Furthermore in newborns, the immune response of thymus-derived immune cells, the so-called T-lymphocytes, is skewed towards a reaction which is associated with an increased risk to develop an allergic state, the Th2 pathway. This reaction includes the synthesis of the antibody Immunoglobulin E (IgE), which is involved in the allergic reaction. In adults, the mature and healthy immune system is skewed towards the Th1 pathway, which is steered towards an efficient anti-microbial response including IgG synthesis.
We have seen that ...
PROTECTIVE GUT & NUTRITION STRATEGIES Scientific data prepared by Dr. Ragia Labieb Presented by: Perwin Aly Waly Neonatology resident N.I.C.U _ Ain Shams University June 2009
These include early administration of intravenous amino acids , lipids and minimal enteral nutrition (by human milk or supplemented formulas ) with full-strength rather than dilute formula or sterile water .
Potential Benefits of Early Aggressive Nutrition
The most critical developmental period of brain growth and function occurs during the last trimester of pregnancy and the first 2 years of postnatal life.
So malnutrition in this period may have long-term developmental consequences
Aggressive nutrition is initiating (TPN) in the first hours after birth and administering it in conjunction with initially small , and then advancing, enteral feedings beginning on the first or second day of life.
But for ELBW infants, postnatal duplication of normal in utero growth rates may not be a realistic goal for medical, practical, and theoretical reasons, especially for the first several weeks of life .
But also relative fluid restriction usually is practiced to prevent development of PDA, with some neonatologists advocating allowing weight to decrease as much as 15% to 20% below BW in the 1 st days of life.
Total Parenteral Nutrition ( TPN ) QUALITY&QUANTITY
We administer substrates aggressively from the first day of life, particularly protein, with a goal of providing fetal nutrient delivery rates to the neonate as soon as possible to avoid the period of early neonatal malnutrition.
Nevertheless, it is common practice in many NICUs to provide intravenous glucose alone for several days and to limit protein administration to ELBW or sick neonates in the early neonatal period because of concerns that these fragile patients may not tolerate protein.
These include decrease the frequency and severity of neonatal hyperglycemia by stimulating endogenous insulin secretion and stimulating growth by enhancing the secretion of insulin and insulin-like growth factors .
The intestine is the primary immune organ in the body because it contains 60% of the total immunoglobulins and more than 10 6 lymphocytes/gm tissue. Role of the gut in immune functions Kelly D Trends in immunology 2005
Immature Conditions of the Neonate’s Immune System Immune system is shifted towards the Th2 pathway to protect the foetus from the mother’s system Limited exposure of antigens in utero Still no memory has been build up
A ntibodies alone serve to transmit the mother's immunologic experience to the fetus and infant; these, and not the fetal T cells, protect the child while its own immune system matures Zinkernagel RM NEJM 2001
The lipids in human milk become antiviral, antibacterial, and antiprotozoal in vivo after digestion in the gastrointestinal tract . Microbial killing by milk lipids is due primarily to FFAs and monoglycerides released from milk triglycerides ( mainly oleic acid ) by both milk-derived bile-salt– stimulated lipase and lipolytic activity in the infant’s gut .
Das UN 2002 & Isaacs CE 2005 lipids
T he protective effect of breast feeding against atopy might be attributed to its high content in ω-6 . In addition, its modulatory influences on Th1 and Th2 responses. Th e favorable action on Th1 and Th2 responses may depend on the ratio between ω -3 and ω -6 fatty acids. A higher ratio of ω -6 to ω -3 favors an enhancement in the Th1 response, whereas a decrease in the ratio between ω -6 to ω -3 may favor the Th2 response . lipids Das UN 2002
nucleotides Agget P 2003; Field CJ 2005; Yu V 2002; Carver JD 2003
Nucleotides affect the composition of intestinal microbiota in lactating infants
Modify the immune system (humoral response and immune cell development)
Reduce incidence of gastrointestinal infections
Increase postprandial superior mesenteric
blood flow velocity
SO Risks of artificial feeding Interferes with bonding More diarrhoea and respiratory infections Malnutrition & Vitamin A deficiency More allergy and milk intolerance Increased risk of some chronic diseases Overweight Lower scores on intelligence tests May become pregnant sooner Increased risk of anaemia, ovarian and breast cancer Adapted from: Breastfeeding counseling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6). Slide 2.26
" sole diet" infants followed up at 7.5 to 8 years of age: those who had received term formula had significantly lower verbal IQ scores than those who received preterm formula , and this difference was most pronounced in males .
There was also a higher incidence of cerebral palsy in the term formula group.
Summary & conclusion A newborn’s immune system needs special measures of protection and support Breast milk strengthens an infant’s immune system, leading to less infections and allergies
Sometimes it is a matter of life or death for babies ! As new study clearly points out for the first time that timing of beginning breast feeding is independently linked to survival of babies. This is the key point of the presentation and discussion
5/2 UNICEF/HQ92-0369/ Roger Lemoyne, Thailand Beginning Breastfeeding within ONE . hour : ( Beginning life with “life”)