Role of Oropharyngeal Administration of Colostrum in Very Low Birth Weight Infants for Reducing Necrotizing Enterocolitis: A Randomized Controlled TrialFunding None.
06 January 2019
30 March 2019
14 May 2019 (online)
Objective This study aimed to study the role of oropharyngeal administration of colostrum (OAC) in very-low-birth-weight infants for reducing necrotizing enterocolitis (NEC).
Study Design In this randomized controlled trial, 117 infants were enrolled, 59 were randomized to OAC group and 58 to routine care group. Infants with birth weight ≤ 1,250 g and/or gestational age ≤ 30 weeks were enrolled. Infants in OAC group received maternal colostrum (0.2 mL), 0.1 mL on either side, after 24 hours of postnatal life and were given every 2 hour for the next 72 hours irrespective of the enteral feeding status of the neonate. The primary outcome of the study was the incidence of NEC (stage 2 or 3).
Results Baseline characteristics were comparable between the two groups. There was no significant reduction in the incidence of NEC in OAC group (0 [0%] vs. 3 [7.1%]; p = 0.11). There was significant reduction of 7 days of hospital stay in OAC group (34.2 ± 5.7 vs. 41.5 ± 6.7 days; p = 0.04).The incidence of early-onset sepsis, late-onset sepsis, blood culture positive sepsis, and ventilator-associated pneumonia were comparable between the two groups.
Conclusion OAC is safe and reduces the duration of hospital stay.
Keywordsduration of hospital stay - necrotizing enterocolitis - oropharyngeal administration of colostrum - very low birth weight
D.S., A.K., and S.A. conceived and designed the experiments. N.F. and S.A. analyzed the data. D.S. and A.K. wrote the first draft of the article. N.F. and S.A. contributed to the writing of the article. D.S., A.K., N.F., and S.A. agree with article results and conclusions. N.F. and S.A. jointly developed the structure and arguments for the article. D.S., A.K., N.F., and S.A. made critical revisions and approved the final version. All authors reviewed and approved the final article.
This study was approved by the ethics committee of Institutional Research Board. Consent was taken by patients for enrollment and publication of study.
- 1 Camacho-Gonzalez A, Spearman PW, Stoll BJ. Neonatal infectious diseases: evaluation of neonatal sepsis. Pediatr Clin North Am 2013; 60 (02) 367-389
- 2 Lozano R, Naghavi M, Foreman K. , et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859): 2095-2128
- 3 Wang H, Liddell CA, Coates MM. , et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384 (9947): 957-979
- 4 van den Hoogen A, Gerards LJ, Verboon-Maciolek MA, Fleer A, Krediet TG. Long-term trends in the epidemiology of neonatal sepsis and antibiotic susceptibility of causative agents. Neonatology 2010; 97 (01) 22-28
- 5 Stoll BJ, Hansen N, Fanaroff AA. , et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2 Pt 1): 285-291
- 6 Sharma D, Farahbakhsh N, Shastri S, Sharma P. Biomarkers for diagnosis of neonatal sepsis: a literature review. J Matern Fetal Neonatal Med 2018; 31 (12) 1646-1659
- 7 Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 1999; 103 (6 Pt 1): 1150-1157
- 8 Furman L, Taylor G, Minich N, Hack M. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med 2003; 157 (01) 66-71
- 9 Underwood MA. Human milk for the premature infant. Pediatr Clin North Am 2013; 60 (01) 189-207
- 10 Ballard O, Morrow AL. Human milk composition: nutrients and bioactive factors. Pediatr Clin North Am 2013; 60 (01) 49-74
- 11 Kverka M, Burianova J, Lodinova-Zadnikova R. , et al. Cytokine profiling in human colostrum and milk by protein array. Clin Chem 2007; 53 (05) 955-962
- 12 Smith DJ, Taubman MA. Ontogeny of immunity to oral microbiota in humans. Crit Rev Oral Biol Med 1992; 3 (1-2): 109-133
- 13 Garofalo R. Cytokines in human milk. J Pediatr 2010; 156 (2, Suppl): S36-S40
- 14 Rodriguez NA, Meier PP, Groer MW, Zeller JM. Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives. J Perinatol 2009; 29 (01) 1-7
- 15 Ogawa J, Sasahara A, Yoshida T. , et al. Role of transforming growth factor-beta in breast milk for initiation of IgA production in newborn infants. Early Hum Dev 2004; 77 (1-2): 67-75
- 16 Goldblum RM, Schanler RJ, Garza C, Goldman AS. Human milk feeding enhances the urinary excretion of immunologic factors in low birth weight infants. Pediatr Res 1989; 25 (02) 184-188
- 17 Westerbeek EAM, van den Berg A, Lafeber HN, Knol J, Fetter WPF, van Elburg RM. The intestinal bacterial colonisation in preterm infants: a review of the literature. Clin Nutr 2006; 25 (03) 361-368
- 18 La Gamma EF, Browne LE. Feeding practices for infants weighing less than 1500 G at birth and the pathogenesis of necrotizing enterocolitis. Clin Perinatol 1994; 21 (02) 271-306
- 19 Bell MJ, Ternberg JL, Feigin RD. , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
- 20 Johnson K, Messier S. Early onset sepsis. S D Med 2016; 69 (01) 29-33
- 21 Bedford Russell AR, Kumar R. Early onset neonatal sepsis: diagnostic dilemmas and practical management. Arch Dis Child Fetal Neonatal Ed 2015; 100 (04) F350-F354
- 22 Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed 2015; 100 (03) F257-F263
- 23 Garland JS. Ventilator-associated pneumonia in neonates: an update. Neoreviews 2014; 15 (06) e225-e235
- 24 Voynow JA. “New” bronchopulmonary dysplasia and chronic lung disease. Paediatr Respir Rev 2017; 24: 17-18
- 25 Early Treatment For Retinopathy Of Prematurity Cooperative Group null. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol Chic III 1960. 2003; 121 (12) 1684-1694
- 26 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
- 27 de Vries LS, Eken P, Dubowitz LM. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 1992; 49 (01) 1-6
- 28 Rodriguez NA, Meier PP, Groer MW, Zeller JM, Engstrom JL, Fogg L. A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother's colostrum to extremely low-birth-weight infants. Adv Neonatal Care 2010; 10 (04) 206-212
- 29 Glass KM, Greecher CP, Doheny KK. Oropharyngeal administration of colostrum increases salivary secretory IgA levels in very low-birth-weight infants. Am J Perinatol 2017; 34 (14) 1389-1395
- 30 Seigel JK, Smith PB, Ashley PL. , et al. Early administration of oropharyngeal colostrum to extremely low birth weight infants. Breastfeed Med 2013; 8 (06) 491-495
- 31 Romano-Keeler J, Azcarate-Peril MA, Weitkamp J-H. , et al. Oral colostrum priming shortens hospitalization without changing the immunomicrobial milieu. J Perinatol 2017; 37 (01) 36-41
- 32 Sohn K, Kalanetra KM, Mills DA, Underwood MA. Buccal administration of human colostrum: impact on the oral microbiota of premature infants. J Perinatol 2016; 36 (02) 106-111
- 33 Lee J, Kim H-S, Jung YH. , et al. Oropharyngeal colostrum administration in extremely premature infants: an RCT. Pediatrics 2015; 135 (02) e357-e366
- 34 Nasuf AWA, Ojha S, Dorling J. Oropharyngeal colostrum in preventing mortality and morbidity in preterm infants. Cochrane Database Syst Rev 2018; 9: CD011921