/kg/day, 0.95 cm/week (length), and 1.01 cm/week (head circumference). Infants receiving <50% vs. >50% DBM had similar growth, but infants receiving >50% DBM were more likely to receive fortification >24 kcal/oz (83% vs. 51.9% in the <50% DBM group; p = 0.005). From birth to 36 weeks CGA (n = 60), there was a negative z-score change across all parameters with the greatest in length (−1.01). Thus, target-pooling does not meet recommended protein intake for VLBW infants. Infants fed target-pooled DBM still demonstrate a disproportionate negative change in length z-score over time. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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Review

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16 pages, 1259 KiB  
Review
Role of Nutrition in Prevention of Neonatal Spontaneous Intestinal Perforation and Its Complications: A Systematic Review
by Oluwabunmi Olaloye, Matthew Swatski and Liza Konnikova
Nutrients 2020, 12(5), 1347; https://doi.org/10.3390/nu12051347 - 8 May 2020
Cited by 8 | Viewed by 4234
Abstract
Background: Spontaneous intestinal perforation (SIP) is a devastating complication of prematurity, and extremely low birthweight (ELBW < 1000 g) infants born prior to 28 weeks are at highest risk. The role of nutrition and feeding practices in prevention and complications of SIP is [...] Read more.
Background: Spontaneous intestinal perforation (SIP) is a devastating complication of prematurity, and extremely low birthweight (ELBW < 1000 g) infants born prior to 28 weeks are at highest risk. The role of nutrition and feeding practices in prevention and complications of SIP is unclear. The purpose of this review is to compile evidence to support early nutrition initiation in infants at risk for and after surgery for SIP. Methods: A search of PubMed, EMBASE and Medline was performed using relevant search terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Abstracts and full texts were reviewed by co-first authors. Studies with infants diagnosed with SIP that included information on nutrition/feeding practices prior to SIP and post-operatively were included. Primary outcome was time to first feed. Secondary outcomes were incidence of SIP, time to full enteral feeds, duration of parenteral nutrition, length of stay, neurodevelopmental outcomes and mortality. Results: Nineteen articles met inclusion criteria—nine studies included feeding/nutrition data prior to SIP and ten studies included data on post-operative nutrition. Two case series, one cohort study and sixteen historical control studies were included. Three studies showed reduced incidence of SIP with initiation of enteral nutrition in the first three days of life. Two studies showed reduced mortality and neurodevelopmental impairment in infants with early feeding. Conclusions: Available data suggest that early enteral nutrition in ELBW infants reduces incidence of SIP without increased mortality. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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13 pages, 723 KiB  
Review
The Impact of Human Milk on Necrotizing Enterocolitis: A Systematic Review and Meta-Analysis
by Emma Altobelli, Paolo Matteo Angeletti, Alberto Verrotti and Reimondo Petrocelli
Nutrients 2020, 12(5), 1322; https://doi.org/10.3390/nu12051322 - 6 May 2020
Cited by 117 | Viewed by 11419
Abstract
Background. Premature infants receiving breastfeed have a lower incidence of NEC than those fed preterm formula. This study aimed: (1) to update a systematic review and meta-analyses to evaluate the relationship between feeding and necrotizing enterocolitis (NEC) in low weight premature infants; (2) [...] Read more.
Background. Premature infants receiving breastfeed have a lower incidence of NEC than those fed preterm formula. This study aimed: (1) to update a systematic review and meta-analyses to evaluate the relationship between feeding and necrotizing enterocolitis (NEC) in low weight premature infants; (2) to conduct meta-regression analyses by subgroups; (3) to describe geographical distribution of milk banks in the world. Methods. Papers included in the meta-analysis were updated as of June 2019. Relative risks were used as a measure of effect size. Random effect models were used to account for different sources of variation among studies. For milk banks, the data reviewed by the literature were integrated with the information collected from countries’ institutional sites and milk bank networks. Results. Thirty-two papers were included in meta-analysis: six randomized controlled trials (RCTs) and 26 observational studies (OS). The census has found 572 milk banks around in the world. Brazil has the most active milk banks. RCTs meta-analysis indicates a risk reduction of NEC using human milk respect to formula: Relative risk (RR) = 0.62 (0.42–0.93). Seven OS compared quantities lower than human milk or higher than the 50th quantile showing a risk reduction of NEC:RR = 0.51 (0.31–0.85); 3 OS that evaluated human milk versus mixed feeding showing that human milk has a protective role on the development of NEC:RR = 0.74 (0.63–0.91). Results of subgroups analysis show that the risk reduction is statistically significant only for studies in which premature infants are given both their own and donated breastmilk. Conclusions. The possibility of preserving human milk and promoting donations guarantees an improvement in the health of newborns. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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13 pages, 1000 KiB  
Review
Understanding the Elements of Maternal Protection from Systemic Bacterial Infections during Early Life
by Sierra A. Kleist and Kathryn A. Knoop
Nutrients 2020, 12(4), 1045; https://doi.org/10.3390/nu12041045 - 10 Apr 2020
Cited by 6 | Viewed by 3861
Abstract
Late-onset sepsis (LOS) and other systemic bloodstream infections are notable causes of neonatal mortality, particularly in prematurely born very low birth weight infants. Breastfeeding in early life has numerous health benefits, impacting the health of the newborn in both the short-term and in [...] Read more.
