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Small volumes of enteral feedings normalise immune function in infants receiving parenteral nutrition
Y Okada1, N Klein, H K van Saene
1Paediatric Surgery Unit, Institute of Child Health and Great Ormond Street Hospital for Children, University College London Medical School, England.
Insights
Adding enteral nutrition to parenteral nutrition significantly improves immune function in infants, enhancing bacterial killing and cytokine response. This suggests gut stimulation is key to preventing infections in neonates receiving parenteral nutrition.
Area of Science:
- Neonatal immunology
- Gastroenterology
- Infectious disease
Background:
- Parenteral nutrition (PN) is linked to increased risk of sepsis, potentially due to impaired immune function.
- The impact of enteral feeding on immune status in infants receiving PN requires further investigation.
Purpose of the Study:
- To investigate the effects of adding enteral feedings to PN on the immune status of human newborn infants.
- To assess changes in host bactericidal activity and cytokine production.
Main Methods:
- Ten surgical infants on PN were studied in two phases: total PN and PN with minimal enteral feeding.
- Host bactericidal activity against coagulase-negative staphylococci (CNS) and tumor necrosis factor-alpha (TNF-alpha) levels were measured.
- A control group of infants on a normal enteral diet was included for comparison.
Main Results:
- Bacterial killing of CNS was significantly impaired during total PN but improved with the addition of enteral feeds.
- TNF-alpha production was low during total PN and increased significantly after enteral feeding was introduced.
- The improvement in bacterial killing correlated with the duration of enteral feeding.
Conclusions:
- Introducing small volumes of enteral feed enhances the impaired killing of CNS and abnormal cytokine response during total PN.
- Stimulation of the gastrointestinal tract may modulate immune function in neonates, potentially preventing bacterial infections.
Background/Purpose:
Parenteral nutrition (PN) is associated with a risk of septicaemia. This may be caused by impairment of immune function related to PN. The authors investigated the effects of the addition of enteral feedings to PN on the immune status of human newborn infants.
Methods:
Ten surgical infants (age less than 6 months) requiring PN were studied in two consecutive phases: (A) after 31.1+/-6.0 days (mean +/- SEM) of PN with no enteral feeding (total PN); and (B) after 4.7+/-1.1 days from the addition of small volumes of enteral feeding to PN. Full blood count and liver function tests were not significantly different between phases A and B. A control group (n = 9) of infants receiving a normal enteral diet was also studied. Host bactericidal activity against coagulase-negative staphylococci (CNS) was measured by an in vitro whole blood model. Bacterial killing was measured after a 45-minute bacterial challenge using the Miles-Misra technique. Tumour necrosis factor-alpha (TNF-alpha) was measured by enzyme-linked immunosorbent assay (ELISA) after 2 hours of bacterial challenge.
Results:
The lowest level of CNS killing (37.7+/-5.2%), was observed in patients receiving total PN. This increased significantly after the addition of small enteral feeds (52.0+/-4.6%, P < .005) approaching the levels measured in controls (65.1+/-3.4%). TNF-alpha production was low during total PN (1467+/-297 pg/mL) and rose significantly after the addition of minimal enteral feeds (4,661+/-1,311 pg/mL, P < .05). The increase in CNS killing after the addition of small enteral feeds in patients on PN was significantly correlated with the duration of enteral feeding (r = 0.8, P = .006).
Conclusions:
These results indicate that the introduction of small volumes of enteral feed improve the impaired killing of CNS and the abnormal cytokine response observed during total PN. This implies that stimulation of the gastrointestinal tract may modulate immune function in neonates and prevent bacterial infection.