Østergaard Mette V, Bering Stine B, Jensen Michael L, Thymann Thomas, Purup Stig, Diness Marie, Schmidt Mette, Sangild Per T
Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.
Department of Animal Science, Faculty of Science and Technology, Aarhus University, Denmark.
JPEN J Parenter Enteral Nutr. 2014 Jul;38(5):576-86. doi: 10.1177/0148607113489313. Epub 2013 May 28.
Necrotizing enterocolitis (NEC) is a severe inflammatory disorder, associated with the difficult transition from parenteral to enteral feeding after preterm birth. We hypothesized that minimal enteral nutrition (MEN) with amniotic fluid (AF), prior to enteral formula feeding, would improve resistance to NEC in preterm pigs.
Experiment 1: IEC-6 cells were incubated with porcine (pAF) and human AF (hAF) to test AF-stimulated enterocyte proliferation and migration in vitro. Experiment 2: Cesarean-delivered, preterm pigs were fed parenteral nutrition and MEN with pAF, hAF, or control fluid (MEN-pAF, MEN-hAF, or MEN-CTRL; all n = 9) for 2 days before tissue collection. Experiment 3: Preterm pigs were fed MEN diets as in experiment 2, but followed by 2 days of enteral formula feeding, which predisposes to NEC (NEC-pAF, NEC-hAF, or NEC-CTRL; n = 10-12).
Both pAF and hAF stimulated enterocyte proliferation and migration in vitro. In experiment 2, MEN-pAF and MEN-hAF pigs showed increased body weight gain and reduced intestinal interleukin (IL)-8 and colonic IL-6 levels, indicating reduced inflammatory response. In experiment 3, body weight gain was highest in the 2 groups fed AF as MEN, but NEC incidences were similar (NEC-pAF) or increased (NEC-hAF) compared with controls.
Intake of pAF or hAF improved body growth and modulated intestinal inflammatory cytokines during a period of parenteral nutrition, but did not protect against later formula-induced NEC in preterm pigs. Further studies are required to show if MEN feeding with species-specific AF, combined with an optimal enteral diet (eg, human milk), will improve adaptation during the transition from parenteral to enteral feeding in preterm neonates.
坏死性小肠结肠炎（NEC）是一种严重的炎症性疾病，与早产出生后从肠外营养过渡到肠内喂养的困难有关。我们假设在肠内配方奶喂养之前给予含羊水（AF）的微量肠内营养（MEN）会提高早产猪对NEC的抵抗力。
实验1：将IEC-6细胞与猪羊水（pAF）和人羊水（hAF）一起孵育，以测试AF在体外刺激肠上皮细胞增殖和迁移的情况。实验2：剖宫产出生的早产猪在组织采集前2天接受肠外营养和含pAF、hAF或对照液的MEN（MEN-pAF、MEN-hAF或MEN-CTRL；每组n = 9）。实验3：早产猪如实验2那样接受MEN饮食，但随后进行2天的肠内配方奶喂养，这易引发NEC（NEC-pAF、NEC-hAF或NEC-CTRL；n = 10 - 12）。
pAF和hAF在体外均刺激了肠上皮细胞的增殖和迁移。在实验2中，MEN-pAF和MEN-hAF组的猪体重增加，肠道白细胞介素（IL）-8和结肠IL-6水平降低，表明炎症反应减轻。在实验3中，作为MEN给予AF的两组猪体重增加最多，但与对照组相比，NEC发生率相似（NEC-pAF）或增加（NEC-hAF）。
摄入pAF或hAF在肠外营养期间改善了身体生长并调节了肠道炎性细胞因子，但并未预防早产猪后期因配方奶诱导的NEC。需要进一步研究以表明用特定物种的AF进行MEN喂养并结合最佳肠内饮食（如母乳）是否会改善早产新生儿从肠外营养过渡到肠内营养期间的适应性。
