Low Diversity of Human Milk Oligosaccharides is Associated with Necrotising Enterocolitis in Extremely Low Birth Weight Infants.

Erik Wejryd,Thomas Abrahamsson,Giovanna Marchini,Anna Werme,Eva Landberg,Magalí Martí,Baldvin Jonsson

doi:10.3390/nu10101556

Abstract

Difference in human milk oligosaccharides (HMO) composition in breast milk may be one explanation why some preterm infants develop necrotizing enterocolitis (NEC) despite being fed exclusively with breast milk. The aim of this study was to measure the concentration of 15 dominant HMOs in breast milk during the neonatal period and investigate how their levels correlated to NEC, sepsis, and growth in extremely low birth weight (ELBW; <1000 g) infants who were exclusively fed with breast milk. Milk was collected from 91 mothers to 106 infants at 14 and 28 days and at postmenstrual week 36. The HMOs were analysed with high-performance anion-exchange chromatography with pulsed amperometric detection. The HMOs diversity and the levels of Lacto-N-difucohexaose I were lower in samples from mothers to NEC cases, as compared to non-NEC cases at all sampling time points. Lacto-N-difucohexaose I is only produced by secretor and Lewis positive mothers. There were also significant but inconsistent associations between 3′-sialyllactose and 6′-sialyllactose and culture-proven sepsis and significant, but weak correlations between several HMOs and growth rate. Our results suggest that the variation in HMO composition in breast milk may be an important factor explaining why exclusively breast milk fed ELBW infants develop NEC.

Highlights

While the care of premature infants has improved dramatically during the last decades, still about30% of the extremely low birth weight (ELBW, birth weight < 1000 g) infants die [1]
The aim of this study was to investigate the composition of 15 dominant human milk oligosaccharides (HMO) in breast milk during the neonatal period and examine how this correlated to necrotizing enterocolitis (NEC), sepsis, and growth in ELBW
Breast milk samples were collected from 91 mothers to 106 infants at 14 (n = 78) and 28 (n = 71) days after delivery and at postmenstrual week (PMW) 36 + 0 (n = 51)

Summary

Introduction

30% of the extremely low birth weight (ELBW, birth weight < 1000 g) infants die [1]. Definite NEC (Bell’s stage II-III [3]) remains among the most devastating diseases encountered in premature infants. It is associated with an excessive inflammatory process in the intestinal mucosa that presents clinically with feeding intolerance, abdominal distension, and bloody stools [4]. The incidence among ELBW infants is approximately 10% [5], but varies in different neonatal settings between 4 to 15% depending. The surgical intervention rate is as high as 50% [4], and the mortality rate in affected infants is 15–30%.

Objectives

Methods

Results