ORIGINAL ARTICLE: NUTRITION
Bacteriological, Biochemical, and Immunological Properties of Colostrum and Mature Milk From Mothers of Extremely Preterm Infants
Laura Moles, ySusana Manzano, Leonides Ferna´ndez, zAntonia Montilla, zNieves Corzo, § Susana Ares, Juan M. Rodrı´guez, and yIrene Espinosa-Martos
ABSTRACT Objectives: The objective of this work was to elucidate the influence of extremely premature birth (gestational age 24–27 weeks) on the microbiological, biochemical, and immunological composition of colostrum and mature milk. Methods: A total of 17 colostrum and 34 mature milk samples were provided by the 22 mothers of extremely preterms who participated in this study. Bacterial diversity was assessed by culture-based methods, whereas the concentration of lactose, glucose, and myo-inositol was determined by a gas chromatography procedure. Finally, the concentrations of a wide spectrum of cytokines, chemokines, growth factors, and immunoglobulins were measured using a multiplex system. Results: Bacteria were present in a small percentage of the colostrum and milk samples. Staphylococci, streptococci, and lactobacilli were the main bacterial groups isolated from colostrum, and they could be also isolated, together with enterococci and enterobacteria, from some mature milk samples. The colostrum concentrations of lactose and glucose were significantly lower than those found in mature milk, whereas the contrary was observed in relation to myo-inositol. The concentrations of most cytokines and immunoglobulins in colostrum were higher than in mature milk, and the differences were significant for immunoglobulin G3, immunoglobulin G4, interleukin (IL)-6, interferon-g, interleukin-4 (IL-4), IL-13, IL-17, macrophage-monocyte chemoattractant protein-1 and macrophage inflammatory protein-1b. Conclusions: The bacteriological, biochemical, and immunological content of colostrum and mature milk from mothers of extremely preterm infants is particularly valuable for such infants. Efforts have to be made to try that preterm neonates receive milk from their own mothers or from donors matching, as much as possible, the gestational age of the preterm.
Received April 25, 2014; accepted September 2, 2014. From the Departamento de Nutricio´n, Bromatologı´a y Tecnologı´a de los Alimentos, Universidad Complutense de Madrid, the yProbisearch, Tres Cantos, the zDepartamento de Bioactividad y Ana´lisis de Alimentos, Instituto de Investigacio´n en Ciencias de la Alimentacio´n, and the §Servicio de Neonatologı´a, Hospital Universitario La Paz, Madrid, Spain. Address correspondence and reprint requests to Dr Irene Espinosa-Martos, Probisearch, C/ Santiago Grisolı´a, 2, 28760 Tres Cantos, Madrid, Spain (e-mail: [email protected]). This work was supported by the CYTED (IBERFUN 110AC0386), CSD2007-00063 (FUN-C-FOOD, Consolider-Ingenio 2010), and AGL2010-15420 projects from the Ministerio de Economı´a y Competitividad (Spain). The authors report no conflicts of interest. Copyright # 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition DOI: 10.1097/MPG.0000000000000560
Key Words: bacteria, carbohydrates, human milk, immunocompounds, myo-inositol, preterm
(JPGN 2015;60: 120–126)
B
reast-feeding is the natural and best advisable way of supporting the growth and development of healthy term infants (1). The benefits of breast milk are well recognized as providing health benefits in early infancy and extending into adulthood. In addition, the present research confirms that breast milk with appropriate fortification is the optimal care for the low- and the very-low-birthweight infants (2). When breast-feeding may not be possible and own mother’s milk may not be available, donor human milk becomes the next alternative (3,4). The benefits of breast milk for preterm infants include faster gastric emptying (5); a faster tolerance to enteral feeding and a reduced need of parental nutrition (6); enhanced nutrient absorption (7); improved visual and cognitive development (8,9); and reduced incidence of necrotizing enterocolitis, sepsis, and other infections (10,11). Such effects are probably because of the combined action of nutrients and a variety of bioactive factors present in colostrum and breast milk, such as inmunoglobulins, inmunocompetent cells, antimicrobial fatty acids, polyamines, oligosaccharides, lysozyme, lactoferrin, and other glycoproteins, antimicrobial peptides and, also, commensal or probiotic bacteria (12,13). It is long known that the concentration of many, if not all, nutrients and bioactive compounds changes from colostrum to mature milk and, in addition, there is a variability associated to several factors, such as host’s genetic background, health status, nutrition, lactation stage (infant’s age), ‘‘circadian’’ rhythm, milk fraction (foremilk, hindmilk), geographic location, and the like (12). Gestational age may also influence the concentration of nutrients and bioactive compounds (14–16). Biochemical and immunological data suggest that mothers’ colostrum or milk feedings may provide the greatest protection from infection for the most immature infants (17) which, in comparison with larger preterm infants, are the most immunocompromised, are exposed routinely to invasive, life-saving procedures and remain in the pathogen-laden neonatal intensive care unit for the longest period. Studies on the composition of colostrum and milk from mothers delivering before the 30th week of gestation are, however, scarce. In this context, the objective of this work was to study a wide variety of microbiological, biochemical, and immunological parameters in milk of mothers of extremely preterm infants (
