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Tailoring Human Milk Oligosaccharides to Prevent Necrotising Enterocolitis Among Preterm Infants
Safiyyah Abbas1, Amy K Keir1,2,3,4, Maria Makrides2,4
1Women's and Children's Health Network, Adelaide, SA, Australia.
Insights
Human milk oligosaccharides (HMOs) show promise for preventing necrotising enterocolitis (NEC) in preterm infants. Current evidence is limited, necessitating further research into tailored HMO supplementation strategies.
Area of Science:
- Neonatal Medicine
- Nutritional Science
- Microbiome Research
Background:
- Necrotising enterocolitis (NEC) remains a significant cause of mortality in preterm infants, with limited therapeutic advancements.
- Human milk oligosaccharides (HMOs) are proposed as a preventive therapy due to their postulated protective functions.
Purpose of the Study:
- To summarize existing evidence on the role of HMOs in NEC development.
- To review emerging strategies for tailoring HMO delivery to preterm infants.
Main Methods:
- Review of current literature on HMOs and NEC prevention.
- Analysis of clinical trials using simple oligosaccharide supplements.
- Exploration of alternative HMO-focused strategies.
Main Results:
- Previous studies using plant-derived simple oligosaccharides showed limited benefits for NEC prevention.
- Alternative strategies like optimizing HMOs in donor milk and synthetic production are under investigation.
- High-quality evidence supporting current implementation in neonatal units is lacking.
Conclusions:
- Further research is required to determine the efficacy of specific HMOs or combinations in preventing NEC.
- Challenges remain in manufacturing, administration, and evaluating long-term effects of oligosaccharide supplementation.
- Tailored oligosaccharide strategies require more investigation to confirm benefits for preterm infants.
Abstract:
Necrotising enterocolitis (NEC) is a devastating disease affecting preterm infants, with little improvement in mortality rates and treatment strategies in the last 30 years. Human milk oligosaccharides (HMOs) are emerging as a potential preventive therapy, with multiple protective functions postulated. Our aim is to summarise the evidence concerning the role of HMOs in NEC development and emerging strategies to tailor the delivery of HMOs to preterm infants. Most research efforts to date have focused on supplementing preterm infants with simple oligosaccharides, which are structurally different to HMOs and derived mainly from plants. Clinical trials demonstrate limited benefits for NEC prevention arising from the use of these supplements. Alternative strategies under investigation include optimising HMOs for infants receiving donor human milk, concentrating oligosaccharides from donor human milk and from animal milks, as well as more sophisticated synthetic oligosaccharide production strategies. Critically, high quality evidence to support implementation of any of these approaches in the neonatal unit is lacking. Whether it is a specific HMO alone or a combination of HMOs that exert protective effects remains to be elucidated. Further challenges include how best to manufacture and administer oligosaccharides whilst retaining bioactivity and safety, including evaluation of the long-term effects of altering the balance of HMOs and gut microbiota in preterm infants. While several human clinical trials are underway, further research is needed to understand whether a tailored approach to oligosaccharide supplementation is beneficial for preterm infants.
