The oropharyngeal administration of own mother’s colostrum, as an immune therapy, is hypothesized to protect ELBW infants via three distinct mechanisms: (1) immunostimulatory effects of cytokine interaction with immune cells in the recipient infant’s OFALT system [ 17, 39, 43, 44, 108 ] , (2) passive mucosal absorption of protective antimicrobial and trophic factors [ 75, 76, 78, 81 ] , and (3) barrier protection against pathogens in the oropharynx [ 18– 22, 27, 28, 74, 109 ] . With oropharyngeal admin- istration, cytokines are not likely to be degraded by proteases or diluted locally as occurs with enteral exposure [ 118– 120 ] . They remain intact and may interact with OFALT immune cells potentially
resulting in an anti-in fl ammatory, protective immunostimulatory response. Mucosal absorption of growth factors among others, and bene fi cial effects of oligosaccharides may promote feeding tolerance and lead to an earlier achievement of full enteral feeds. Barrier protection, provided by oligosaccha- rides, lactoferrin, and sIgA, may prevent the adherence and penetration of respiratory pathogens;
protecting against VAP.
The oropharyngeal administration of colostrum is a new intervention and to date, only two pilot studies and a small RCT have reported its use [ 40– 42 ] . One pilot study [ 40 ] examined the feasibility, safety, and infant’s response to the oropharyngeal administration of colostrum. In that study, fi ve ELBW infants received 0.2 mL of colostrum administered oropharyngeally every 2 h for a treatment period of 48 consecutive hours starting before 48 h of life. The intervention was well tolerated by all of the infants. No adverse effects were noted and all infants began to suck on the breathing tube during the administration of the colostrum drops. Another pilot study [ 42 ] , examined the feasibility of admin- istering small volumes (0.2 mL) of colostrum every 3 h via oropharyngeal swabbing to very low birth weight infants for seven consecutive days. Results demonstrated that 80–90% of mothers were able to supply the colostrum, although the initial colostrum was typically not available until the infant’s second day of life. Once started, approximately 75–80% of the planned swabbings were administered as planned [ 42 ] . A more recent study [ 41 ] , a small blinded placebo-controlled randomized clinical trial, was designed to determine whether own mother’s colostrum has an immunostimulatory effects when administered oropharyngeally to ELBW infants in the fi rst days of life. Sixteen ELBW infants served as subjects and were randomly assigned to either the experimental group or the control group.
Infants in the experimental group received 0.2 mL of colostrum administered oropharyngeally every 2 h for 48 consecutive hours starting within 48 h post-birth. Infants in the placebo group received sterile water, using the same dose and following the same protocol as those in the experimental group.
Dependent measures were collected at baseline and at the completion of the 48-h treatment protocol.
The most compelling fi nding was that colostrum-treated infants had a shorter time to full feedings.
Infants in the colostrum group were smaller and younger (mean BW: 776.1g vs. 940.8g, mean GA 25.9 vs. 26.8) compared to those in the placebo group, yet they reached full enteral feedings (150 mL/
kg/day) sooner, at an average of 14.3 ± 5.7 (range 9–25) days compared to 24.2 ± 8.7 (15–37) days for the placebo group. This was the only characteristic that was statistically signi fi cant ( p = 0.032). The between group comparisons did not reveal any statistically signi fi cant differences in any of the immune markers; however, the sample size was small and may have lacked suf fi cient power to achieve a signi fi cant result. These studies were all limited by a very small sample size, but results will inform future studies. Further research is needed to fully investigate the health outcomes of this easy, inex- pensive intervention using a natural immune therapy; own mother’s colostrum.
Summary
The use of human preterm colostrum as a potential immune therapy for the ELBW infant is supported by the observation that in all mammals, maternal milk compensates for postnatal immune de fi ciencies by replacing defense agents that are lacking; enhancing survival of the offspring [ 121 ] . In human beings, the immune system is underdeveloped at birth; with immunocompetence being directly related to gestational age. ELBW infants are therefore at highest risk for acquiring nosocomial infections.
However, the lactating mammary gland compensates for prematurity-associated immune de fi ciencies with enhanced production of immunologically derived protective factors to meet the speci fi c needs of the ELBW recipient infant [ 121 ] . As such, preterm colostrum is a potential immune therapy for ELBW infants. However, because of clinical instability, ELBW infants do not typically receive colos- trum during the fi rst days post-birth; a potentially critical exposure period. The administration of colostrum via the oropharyngeal route serves to provide immunostimulation via OFALT, mucosal
absorption of protective factors, and barrier protection against pathogens; providing protection against bacteremia, VAP, and NEC. Preliminary research has demonstrated the feasibility of this intervention.
Future research is warranted to investigate the health outcomes for ELBW infants who receive this intervention and mechanisms to maximize the use of human colostrum, as a potential immune therapy, for immunode fi cient extremely premature infants.
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