Oropharyngeal colostrum may boost immunity, reduce sepsis

By Will Boggs MD

NEW YORK (Reuters Health) - Delivering small amounts of colostrum to the posterior oropharynx improves immune markers and reduces sepsis rates in extremely premature infants, researchers from Korea report.

"The benefits of colostrum have been known and accepted widely," Dr. Han-Suk Kim, from Seoul National University College of Medicine, told Reuters Health by email. "We hope for neonatologists to have a chance to consider this option of administration method of colostrum in extremely premature infants who cannot start feeding yet for various reasons."

Several studies have demonstrated the immunoprotective properties of colostrum, but many preterm infants cannot tolerate enteral feedings and, therefore, do not receive maternal colostrum. This may contribute to their increased susceptibility to various infectious and inflammatory conditions.

Dr. Kim's team evaluated the immunological effects of instilling 0.2 mL of the mother's colostrum (versus 0.2 mL sterile water) into each posterior oropharynx of 48 extremely premature infants (<28 weeks' gestation) every three hours for 72 hours (regardless of whether the infant was fed enterally).

Urinary secretory immunoglobulin A (IgA) and lactoferrin levels were significantly increased at one week in the colostrum group (compared with the sterile water group), while urinary interleukin (IL)-1beta levels were significantly reduced at two weeks.

Similarly, salivary secretory IgA and epidermal growth factor were increased at one week in the colostrum group, and salivary transforming growth factor (TGF)-beta1 and IL-8 levels were reduced at two weeks, according to the January 26 Pediatrics online report.

Clinical sepsis was significantly less common in the colostrum group (50% vs 92%; p=0.003), although there was no difference in culture-proven sepsis. The colostrum group had shorter antibiotic duration (mean, six days) than the sterile water group (mean, 9.5 days).

The two groups did not differ in rates of necrotizing enterocolitis, bronchopulmonary dysplasia, ventilator-associated pneumonia, intraventricular hemorrhage, retinopathy of prematurity requiring laser surgery, or in the time to reach full enteral feeding, hospitalization duration, or mortality.

"Although this small study cannot draw a conclusive statement about the clinical benefit of colostrum, it provides evidence suggesting that oropharyngeal administration of colostrum during the first few days of life can potentially enhance immune function in the sickest premature infants," the researchers say. "Additionally, our findings suggest the possible usefulness of colostrum as an oropharyngeal immune-boosting agent to prevent sepsis and excessive mucosal inflammation in the preterm population."

"The procedure is really simple and easy overall," Dr. Kim said. "But using a sterile technique is necessary, because extremely premature infants are very vulnerable for infection."

The researchers explain in the paper that at each session, two syringes were first warmed in the infant's incubator and then placed on the patient's right or left buccal mucosa, one at a time, and the colostrum or placebo drops were administered toward the posterior oropharynx for at least 10 seconds. The session was stopped if the babies developed bradycardia or tachycardia or become otherwise unstable.

"It would be good news for the mothers of patients in the NICU, because they can participate in the care of preterm infants by giving the colostrum to their extremely preterm babies," Dr. Kim added.

"We provided only basic scientific evidence of immunological benefits of oropharyngeal colostrum administration, so further large-scale randomized controlled trials are needed for solid clinical benefits for extremely preterm infants," Dr. Kim said.

Donna Pletsch, a nurse and NICU clinical educator at London Health Sciences Center, Ontario, Canada, told Reuters Health by email, "We have incorporated OIT (Oral Immune Therapy) as standard admission orders on all infants admitted to the NICU."

"We provide OIT kits to the mothers to make it easy," Pletsch said. "A pre-made bag of 1 mL syringes is provided to the mother. We also provide breast milk labels to the mother after verifying her name and health card number is correct, and matches her infant. Mothers are instructed and supported to manually express, pump, and divide their fresh milk/colostrum into individual syringes. We teach those mothers . . . when it is highly likely their infant will be admitted to the NICU."

"Our ability to support mothers expressing breast milk and provide OIT early on has correlated to a higher incidence of exclusive breast milk feeding at discharge," she said.

Pletsch concluded, "Oral immune therapy, using the mother's own milk/colostrum, should be regarded as a standard order for all newborn NICU infants, and continue until they are orally feeding."

This research was funded by Seoul National University College of Medicine. The authors report no disclosures.

SOURCE: http://bit.ly/1JBAwip

Pediatrics 2015.

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