A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother's colostrum to extremely low-birth-weight infants.
A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother's colostrum to extremely low-birth-weight infants.
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DOI：
10.1097/anc.0b013e3181e94133
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发表时间：
2010-08-01
期刊：
影响因子：
--
通讯作者：
Fogg, Lou
中科院分区：
文献类型：
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作者：
Rodriguez, Nancy A;Meier, Paula P;Fogg, Lou
未标记：母亲的初乳含有丰富的细胞因子和其他免疫因子，如果在出生后的头几天给极低出生体重（ELBW）婴儿口咽部，当肠内喂养是禁忌的，可能会刺激口咽相关淋巴组织。然而，口咽途径给药初乳的安全性和可行性尚未确定。目的：探讨初生婴儿初乳经口咽给药的安全性。第二个目的是研究以下方法的可行性：(1)在出生后第一天将这种干预措施用于ELBW婴儿；(2)测量这些婴儿气管吸入分泌物和尿液中分泌性免疫球蛋白A和乳铁蛋白的浓度。研究对象：5例ELBW婴儿（平均出生体重657 g，平均胎龄25.5周）。设计：准实验，1组，前测后测设计。方法：受试者从出生48小时开始，每2小时口服0.2 mL自己母亲的初乳，连续48小时。在基线、干预结束时和2周后分别测量每位受试者气管吸入物和尿液中分泌性免疫球蛋白A和乳铁蛋白的浓度。结果：所有婴儿均完成了整个治疗方案，每人接受24次治疗。共收集了15份尿液标本，其中14份有足够的量供分析。共收集气管抽吸物15份，但只有7份（47%）的体积足够分析。5例患儿尿液和气管吸入物中分泌性免疫球蛋白A和乳铁蛋白浓度差异较大；然而，一些结果超出了测定检测的范围。所有婴儿在给药初乳滴剂期间开始吸吮气管内管。在每次治疗期间，血氧饱和度保持稳定或略有增加。未出现呼吸暂停、心动过缓、低血压或其他与初乳相关的不良反应。结论：即使是最小和病情最严重的ELBW婴儿，经口咽部给药自己母亲的初乳是简单、廉价且耐受性良好的。未来的研究应该继续检查测量这种治疗的直接免疫效果的最佳程序，以及临床结果，如感染，特别是呼吸机相关性肺炎。
UNLABELLED: Own mother's colostrum is rich in cytokines and other immune agents that may stimulate oropharyngeal-associated lymphoid tissue if administered oropharyngeally to extremely low-birth-weight (ELBW) infants during the first days of life when enteral feeding is contraindicated. However, the safety and feasibility of the oropharyngeal route for the administration of colostrum have not been determined.PURPOSE: To determine the safety of oropharyngeal administration of own mother's colostrum to ELBW infants in first days of life. A secondary purpose was to investigate the feasibility of (1) delivering this intervention to ELBW infants in the first days of life and (2) measuring concentrations of secretory immunoglobulin A and lactoferrin in tracheal aspirate secretions and urine of these infants.SUBJECTS: Five ELBW infants (mean birth weight and gestational age = 657 g and 25.5 weeks, respectively).DESIGN: Quasi-experimental, 1 group, pretest-posttest design.METHODS: Subjects received 0.2 mL of own mother's colostrum administered oropharyngeally every 2 hours for 48 consecutive hours, beginning at 48 hours of life. Concentrations of secretory immunoglobulin A and lactoferrin were measured in tracheal aspirates and urine of each subject at baseline, at the completion of the intervention and again 2 weeks later.RESULTS: All infants completed the entire treatment protocol, each receiving 24 treatments. A total of 15 urine specimens were collected and 14 were sufficient in volume for analysis. A total of 15 tracheal aspirates were collected, but only 7 specimens (47%) were sufficient in volume for analysis. There was wide variation in concentrations of secretory immunoglobulin A and lactoferrin in urine and tracheal aspirates among the 5 infants; however, several results were outside the limits of assay detection. All infants began to suck on the endotracheal tube during the administration of colostrum drops. Oxygen saturation measures remained stable or increased slightly during each of the treatment sessions. There were no episodes of apnea, bradycardia, hypotension, or other adverse effects associated with the administration of colostrum.CONCLUSIONS: Oropharyngeal administration of own mother's colostrum is easy, inexpensive, and well-tolerated by even the smallest and sickest ELBW infants. Future research should continue to examine the optimal procedure for measuring the direct immune effects of this therapy, as well as the clinical outcomes such as infections, particularly ventilator-associated pneumonia.