Late-onset sepsis (LOS) and other systemic bloodstream infections are notable causes of neonatal mortality, particularly in prematurely born very low birth weight infants. Breastfeeding in early life has numerous health benefits, impacting the health of the newborn in both the short-term and in the long-term. Though the known benefits of an exclusive mother’s own milk diet in early life have been well recognized and described, it is less understood how breastfed infants enjoy a potential reduction in risk of LOS and other systemic infections. Here we review how gut residing pathogens within the intestinal microbiota of infants can cause a subset of sepsis cases and the components of breastmilk that may prevent the dissemination of pathogens from the intestine. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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13 pages, 295 KiB  
Review
The Therapeutic Potential of Breast Milk-Derived Extracellular Vesicles
by Jeffrey D. Galley and Gail E. Besner
Nutrients 2020, 12(3), 745; https://doi.org/10.3390/nu12030745 - 11 Mar 2020
Cited by 63 | Viewed by 5493
Abstract
In the past few decades, interest in the therapeutic benefits of exosomes and extracellular vesicles (EVs) has grown exponentially. Exosomes/EVs are small particles which are produced and exocytosed by cells throughout the body. They are loaded with active regulatory and stimulatory molecules from [...] Read more.
In the past few decades, interest in the therapeutic benefits of exosomes and extracellular vesicles (EVs) has grown exponentially. Exosomes/EVs are small particles which are produced and exocytosed by cells throughout the body. They are loaded with active regulatory and stimulatory molecules from the parent cell including miRNAs and enzymes, making them prime targets in therapeutics and diagnostics. Breast milk, known for years to have beneficial health effects, contains a population of EVs which may mediate its therapeutic effects. This review offers an update on the therapeutic potential of exosomes/EVs in disease, with a focus on EVs present in human breast milk and their remedial effect in the gastrointestinal disease necrotizing enterocolitis. Additionally, the relationship between EV miRNAs, health, and disease will be examined, along with the potential for EVs and their miRNAs to be engineered for targeted treatments. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
15 pages, 866 KiB  
Review
Bioactive Factors in Human Breast Milk Attenuate Intestinal Inflammation during Early Life
by Julie D. Thai and Katherine E. Gregory
Nutrients 2020, 12(2), 581; https://doi.org/10.3390/nu12020581 - 23 Feb 2020
Cited by 78 | Viewed by 10903
Abstract
Human breast milk is well known as the ideal source of nutrition during early life, ensuring optimal growth during infancy and early childhood. Breast milk is also the source of many unique and dynamic bioactive components that play a key role in the [...] Read more.
Human breast milk is well known as the ideal source of nutrition during early life, ensuring optimal growth during infancy and early childhood. Breast milk is also the source of many unique and dynamic bioactive components that play a key role in the development of the immune system. These bioactive components include essential microbes, human milk oligosaccharides (HMOs), immunoglobulins, lactoferrin and dietary polyunsaturated fatty acids. These factors all interact with intestinal commensal bacteria and/or immune cells, playing a critical role in establishment of the intestinal microbiome and ultimately influencing intestinal inflammation and gut health during early life. Exposure to breast milk has been associated with a decreased incidence and severity of necrotizing enterocolitis (NEC), a devastating disease characterized by overwhelming intestinal inflammation and high morbidity among preterm infants. For this reason, breast milk is considered a protective factor against NEC and aberrant intestinal inflammation common in preterm infants. In this review, we will describe the key microbial, immunological, and metabolic components of breast milk that have been shown to play a role in the mechanisms of intestinal inflammation and/or NEC prevention. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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20 pages, 1164 KiB  
Review
The Role of Glycosaminoglycans in Protection from Neonatal Necrotizing Enterocolitis: A Narrative Review
by Kathryn Burge, Erynn Bergner, Aarthi Gunasekaran, Jeffrey Eckert and Hala Chaaban
Nutrients 2020, 12(2), 546; https://doi.org/10.3390/nu12020546 - 20 Feb 2020
Cited by 11 | Viewed by 3669
Abstract
Necrotizing enterocolitis, a potentially fatal intestinal inflammatory disorder affecting primarily premature infants, is a significant cause of morbidity and mortality in neonates. While the etiology of the disease is, as yet, unknown, a number of risk factors for the development of necrotizing enterocolitis [...] Read more.
