Early Human-Milk Metabolome in Cases of Intrauterine Growth-Restricted and Macrosomic Infants.

BACKGROUND: Abnormal fetal growth is associated with short-term and long-term metabolic dysregulation and susceptibility to obesity-related disorders. Maternal milk, the ideal source of infantile nutrition, protects from metabolic diseases in adulthood. By applying nuclear magnetic resonance (NMR) metabolomics, this study investigated the metabolic profile of early human milk/colostrum (EHM/C) at the extremes of fetal-growth conditions, which could affect its nutritional value. METHODS: From 98 mothers delivering 60 appropriate-for-gestational-age (AGA), 19 large-for-gestational-age (LGA), and 19 intrauterine growth-restricted (IUGR) full-term neonates, milk samples collected on the third to fourth day post partum were examined by NMR spectroscopy. Multivariate data analysis elicited information from NMR spectra and probed to metabolic signatures of EHM/C. RESULTS: LGA and IUGR EHM/C samples depicted increased content in lactose, citric acid, choline, phosphocholine, and N-acetylglutamine. AGA samples exhibited increased isoleucine and valine. Metabolic pathways involved were valine, leucine/isoleucine biosynthesis and degradation, glycerophospholipid metabolism, aminoacyl-transfer RNA biosynthesis, and citrate cycle. Orthogonal projections to latent structures discriminant analysis models were validated. CONCLUSION: This holistic metabolomics study framed an increased content of certain essential nutrients in EHM/C samples following the birth of LGA and IUGR infants prone to short- and long-term metabolic disorders, thus stressing additional benefits of early breastfeeding. Assessing the metabolic profile of EHΜ/C enables evaluation of its nutrition value, adjusted to fetal growth, and introduction of appropriate dietary interventions.

Factors affecting human colostrum fatty acid profile: A case study.

The role of maternal colostrum to infant development has been extensively studied and presented. Among the main factors which contribute to breast milk composition are maternal diet, age and body mass index, parity, duration of pregnancy and stage of lactation. This study aims to investigate the potential impact of several factors including demographic (i.e. maternal age and nationality) on the colostrum fatty acid profile. Colostrum was collected the third day postpartum in a Greek maternity hospital. Certain lipid quality indices and fatty acid ratios were estimated and results were statistically processed. The main identified fatty acids were palmitic (C16:0), oleic (C18:1ω-9), and linoleic (C18:2ω-6) acids. Among fatty acids, saturated fatty acids predominated (47.61%), followed by monounsaturated fatty acids (39.26%), while polyunsaturated fatty acids had the lowest proportion (13.13%). Values of lipid quality indices were within the reported in the literature ranges. Maternal body mass index, nationality, age, mode of delivery, gender and fetal weight percentile were studied in respect to their potential influence on the fatty acid profile of colostrum fat. Results suggest that colostrum fatty acid profile was mainly dependent on maternal nationality and age rather than mode of delivery and maternal BMI. Regarding the effect of maternal nationality, significant differences were found for saturated and monounsaturated fatty acids. Of the most interesting findings is that colostrum fat from older (≥35 years) mothers had less saturated fat and more appropriate LQIs values. Finally, a reversed correlation was observed between the customized centile of the infants and the colostrum fat content.

Novel bioactive substances in human colostrum: could they play a role in postnatal adaptation?

OBJECTIVE: To determine maternal colostrum/serum concentrations of the bioactive substances irisin, adropin and copeptin and investigate their association with several perinatal parameters and pathologic conditions during pregnancy. METHODS: In a cohort of 81 mothers with full-term deliveries, colostrum/serum concentrations of irisin, adropin and copeptin were prospectively evaluated by ELISA on Day 3-4 postpartum. RESULTS: Copeptin and adropin were detectable in human colostrum at higher, while irisin at lower concentrations than in maternal serum (p < 0.001 in all cases). Colostrum adropin and copeptin concentrations positively correlated with maternal serum ones (r = 0.421, p < 0.001 and r = 0.304, p = 0.006, respectively). CONCLUSIONS: Irisin, adropin and copeptin are present in colostrum and we speculate that they may be implicated in postnatal adaptation with respect to thermoregulation, vascular adaptation, glucose metabolism, lung function and fluid homeostasis. These findings may possibly enhance the necessity for early breastfeeding, particularly of infants born by cesarean section, who are prone to hypothermia, breathing disorders and dehydration.

Importance of Direct Antiglobulin Test (DAT) in Cord Blood: Causes of DAT (+) in a Cohort Study.

