Do preterm infants' retinas like bovine colostrum? A randomized controlled trial
Marwa Mohamed Farag1, Mohamed Alaa Eldin Hassan Thabet2, Islam Sh Ahmed3
1Pediatrics and Neonatology, Pediatric Department, Alexandria University Faculty of Medicine, Alexandria University, Alexandria, Egypt. d.marwa.farag@gmail.com.
Insights
Bovine colostrum (BC) supplementation significantly reduced retinopathy of prematurity (ROP) in preterm infants. This intervention also improved growth, hemoglobin levels, and reduced sepsis markers, suggesting BC as a beneficial neonatal nutritional strategy.
Area of Science:
- Neonatal Medicine
- Nutritional Science
- Ophthalmology
Background:
- Premature infants face risks like retinopathy of prematurity (ROP).
- Bovine colostrum (BC) with a liposomal delivery system (LDS) is explored as a supplement to protect against ROP.
- BC-LDS may target multiple factors contributing to ROP in developing retinas.
Purpose of the Study:
- To evaluate the efficacy of BC with LDS in preventing ROP in preterm infants.
- To assess the impact of BC-LDS on other neonatal morbidities and growth parameters.
Main Methods:
- A single-center, randomized controlled trial involving 211 preterm infants (gestational age ≤ 32 weeks).
- Infants were allocated to either a non-BC group or a BC group receiving 3.5 ml/kg/day of BC for 14 days.
- Monitoring included ROP development, anemia, sepsis, bronchopulmonary dysplasia, periventricular leukomalacia, necrotizing enterocolitis, and growth assessment.
Main Results:
- The BC group showed a significantly lower incidence of ROP (5/100) compared to the non-BC group (16/100) (p=0.033).
- BC administration decreased C-reactive protein (CRP) levels and increased weight gain by day 14.
- The BC group had significantly less suspected sepsis and higher hemoglobin levels on day 14.
Conclusions:
- BC supplementation may reduce ROP incidence in preterm neonates.
- Improved Hb levels, growth rate, and anti-inflammatory effects (decreased CRP) likely contribute to ROP prevention.
- While BC intake was a factor, multivariate analysis identified weight gain and birth weight as most significant for ROP development.
Background:
Bovine colostrum (BC) with liposomal delivery system (LDS) is a promising supplement to premature infant formula in absence of mother own milk. We propose that BC with LDS can target multiple etiological factors that threaten the developing retina, making premature infant less liable for retinopathy of prematurity (ROP). The aim of this study was to evaluate the effect of BC with LDS in the prevention of ROP.
Methods:
This was a single center, randomized, controlled trial. Two hundred and eleven preterm infants of gestational age ≤ 32weeks were admitted to the NICU of Alexandria University Children Hospital, Egypt, and randomly allocated into either non-BC group (n = 105) or BC group (n = 106). Patients in BC group received 3.5 ml /kg/day of BC for 14 days. All patients were monitored for development of ROP, anemia, late onset sepsis (LOS), bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC), in addition to growth assessment. Multivariate binary logistic regression analysis was performed to determine factors predicting ROP development.
Results:
Compared with the non-BC group, BC group was associated with a significantly lower incidence of ROP (5/100 vs. 16/100, respectively) with a p-value of 0.033. The administration of BC significantly decreased serum C- reactive protein (CRP) level and increased weight on day-14 of the study in comparison with the CRP level and birthweight at the beginning of study, with Cohen's D= -0.184, D = -2.246, respectively. Patients with suspected sepsis were significantly less in BC than non-BC group, p = 0.004. Patients with BC had significantly higher hemoglobin level on day-14 than non-BC-group, with median (IQR) 12.2 (11.0-13.9) and 11.7 (10.5-12.9), respectively. BC intake is one of factors that decreased development of ROP in univariate analysis. Nevertheless, weight gain and birth weight were the most significant factors affecting ROP development in multivariate-regression model.
Conclusion:
BC may reduce the incidence of ROP in preterm neonates aged ≤ 32 weeks. This might be due to keeping better Hb level and growth rate, as well as anti-inflammatory properties through its ability to decrease CRP level.
Trial Registration:
This work was registered on 06/13/2022 in clinicaltrial.gov with ID no.: NCT05438680 and URL: https://classic.
Clinicaltrials:
gov/ct2/show/NCT05438680?term=NCT05438680&draw=2&rank=1 .
