Brunse Anders, Peng Yueming, Li Yanqi, Lykkesfeldt Jens, Sangild Per Torp
Comparative Pediatrics and Nutrition, Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Neonatology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China.
Front Pediatr. 2021 Apr 1;9:636638. doi: 10.3389/fped.2021.636638. eCollection 2021.
Preterm infants are born with immature organs, leading to morbidities such as necrotizing enterocolitis (NEC), a gut inflammatory disease associated with adverse feeding responses but also hemodynamic and respiratory instability. Skin-to-skin contact including "kangaroo care" may improve infant survival and health improved vital functions (e.g., pulmonary, cardiovascular) and endocrine influences by adrenal glucocorticoids. Clinical effects of skin-to-skin contact for newborn siblings ("co-bedding") are not known. Using NEC-susceptible Preterm pigs as models, we hypothesized that co-bedding and exogenous glucocorticoids improve vital functions and NEC resistance. In experiment 1, cesarean-delivered, formula-fed Preterm pigs were reared in incubators with (co-bedding, COB, = 30) or without (single-bedding, SIN, = 29) a sibling until euthanasia and tissue collection on day four. In experiment 2, single-bedded Preterm pigs were treated postnatally with a tapering dose of hydrocortisone (HC, = 19, 1-3 mg/kg/d) or saline (CON, = 19). Co-bedding reduced NEC incidence (38 vs. 65%, < 0.05) and increased the density of colonic goblet cells (+20%, < 0.05) but had no effect on pulmonary and cardiovascular functions (respiration, blood pressure, heart rate, blood gases) or cortisol levels. There were limited differences in intestinal villous architecture and digestive enzyme activities. In experiment 2, HC treatment increased NEC lesions in the small intestine without any effects on pulmonary or cardiovascular functions. Co-bedding may improve gut function and NEC resistance independently of cardiorespiratory function and cortisol levels, but pharmacological cortisol treatment predispose to NEC. Preterm pigs may be a useful tool to better understand the physiological effects of co-bedding, neonatal stressors and their possible interactions with morbidities in Preterm neonates.
早产儿出生时器官不成熟，会引发多种疾病，如坏死性小肠结肠炎（NEC），这是一种肠道炎症性疾病，与不良喂养反应、血流动力学和呼吸不稳定有关。包括“袋鼠式护理”在内的皮肤接触可能会提高婴儿存活率和健康水平，改善重要功能（如肺部、心血管功能）以及肾上腺糖皮质激素的内分泌影响。新生儿兄弟姐妹之间皮肤接触（“同床共眠”）的临床效果尚不清楚。我们以易患NEC的早产猪为模型，假设同床共眠和外源性糖皮质激素可改善重要功能并增强对NEC的抵抗力。在实验1中，剖宫产出生、人工喂养的早产猪在孵化器中饲养，有（同床共眠，COB，n = 30）或没有（单独饲养，SIN，n = 29）兄弟姐妹陪伴，直至在第4天安乐死并收集组织。在实验2中，单独饲养的早产猪在出生后接受逐渐减量的氢化可的松（HC，n = 19，1 - 3 mg/kg/d）或生理盐水（CON，n = 19）治疗。同床共眠降低了NEC发病率（38% 对65%，P < 0.05），增加了结肠杯状细胞密度（+20%，P < 0.05），但对肺部和心血管功能（呼吸、血压、心率、血气）或皮质醇水平没有影响。肠绒毛结构和消化酶活性的差异有限。在实验2中，HC治疗增加了小肠中的NEC病变，但对肺部或心血管功能没有任何影响。同床共眠可能独立于心肺功能和皮质醇水平改善肠道功能和对NEC的抵抗力，但药物性皮质醇治疗易引发NEC。早产猪可能是更好地理解同床共眠、新生儿应激源及其与早产新生儿疾病可能相互作用的生理效应的有用工具。
