The oligosaccharides contained in breast milk would be important for the diet of premature children because they help prevent digestive disorders and subsequent health problems. But their composition in breast milk would not be insignificant.
In premature infants, the health benefits of breast milk and the oligosaccharides it contains (HMO) have just been reassessed in a new study published in Nutrients. The interest of breast milk oligosaccharides seems well supported to stimulate the intestinal adaptation of premature infants to food and reduce the frequency of a frequent intestinal disease at the beginning of the life of premature infants, necrotizing enterocolitis. However, there are discrepancies between studies that suggest an underlying cause.
Prematurity and intestinal immaturity
Intestinal immaturity in newborn infants frequently causes difficulty in tolerating feeding by the digestive tract (enteral feeding) with infant formula. On the other hand, physiological bacterial colonization at this stage can occur abnormally with a high risk of necrotizing enterocolitis, an inflammatory bowel disease, especially when breast milk is insufficient.
Benefit of oligosaccharides
Human milk oligosaccharides have been credited in several studies of a benefit on the prevention of these disorders. These health benefits of breastfeeding are partly explained by the abundance and, above all, the variety of oligosaccharides in breast milk, which serve as prebiotics and immunomodulators. The concentration of oligosaccharides in breast milk is highly variable and the intestinal microbiota is also highly variable after a premature birth. Breast milk oligosaccharide supplementation may become important for gut protection in preterm infants, especially when the gut has reached a more mature stage.
Oligosaccharides and heterogeneity
The difference in oligosaccharide composition in breast milk may partly explain why some premature infants develop necrotizing enterocolitis when fed exclusively breast milk, according to the study in Nutrients.
The aim of this study was to measure the concentration of 15 dominant human milk oligosaccharides (HMOs) in human milk during the neonatal period and to investigate the correlations between their levels and the occurrence of enterocolitis, sepsis and growth retardation in 106 premature infants with extremely low birth weight (less than 1000 g), exclusively fed with breast milk.
It appears that human milk oligosaccharide diversity and Lacto-N-difucohexaose I levels were lower in samples from mothers with enterocolitis, compared to premature infants without enterocolitis. The oligosaccharide composition of breast milk is therefore not insignificant. However, lacto-N-difucohexaose I is only produced by Lewis positive mothers, that is to say those who are genetically programmed to do so.
Prematurity and health risk
Premature birth (less than 37 weeks of amenorrhea) is a major risk for the child and the main cause of neonatal mortality. Rates of preterm birth remain high, and are even increasing in some countries. Advances in medicine have dramatically improved survival rates for preterm infants, even in very preterm infants (less than 28 weeks), but the transition to digestive feeding at birth poses a significant challenge for the digestive tract of these babies due to their immature digestive and immune functions.
This immaturity exposes to neonatal complications such as sepsis and necrotizing enterocolitis which is an inflammatory bowel disease that can lead to necrosis and perforation of the intestine. These complications can also pave the way for different diseases later in life, including impaired neurological development, allergic diseases and retinopathy.
In premature infants, breastmilk feeding is essential for the adaptation of the digestive tract to feeding, but all breastmilks are probably not the same.
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