What are the Benefits of Oral Colostrum Therapy for Extremely Low Birth Weight Infants?
by Anne Eglash MD, IBCLC, FABM
Extremely low birth weight infants (ELBWIs) are, by definition, born less than 1000 grams, and are usually less than 28 weeks gestation. These infants often need mechanical ventilation and intravenous nutrition, so typically miss out on the early immune benefits of colostrum and human milk, which have many factors that help to mature underdeveloped organs and protect premature infants from oxidative stresses that create life threatening illnesses such as necrotizing enterocolitis.
The researchers of this week’s article investigated the effect of providing oral immune therapy in a Chinese Hospital. They conducted a randomized controlled trial among 51 ELBWIs receiving early colostrum therapy vs a control group of 53 receiving only saline oral care. The colostrum oral therapy involved administering 0.2ml of colostrum along the inner cheek within the first 24 hours and then every 4 hours for 5 days. Secretory IgA and lactoferrin levels in airway secretions and urine were measured in both groups before starting colostrum therapy and on day 6. They also monitored indications of feeding intolerance, as measured by gastric residual, and necrotizing enterocolitis.
They found that when compared to the control group, the ELBWIs who received colostrum therapy had significantly lower risk of feeding intolerance (29.41% vs 54.72%), and lower risk of necrotizing enterocolitis (5.88% vs 20.75%). What else did they find? Check out the question!
- For infants receiving colostrum therapy, the secretory IgA and lactoferrin levels in airway secretions and urine rose 2-3 times by day 6 as compared to baseline.
- For infants who did not receive colostrum, the secretory IgA and lactoferrin levels in airway secretions and urine trended down slightly from baseline to day 6.
- The infants receiving colostrum therapy reached full enteral nutrition faster than the control group.
- The infants receiving colostrum therapy reached birth weight sooner than the control group.
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Abstract
Background
For extremely low-birth-weight infants (ELBWIs), mechanical ventilation and total parenteral nutrition are generally required in the early stages and lose the protective effect of early gastrointestinal nutrition of colostrum. We conducted a prospective randomized controlled trial to explore the effectiveness of early colostrum oropharyngeal administration on the feeding status of ELBWIs on mechanical ventilation.
Materials and Methods
We randomly divided mechanically ventilated ELBWIs into an intervention group and a control group. In the intervention group, we provided oropharyngeal administration of colostrum during mechanical ventilation. The first colostrum oropharyngeal administration ended within 24 hours of birth. In the control group, we gave colostrum only for gastrointestinal nutrition, and other interventions were the same as for the intervention group. We collected the 1st and 6th day of life airway secretions and urine specimens from both groups. We recorded feeding status, including corrected gestational age at onset of enteral nutrition, corrected gestational age of no gastric retention during feeding, corrected gestational age of full enteral nutrition, corrected gestational age of sucking began, and corrected gestational age of per oral feeding. We also recorded growth of body mass, the incidence of feeding intolerance, and necrotizing enterocolitis (NEC).
Results
On the 6th day of life, concentrations of secretory immunoglobulin A, and lactoferrin in airway secretions and urine of the intervention group were significantly higher than those of the control group (p < 0.05). The intervention group showed younger corrected gestational age of no gastric retention during feeding, corrected gestational age of full enteral nutrition, the corrected gestational age of sucking began and per oral feeding than those in the control group (p < 0.05). The day of recovery to birth weight was earlier than those in the control group (p < 0.05). The rate of feeding intolerance and NEC incidence in the intervention group was significantly lower than in the control group (p < 0.05).
Conclusions
Early oropharyngeal administration of colostrum improves immune function of the gastrointestinal tract and the systemic anti-infective capability in ELBWI on mechanical ventilation, promoting the maturity of gastrointestinal function, improving feeding condition, and reducing the risk of feeding intolerance and NEC.
I love studies like this that show such clear-cut differences in the health of infants receiving human milk.
Most of the literature on oral immune therapy with colostrum discusses the growth and immune factors in breastmilk that would theoretically mature the infant gut and protect the infant from infection while moderating the inflammatory response to prevent NEC. This study adds evidence to support this theory, demonstrating that immune factors in colostrum disperse to other organ systems to provide systemic immune protection and likely mucosal maturity.
This is a small study, so more work is needed to substantiate these findings.
This population does not appear to represent typical NICU populations, as the necrotizing enterocolitis rates are high compared to rates reported in the literature. A 2020 meta-analysis found that globally, 6% of very low birth weight infants and 7% of extremely low birth weight infants are diagnosed with necrotizing enterocolitis.
Nora Klein
Appears to be an important finding and in the absence of evidence to the contrary should guide universal adaptation of colostrum feeding to very premature babies. One would like a one year developmental follow up.