BACKGROUND: The direct antiglobulin test (DAT) is the cornerstone of the diagnosis of hemolytic disease of the newborn (HDN). The aim of this study was to review the incidence and causes of positive DAT in cord blood in relation to development of HDN. METHODS: We retrospectively reviewed all results of DAT, which is routinely performed in cord blood samples, along with the laboratory and infants' medical records. RESULTS: DAT was positive in 70/2695 (2.59%) cases. In 64/70 (91.43%) cases, DAT positivity was attributed to ABO incompatibility. There were 50/218 (22.93%) DAT (+) cases in the A/O group and 13/97 (13.40%) cases in the B/O group (p = 0.0664). Two DAT (+) cases were attributed to maternal alloimmunization (anti-Fya and anti-JKb, respectively), and one to maternal IgG autoantibodies that developed after methyldopa treatment. Among the 70 DAT (+) cases, 30 (42.86%) cases required phototherapy with no difference between the A/O and B/O groups. The duration of phototherapy in the B/O group was significantly longer than in the A/O group (p = 0.024). There was a trend of correlation of increasing strength of DAT positivity with phototherapy need. No false positive DAT case was detected. CONCLUSIONS: Although ABO incompatibility remains the main reason of DAT (+), other causes (e.g., alloimmunization, drugs) should also be explored. The relevant impact of DAT (+) on HDN development should be considered.

Enteral L-arginine supplementation for prevention of necrotizing enterocolitis in very low birth weight neonates: a double-blind randomized pilot study of efficacy and safety.

BACKGROUND: Necrotizing enterocolitis (NEC) is the most common acquired gastrointestinal disease in premature infants and has high mortality and morbidity. Endothelial nitric oxide is an important regulator of vascular perfusion and is synthetized from the amino acid L-arginine. Hypoargininemia is frequently observed in preterm neonates and may predispose them to NEC. Our objective was to determine the effect of enteral L-arginine supplementation on the incidence and severity of NEC in very low birth weight (VLBW) neonates. MATERIALS AND METHODS: We conducted a parallel blind randomized pilot study, comprising VLBW neonates with birth weight ≤1500 g and gestational age ≤34 weeks. VLBW neonates were randomly assigned to receive enteral L-arginine supplementation (1.5 mmol/kg/d bid) between the 3rd and 28th day of life or placebo. Diagnosis and classification of NEC were done according to modified Bell's criteria. RESULTS: Eighty-three neonates were randomized to the arginine (n = 40) or placebo (n = 43) group. No adverse effects were observed in neonates receiving L-arginine supplementation. The incidence of NEC stage III was significantly lower in the arginine-supplemented group (2.5% vs 18.6%, P = .030). CONCLUSIONS: Enteral L-arginine supplementation of 1.5 mmol/kg/d bid can be safely administered in VLBW neonates from the 3rd to the 28th day of life. Enteral L-arginine supplementation appears to reduce the incidence of stage III NEC in VLBW infants. Larger studies are needed to further evaluate the effect of L-arginine supplementation in preventing NEC in VLBW infants.

The impact of oral glutamine supplementation on the intestinal permeability and incidence of necrotizing enterocolitis/septicemia in premature neonates.

OBJECTIVE: To examine the impact of oral glutamine (Gln) supplementation on gut integrity and on the incidence of necrotizing enterocolitis (NEC)/septicemia of premature neonates. METHODS: Preterm neonates (n = 101, gestational age <34 weeks, birth weight <2000 g) were randomly allocated to receive from day 3 to day 30 postpartum, either oral Gln (0.3 g/kg/day, n = 51-Gln group) or placebo (caloreen-isocaloric, n = 50-control group). Intestinal permeability was determined from the urinary lactulose/mannitol recovery (L/M ratio) following their oral administration and assessed at three time points: day 2 (before first administration), day 7 and day 30 of life. The incidence of NEC and septicemia over the study period was also recorded. RESULTS: A decrease of lactulose recovery at days 7 (p = 0.001) and 30 (p < 0.001) and a decrease of L/M ratio at day 7 (p = 0.002) were observed only in the Gln group. Lactulose recovery and L/M ratio at day 7 (p = 0.022 and p = 0.004, respectively), as well as lactulose recovery (p = 0.001), mannitol recovery (p = 0.042), and L/M ratio (p = 0.001) at day 30, were decreased in the Gln group as compared to controls. NEC and septicemia were lower in the Gln group at the end of the first week (p = 0.009 and p = 0.041, respectively) and up to the end of the study (p < 0.001 and p = 0.048, respectively). CONCLUSION: Oral Gln administration may have beneficial effects on intestinal integrity and the overall incidence of NEC/septicemia in preterm infants.