Breast milk and the prevention of neonatal and preterm gastrointestinal disease states: a new perspective.

In this review of the protective properties of human breast milk, a new perspective is taken to underscore the passive and active protection properties of breast milk in providing specific protection against selective gastrointestinal disease affecting the neonate and preterm infant. The normal protective properties of the gastrointestinal epithelial barrier (immunologic and nonimmunologic) are considered as is the development of barriers to antigen absorption in the immature infant human intestine as a background for considering three accelerated gastrointestinal diseases-necrotizing enterocolitis, intestinal allergy, and bacterial gastroenteritis. In each of these conditions, the developmental protective defect is considered and the role of breast milk plays in filling the protective void discussed. Besides considering passive protection of breast milk including the new roles assigned to nutrients such as lactoferrin and nucleotides, and importance of active substances in breast milk such as growth factors, cytokines and hormones are discussed in the context of actively stimulating the infant's own intestinal defenses to function as a protective barrier. Future studies at the cellular and molecular level should be helpful in designing both preventative and treatment strategies to deal with these diseases.