Necrotizing enterocolitis, a potentially fatal intestinal inflammatory disorder affecting primarily premature infants, is a significant cause of morbidity and mortality in neonates. While the etiology of the disease is, as yet, unknown, a number of risk factors for the development of necrotizing enterocolitis have been identified. One such risk factor, formula feeding, has been shown to contribute to both increased incidence and severity of the disease. The protective influences afforded by breastfeeding are likely attributable to the unique composition of human milk, an extremely potent, biologically active fluid. This review brings together knowledge on the pathogenesis of necrotizing enterocolitis and current thinking on the instrumental role of one of the more prominent classes of bioactive components in human breast milk, glycosaminoglycans. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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17 pages, 619 KiB  
Review
Breast Milk Lipids and Fatty Acids in Regulating Neonatal Intestinal Development and Protecting against Intestinal Injury
by David Ramiro-Cortijo, Pratibha Singh, Yan Liu, Esli Medina-Morales, William Yakah, Steven D. Freedman and Camilia R. Martin
Nutrients 2020, 12(2), 534; https://doi.org/10.3390/nu12020534 - 19 Feb 2020
Cited by 73 | Viewed by 9708
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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16 pages, 723 KiB  
Review
Nutrition in Necrotizing Enterocolitis and Following Intestinal Resection
by Jocelyn Ou, Cathleen M. Courtney, Allie E. Steinberger, Maria E. Tecos and Brad W. Warner
Nutrients 2020, 12(2), 520; https://doi.org/10.3390/nu12020520 - 18 Feb 2020
Cited by 50 | Viewed by 12232
Abstract
This review aims to discuss the role of nutrition and feeding practices in necrotizing enterocolitis (NEC), NEC prevention, and its complications, including surgical treatment. A thorough PubMed search was performed with a focus on meta-analyses and randomized controlled trials when available. There are [...] Read more.
This review aims to discuss the role of nutrition and feeding practices in necrotizing enterocolitis (NEC), NEC prevention, and its complications, including surgical treatment. A thorough PubMed search was performed with a focus on meta-analyses and randomized controlled trials when available. There are several variables in nutrition and the feeding of preterm infants with the intention of preventing necrotizing enterocolitis (NEC). Starting feeds later rather than earlier, advancing feeds slowly and continuous feeds have not been shown to prevent NEC and breast milk remains the only effective prevention strategy. The lack of medical treatment options for NEC often leads to disease progression requiring surgical resection. Following resection, intestinal adaptation occurs, during which villi lengthen and crypts deepen to increase the functional capacity of remaining bowel. The effect of macronutrients on intestinal adaptation has been extensively studied in animal models. Clinically, the length and portion of intestine that is resected may lead to patients requiring parenteral nutrition, which is also reviewed here. There remain significant gaps in knowledge surrounding many of the nutritional aspects of NEC and more research is needed to determine optimal feeding approaches to prevent NEC, particularly in infants younger than 28 weeks and <1000 grams. Additional research is also needed to identify biomarkers reflecting intestinal recovery following NEC diagnosis individualize when feedings should be safely resumed for each patient. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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14 pages, 507 KiB  
Review
A Review of the Immunomodulating Components of Maternal Breast Milk and Protection Against Necrotizing Enterocolitis
by Lila S. Nolan, Olivia B. Parks and Misty Good
Nutrients 2020, 12(1), 14; https://doi.org/10.3390/nu12010014 - 19 Dec 2019
Cited by 91 | Viewed by 11628
Abstract
Breast milk contains immunomodulating components that are beneficial to newborns during maturation of their immune system. Human breast milk composition is influenced by an infant’s gestational and chronological age, lactation stage, and the mother and infant’s health status. Major immunologic components in human [...] Read more.
Breast milk contains immunomodulating components that are beneficial to newborns during maturation of their immune system. Human breast milk composition is influenced by an infant’s gestational and chronological age, lactation stage, and the mother and infant’s health status. Major immunologic components in human milk, such as secretory immunoglobulin A (IgA) and growth factors, have a known role in regulating gut barrier integrity and microbial colonization, which therefore protect against the development of a life-threatening gastrointestinal illness affecting newborn infants called necrotizing enterocolitis (NEC). Breast milk is a known protective factor in the prevention of NEC when compared with feeding with commercial formula. Breast milk supplements infants with human milk oligosaccharides, leukocytes, cytokines, nitric oxide, and growth factors that attenuate inflammatory responses and provide immunological defenses to reduce the incidence of NEC. This article aims to review the variety of immunomodulating components in breast milk that protect the infant from the development of NEC. Full article
(This article belongs to the Special Issue Neonatal Nutrition for Inflammatory Disorders and Necrotizing Enterocolitis)
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