Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Lilling Family Neonatal Research Lab, Feinstein Institutes for Medical Research, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA.
Breastfeed Med. 2020 Dec;15(12):776-778. doi: 10.1089/bfm.2020.0205. Epub 2020 Sep 30.
Fecal calprotectin, a recognized marker of intestinal inflammation, is derived from neutrophil migration to a site of inflammation. Introduction of bovine-based human milk fortifier containing intact protein in preterm infants is associated with an increase in fecal calprotectin suggestive of intestinal inflammation. Newer fortifiers contain protein hydrolysates in place of intact protein. To measure fecal calprotectin in human milk-fed preterm infants before and after human milk fortification using a fortifier containing hydrolyzed protein. Serial stool samples were collected from 24 infants beginning at the first week to 60 days postnatal age. To compare the effect of human milk fortification, samples collected before and after fortification were compared. Infant demographics, diet, postnatal morbidities, and maternal characteristics were recorded. A total of 401 stool samples were collected from 24 study infants who had a birth weight of 993 ± 277 g (mean ± standard deviation), gestational age 27.5 ± 2.8 weeks, and fortifier initiation at 14 days. Median fecal calprotectin before and after fortification were similar. Calprotectin levels were not correlated with birth weight or gestational age but were inversely correlated with postnatal age ( = 0.005), use of fortifier ( < 0.001), receipt of antibiotics antenatally ( = 0.007) and postnatally ( = 0.008). After adjusting for postnatal age, calprotectin levels were significantly lower following receipt of fortifier ( < 0.001) and postnatal antibiotics ( < 0.001). The feeding of protein hydrolysate-containing human milk fortifiers does not appear to be associated with increases in a marker of intestinal inflammation.
粪便钙卫蛋白是肠道炎症的公认标志物，来源于中性粒细胞向炎症部位的迁移。在早产儿中引入含有完整蛋白质的基于牛的人乳强化剂与粪便钙卫蛋白增加有关，提示存在肠道炎症。更新的强化剂含有蛋白质水解物而不是完整蛋白质。本研究旨在使用含有水解蛋白的强化剂，在人乳喂养的早产儿中测量人乳强化前后粪便钙卫蛋白。从出生后第一周到 60 天，对 24 名婴儿连续采集粪便样本。为了比较人乳强化的效果，比较了强化前后采集的样本。记录了婴儿人口统计学特征、饮食、围产期并发症和母亲特征。本研究共采集了 24 名研究婴儿的 401 份粪便样本，这些婴儿的出生体重为 993±277g（均值±标准差），胎龄为 27.5±2.8 周，强化剂起始于出生后 14 天。强化前后粪便钙卫蛋白中位数相似。钙卫蛋白水平与出生体重或胎龄无关，但与出生后年龄呈负相关（r=0.005），与强化剂的使用（r<0.001）、产前（r=0.007）和产后（r=0.008）使用抗生素有关。在校正出生后年龄后，接受强化剂（r<0.001）和产后抗生素（r<0.001）后，钙卫蛋白水平显著降低。喂养含有蛋白质水解物的人乳强化剂似乎不会导致肠道炎症标志物增加。
