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Early feeding, antenatal glucocorticoids, and human milk decrease intestinal permeability in preterm infants
R J Shulman1, R J Schanler, C Lau
1USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, and Texas Children's Hospital, Houston 77030, USA.
Insights
Early feeding and antenatal steroids improve intestinal permeability in preterm infants. Human milk also reduces permeability, highlighting key factors for infant gut health and development.
Area of Science:
- Neonatal physiology
- Gastroenterology
- Pediatric nutrition
Background:
- Intestinal permeability is a critical factor in preterm infant health.
- Factors influencing gut barrier function in neonates require further investigation.
Purpose of the Study:
- To investigate the impact of age, feeding regimen, and antenatal glucocorticoids on intestinal permeability in preterm infants.
- To compare the effects of different feeding strategies and diets on gut barrier function.
Main Methods:
- A randomized controlled trial involving 132 preterm infants.
- Stratification by gestational age and diet (mother's own milk vs. preterm formula).
- Assessment of intestinal permeability using the lactulose/mannitol ratio at 10, 28, and 50 days of age.
Main Results:
- Intestinal permeability significantly changed with infant age (p = 0.003).
- Early feeding strategies reduced permeability at 10 days (p = 0.01).
- Antenatal steroid administration (p = 0.017) and human milk feeding (p = 0.02) decreased permeability at 28 days.
Conclusions:
- Age, early feeding initiation, antenatal glucocorticoids, and human milk consumption are significant modulators of intestinal permeability in preterm infants.
- Feeding regimens and diet play a crucial role in establishing gut barrier integrity during early infancy.
- Continuous versus bolus feeding did not demonstrate a significant effect on intestinal permeability.
Abstract:
To determine the effects of age, feeding regimen, and antenatal glucocorticoids on intestinal permeability, preterm infants (n = 132) were stratified by gestational age and by diet (mothers' own milk versus preterm formula), and assigned randomly to one of four feeding regimens: early-continuous, early-bolus, standard-continuous, and standard-bolus. At 10, 28, and 50 d of age permeability was determined by measuring the ratio of lactulose/ mannitol in the urine after the two sugars were administered enterally for 30 h. The mean (+/-SE) birth weight and gestational age of the infants were 1044 +/- 13 g and 27 +/- 0.1 wk, respectively. Permeability changed as a function of age (p = 0.003). Early feeding was associated with a reduction in permeability at 10 d of age (p = 0.01). Antenatal steroid administration was associated with decreased permeability at 28 d of age (p = 0.017). The feeding of human milk (versus formula) was associated with decreased permeability at 28 d of age (p = 0.02). Continuous versus bolus feeding did not affect permeability.