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Intestinal Barrier Maturation in Very Low Birthweight Infants: Relationship to Feeding and Antibiotic Exposure.
- Source :
-
The Journal of pediatrics [J Pediatr] 2017 Apr; Vol. 183, pp. 31-36.e1. Date of Electronic Publication: 2017 Jan 31. - Publication Year :
- 2017
-
Abstract
- Objective: To test the hypothesis that feeding and antibiotic exposures affect intestinal barrier maturation in preterm infants, we serially measured intestinal permeability (IP) biomarkers in infants <33 weeks gestation (gestational age [GA]) during the first 2 weeks of life.<br />Study Design: Eligible infants <33 weeks GA were enrolled within 4 days of birth in a prospective study of IP biomarkers (NCT01756040). Study participants received the nonmetabolized sugars lactulose/rhamnose enterally on study days 1, 8, and 15 and lactulose/rhamnose were measured in urine by high-performance liquid chromatography. Serum zonulin and fecal alpha-1-anti-trypsin, 2 other IP markers, were measured by semiquantitative Western blot and ELISA, respectively.<br />Results: In a cohort of 43 subjects, the lactulose/rhamnose ratio was increased on day 1 and decreased over 2 weeks, but remained higher in infants born at ≤28 weeks of gestation compared with IP in infants born at >28 weeks of gestation. Exclusive breastmilk feeding was associated with more rapid maturation in intestinal barrier function. A cluster analysis of 35 subjects who had urine samples from all time points revealed 3 IP patterns (cluster 1, normal maturation: n = 20 [57%]); cluster 2, decreased IP during the first week and subsequent substantial increase: n = 5 [14%]); and cluster 3, delayed maturation: n = 10 [29%]). There were trends toward more prolonged antibiotic exposure (P = .092) and delayed initiation of feeding ≥4 days (P = .064) in infants with abnormal IP patterns.<br />Conclusions: Intestinal barrier maturation in preterm infants is GA and postnatal age dependent, and is influenced by feeding with a maturational effect of breastmilk feeding and possibly by antibiotic exposures.<br />Trial Registration: ClinicalTrials.gov: NCT01756040.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Analysis of Variance
Anti-Bacterial Agents pharmacokinetics
Biomarkers analysis
Case-Control Studies
Child Development physiology
Feeding Methods
Female
Follow-Up Studies
Gestational Age
Humans
Infant
Infant Formula
Infant Nutritional Physiological Phenomena
Infant, Newborn
Intestinal Mucosa metabolism
Intestines drug effects
Lactose administration & dosage
Lactose pharmacokinetics
Male
Permeability drug effects
Prospective Studies
Rhamnose administration & dosage
Rhamnose pharmacokinetics
Anti-Bacterial Agents administration & dosage
Infant, Very Low Birth Weight metabolism
Intestinal Absorption physiology
Milk, Human metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6833
- Volume :
- 183
- Database :
- MEDLINE
- Journal :
- The Journal of pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 28159311
- Full Text :
- https://doi.org/10.1016/j.jpeds.2017.01.013