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Oropharyngeal Colostrum Administration in Very Low Birth Weight Infants: A Randomized Controlled Trial
Yuxia Zhang1, Futing Ji, Xiaojing Hu
11Department of Nursing, Children's Hospital of Fudan University, Shanghai, People's Republic of China. 2Nursing School of Fudan University, Shanghai, People's Republic of China. 3Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, People's Republic of China. 4School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, United Kingdom.
Insights
Oropharyngeal colostrum administration increased salivary lactoferrin in very low birth weight infants. This intervention showed no significant impact on secretory immunoglobulin A or lactoferrin in urine and saliva.
Area of Science:
- Neonatal immunology
- Pediatric gastroenterology
Background:
- Oropharyngeal colostrum administration is safe for very low birth weight (VLBW) infants.
- The impact of this intervention on the developing immune system requires further investigation.
Purpose of the Study:
- To evaluate the effect of oropharyngeal colostrum administration on secretory immunoglobulin A (sIgA) and lactoferrin levels in VLBW infants.
- To assess changes in immune markers in saliva and urine.
Main Methods:
- A randomized controlled trial was conducted with VLBW infants.
- The intervention group received 0.2 mL of mother's colostrum every 4 hours for 7 days, while the control group received saline.
- Secretory immunoglobulin A and lactoferrin were measured in saliva and urine at baseline, 7 days, and 21 days.
Main Results:
- A statistically significant increase in salivary lactoferrin was observed at 7 days (p < 0.001) and 21 days (p = 0.02) in the colostrum group.
- No significant differences were found in salivary or urinary secretory immunoglobulin A, or urinary lactoferrin levels.
- Clinical outcomes, including time to full enteral feeding, sepsis rates, and necrotizing enterocolitis, did not differ between groups.
Conclusions:
- Oropharyngeal colostrum administration effectively increases salivary lactoferrin levels in VLBW infants.
- The study did not demonstrate a significant effect on secretory immunoglobulin A or urinary lactoferrin.
- Larger trials are warranted to fully elucidate the benefits of oropharyngeal colostrum administration in this vulnerable population.
Objectives:
Studies have confirmed the safety of oropharyngeal administration of colostrum in very low birth weight infants. However, the effect of oropharyngeal administration of colostrum on immune system is inconclusive. This study aims to evaluate the effect of oropharyngeal administration of colostrum on secretory immunoglobulin A and lactoferrin in very low birth weight infants.
Design:
Randomized controlled trial.
Setting:
Forty-bedded neonatal ICU in a university children's hospital in the People's Republic of China.
Patients:
Very low birth weight infants were allocated to the study group (n = 32) and control group (n = 32).
Intervention:
The intervention was oropharyngeal administration of 0.2 mL of their mother's colostrum every 4 hours for 7 days. The control group received saline solution.
Measurements And Main Results:
Secretory immunoglobulin A and lactoferrin in urine and saliva were measured within 24 hours of life (baseline) and at 7 and 21 days. Primary outcomes were changes of secretory immunoglobulin A and lactoferrin in urine and saliva between baseline and at 7 and 21 days. Infant's clinical data were also collected during hospitalization. Change from baseline in lactoferrin in saliva at 7 days (5.18 ± 7.07 vs -1.74 ± 4.67 µg/mL; p < 0.001) and 21 days (5.31 ± 9.74 vs -1.17 ± 10.38 µg/mL; p = 0.02) shows statistic difference. No differences were found of lactoferrin in urine and also no differences of secretory immunoglobulin A in urine and saliva. There were also no differences between days to full enteral feeding, occurrence rate of clinical sepsis, proven sepsis, and necrotizing enterocolitis.
Conclusions:
Oropharyngeal administration of colostrum can increases the level of lactoferrin in saliva in very low birth weight infants. No effect could be documented of secretory immunoglobulin A and lactoferrin in urine. Larger trials are needed to better describe the benefit of oropharyngeal administration of colostrum, if any, in very low birth weight infants.
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