Journal article
Transition from parenteral to enteral nutrition induces immediate diet-dependent gut histological and immunological responses in preterm neonates
University of Copenhagen1
Bacteriology & Pathology, Division of Veterinary Diagnostics and Research, National Veterinary Institute, Technical University of Denmark2
Division of Veterinary Diagnostics and Research, National Veterinary Institute, Technical University of Denmark3
National Veterinary Institute, Technical University of Denmark4
Innate Immunology, Division of Veterinary Diagnostics and Research, National Veterinary Institute, Technical University of Denmark5
Aarhus University6
Microbial Ecology, Division of Veterinary Diagnostics and Research, National Veterinary Institute, Technical University of Denmark7
Necrotizing enterocolitis (NEC) in preterm infants develops very rapidly from a mild intolerance to enteral feeding into intestinal mucosal hemorrhage, inflammation, and necrosis. We hypothesized that immediate feeding-induced gut responses precede later clinical NEC symptoms in preterm pigs. Fifty-six preterm pigs were fed total parenteral nutrition (TPN) for 48 h followed by enteral feeding for 0, 8, 17, or 34 h with either colostrum (Colos, n = 20) or formula (Form, n = 31).
Macroscopic NEC lesions were detected in Form pigs throughout the enteral feeding period (20/31, 65%), whereas most Colos pigs remained protected (1/20, 5%). Just 8 h of formula feeding induced histopathological lesions, as evidenced by capillary stasis and necrosis, epithelial degeneration, edema, and mucosal hemorrhage.
These immediate formula-induced changes were paralleled by decreased digestive enzyme activities (lactase and dipeptidylpeptidase IV), increased nutrient fermentation, and altered expression of innate immune defense genes such as interleukins (IL-1α, IL-6, IL-18), nitric oxide synthetase, tight junction proteins (claudins), Toll-like receptors (TLR-4), and TNF-α.
In contrast, the first hours of colostrum feeding induced no histopathological lesions, increased maltase activity, and induced changes in gene expressions related to tissue development. Total bacterial density was high after 2 days of parenteral feeding and was not significantly affected by diet (colostrum, formula) or length of enteral feeding (8–34 h), except that a few bacterial groups (Clostridium, Enterococcus, Streptococcus species) increased with time.
We conclude that a switch from parenteral to enteral nutrition rapidly induces diet-dependent histopathological, functional, and proinflammatory insults to the immature intestine. Great care is required when introducing enteral feeds to TPN-fed preterm infants, particularly when using formula, because early feeding-induced insults may predispose to NEC lesions that are difficult to revert by later dietary or medical interventions.
Language: | English |
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Publisher: | American Physiological Society |
Year: | 2011 |
Pages: | G435-45 |
ISSN: | 15221547 and 01931857 |
Types: | Journal article |
DOI: | 10.1152/ajpgi.00400.2010 |
ORCIDs: | 0000-0001-7480-6064 , 0000-0002-6125-7892 , Jensen, Tim Kåre , Skovgaard, Kerstin and Boye, Mette |