Bacteriological, Biochemical, and Immunological Properties of Colostrum and Mature Milk From Mothers of Extremely Preterm Infants
Laura Moles, ySusana Manzano, Leonides Ferna´ndez, zAntonia Montilla, zNieves Corzo, § Susana Ares, Juan M. Rodrı´guez, and yIrene Espinosa-Martos
ABSTRACT Objectives: The objective of this work was to elucidate the influence of extremely premature birth (gestational age 24–27 weeks) on the microbiological, biochemical, and immunological composition of colostrum and mature milk. Methods: A total of 17 colostrum and 34 mature milk samples were provided by the 22 mothers of extremely preterms who participated in this study. Bacterial diversity was assessed by culture-based methods, whereas the concentration of lactose, glucose, and myo-inositol was determined by a gas chromatography procedure. Finally, the concentrations of a wide spectrum of cytokines, chemokines, growth factors, and immunoglobulins were measured using a multiplex system. Results: Bacteria were present in a small percentage of the colostrum and milk samples. Staphylococci, streptococci, and lactobacilli were the main bacterial groups isolated from colostrum, and they could be also isolated, together with enterococci and enterobacteria, from some mature milk samples. The colostrum concentrations of lactose and glucose were significantly lower than those found in mature milk, whereas the contrary was observed in relation to myo-inositol. The concentrations of most cytokines and immunoglobulins in colostrum were higher than in mature milk, and the differences were significant for immunoglobulin G3, immunoglobulin G4, interleukin (IL)-6, interferon-g, interleukin-4 (IL-4), IL-13, IL-17, macrophage-monocyte chemoattractant protein-1 and macrophage inflammatory protein-1b. Conclusions: The bacteriological, biochemical, and immunological content of colostrum and mature milk from mothers of extremely preterm infants is particularly valuable for such infants. Efforts have to be made to try that preterm neonates receive milk from their own mothers or from donors matching, as much as possible, the gestational age of the preterm.
Received April 25, 2014; accepted September 2, 2014. From the Departamento de Nutricio´n, Bromatologı´a y Tecnologı´a de los Alimentos, Universidad Complutense de Madrid, the yProbisearch, Tres Cantos, the zDepartamento de Bioactividad y Ana´lisis de Alimentos, Instituto de Investigacio´n en Ciencias de la Alimentacio´n, and the §Servicio de Neonatologı´a, Hospital Universitario La Paz, Madrid, Spain. Address correspondence and reprint requests to Dr Irene Espinosa-Martos, Probisearch, C/ Santiago Grisolı´a, 2, 28760 Tres Cantos, Madrid, Spain (e-mail: [email protected]). This work was supported by the CYTED (IBERFUN 110AC0386), CSD2007-00063 (FUN-C-FOOD, Consolider-Ingenio 2010), and AGL2010-15420 projects from the Ministerio de Economı´a y Competitividad (Spain). The authors report no conflicts of interest. Copyright # 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition DOI: 10.1097/MPG.0000000000000560
Key Words: bacteria, carbohydrates, human milk, immunocompounds, myo-inositol, preterm
(JPGN 2015;60: 120–126)
B
reast-feeding is the natural and best advisable way of supporting the growth and development of healthy term infants (1). The benefits of breast milk are well recognized as providing health benefits in early infancy and extending into adulthood. In addition, the present research confirms that breast milk with appropriate fortification is the optimal care for the low- and the very-low-birthweight infants (2). When breast-feeding may not be possible and own mother’s milk may not be available, donor human milk becomes the next alternative (3,4). The benefits of breast milk for preterm infants include faster gastric emptying (5); a faster tolerance to enteral feeding and a reduced need of parental nutrition (6); enhanced nutrient absorption (7); improved visual and cognitive development (8,9); and reduced incidence of necrotizing enterocolitis, sepsis, and other infections (10,11). Such effects are probably because of the combined action of nutrients and a variety of bioactive factors present in colostrum and breast milk, such as inmunoglobulins, inmunocompetent cells, antimicrobial fatty acids, polyamines, oligosaccharides, lysozyme, lactoferrin, and other glycoproteins, antimicrobial peptides and, also, commensal or probiotic bacteria (12,13). It is long known that the concentration of many, if not all, nutrients and bioactive compounds changes from colostrum to mature milk and, in addition, there is a variability associated to several factors, such as host’s genetic background, health status, nutrition, lactation stage (infant’s age), ‘‘circadian’’ rhythm, milk fraction (foremilk, hindmilk), geographic location, and the like (12). Gestational age may also influence the concentration of nutrients and bioactive compounds (14–16). Biochemical and immunological data suggest that mothers’ colostrum or milk feedings may provide the greatest protection from infection for the most immature infants (17) which, in comparison with larger preterm infants, are the most immunocompromised, are exposed routinely to invasive, life-saving procedures and remain in the pathogen-laden neonatal intensive care unit for the longest period. Studies on the composition of colostrum and milk from mothers delivering before the 30th week of gestation are, however, scarce. In this context, the objective of this work was to study a wide variety of microbiological, biochemical, and immunological parameters in milk of mothers of extremely preterm infants (
