title: Oropharyngeal colostrum administration in extremely premature infants: an RCT.
abstract: OBJECTIVE
  To determine the immunologic effects of oropharyngeal colostrum administration in extremely premature infants.
  
  
  METHODS
  We conducted a double-blind, randomized, placebo-controlled trial involving 48 preterm infants born before 28 weeks' gestation. Subjects received 0.2 mL of their mother's colostrum or sterile water via oropharyngeal route every 3 hours for 3 days beginning at 48 to 96 hours of life. To measure concentrations of secretory immunoglobulin A, lactoferrin, and several immune substances, urine and saliva were obtained during the first 24 hours of life and at 8 and 15 days. Clinical data during hospitalization were collected.
  
  
  RESULTS
  Urinary levels of secretory immunoglobulin A at 1 week (71.4 vs 26.5 ng/g creatinine, P = .04) and 2 weeks (233.8 vs 48.3 ng/g creatinine, P = .006), and lactoferrin at 1 week (3.5 vs 0.9 μg/g creatinine, P = .01) were significantly higher in colostrum group. Urine interleukin-1β level was significantly lower in colostrum group at 2 weeks (55.3 vs 91.8 μg/g creatinine, P = .01). Salivary transforming growth factor-β1 (39.2 vs 69.7 μg/mL, P = .03) and interleukin-8 (1.2 vs 4.9 ng/mL, P = .04) were significantly lower at 2 weeks in colostrum group. A significant reduction in the incidence of clinical sepsis was noted in colostrum group (50% vs 92%, P = .003).
  
  
  CONCLUSIONS
  This study suggests that oropharyngeal administration of colostrum may decrease clinical sepsis, inhibit secretion of pro-inflammatory cytokines, and increase levels of circulating immune-protective factors in extremely premature infants. Larger studies to confirm these findings are warranted.
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea; and.
authors.forename: Juyoung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea; and kimhans@snu.ac.kr.
authors.forename: Han-Suk
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea; and.
authors.forename: Young Hwa
authors.initials: YH
authors.lastname: Jung
authors.affiliation: Department of Pediatrics, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea.
authors.forename: Ka Young
authors.initials: KY
authors.lastname: Choi
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea; and.
authors.forename: Seung Han
authors.initials: SH
authors.lastname: Shin
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea; and.
authors.forename: Ee-Kyung
authors.initials: EK
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea; and.
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Choi
mesh_terms: D003126:Colostrum / Q000276:immunology*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D004750:Enteral Nutrition / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D007071:Immunoglobulin A, Secretory / Q000097:blood; D052577:Infant, Extremely Low Birth Weight / Q000276:immunology*; D007231:Infant, Newborn; D053583:Interleukin-1beta / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007781:Lactoferrin / Q000097:blood; D056910:Republic of Korea; D012463:Saliva / Q000737:chemistry; D018805:Sepsis / Q000276:immunology* / Q000517:prevention & control*; D053773:Transforming Growth Factor beta1 / Q000097:blood
chemical_list: D007071:Immunoglobulin A, Secretory; D053583:Interleukin-1beta; D016209:Interleukin-8; D053773:Transforming Growth Factor beta1; D003404:Creatinine; D007781:Lactoferrin
keywords: colostrum; extremely premature infant; human milk