Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT
Oropharyngeal Colostrum Administration in Extremely Premature Infants: An RCT
复制标题
DOI：
10.1542/peds.2014-2004
复制
发表时间：
2015-02-01
期刊：
影响因子：
8
通讯作者：
Choi, Jung-Hwan
中科院分区：
文献类型：
--
作者：
Lee, Juyoung;Kim, Han-Suk;Choi, Jung-Hwan
目的：观察极早产儿经口咽初乳的免疫效果。方法：我们进行了一项双盲、随机、安慰剂对照试验，涉及48名妊娠28周前出生的早产儿。受试者从48 - 96小时开始，每3小时经口咽途径给予0.2 mL母亲初乳或无菌水，持续3天。为了测量分泌性免疫球蛋白A、乳铁蛋白和几种免疫物质的浓度，在出生后24小时、8天和15天采集尿液和唾液。收集住院期间的临床资料。结果：初乳组1周（71.4 vs 26.5 ng/g肌酐，P = 0.04）、2周（233.8 vs 48.3 ng/g肌酐，P = 0.006）、1周乳铁蛋白水平（3.5 vs 0.9 μ g/g肌酐，P = 0.01）显著升高。初乳组2周尿白细胞介素-1 β水平显著降低（55.3 μ g/g肌酐vs 91.8 μ g/g肌酐，P = 0.01）。初乳组唾液转化生长因子- 1 （39.2 vs 69.7 μ g/mL, P = 0.03）和白细胞介素-8 （1.2 vs 4.9 ng/mL, P = 0.04）在第2周显著降低。初乳组临床败血症发生率显著降低（50% vs 92%, P = 0.003）。结论：本研究提示，经口咽部给药初乳可减少极早产儿的临床脓毒症，抑制促炎细胞因子的分泌，提高循环免疫保护因子水平。有必要进行更大规模的研究来证实这些发现。
OBJECTIVE: To determine the immunologic effects of oropharyngeal colostrum administration in abstract extremely premature infants.METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving 48 preterm infants born before 28 weeks' gestation. Subjects received 0.2 mL of their mother's colostrum or sterile water via oropharyngeal route every 3 hours for 3 days beginning at 48 to 96 hours of life. To measure concentrations of secretory immunoglobulin A, lactoferrin, and several immune substances, urine and saliva were obtained during the first 24 hours of life and at 8 and 15 days. Clinical data during hospitalization were collected.RESULTS: Urinary levels of secretory immunoglobulin A at 1 week (71.4 vs 26.5 ng/g creatinine, P = .04) and 2 weeks (233.8 vs 48.3 ng/g creatinine, P = .006), and lactoferrin at 1 week (3.5 vs 0.9 mu g/g creatinine, P = .01) were significantly higher in colostrum group. Urine interleukin-1 beta level was significantly lower in colostrum group at 2 weeks (55.3 vs 91.8 mu g/g creatinine, P = .01). Salivary transforming growth factor-beta 1 (39.2 vs 69.7 mu g/mL, P = .03) and interleukin-8 (1.2 vs 4.9 ng/mL, P = .04) were significantly lower at 2 weeks in colostrum group. A significant reduction in the incidence of clinical sepsis was noted in colostrum group (50% vs 92%, P = .003).CONCLUSIONS: This study suggests that oropharyngeal administration of colostrum may decrease clinical sepsis, inhibit secretion of pro-inflammatory cytokines, and increase levels of circulating immune-protective factors in extremely premature infants. Larger studies to confirm these findings are warranted.