title: Provision of Amniotic Fluid During Parenteral Nutrition Increases Weight Gain With Limited Effects on Gut Structure, Function, Immunity, and Microbiology in Newborn Preterm Pigs.
abstract: Small enteral boluses with human milk may reduce the risk of subsequent feeding intolerance and necrotizing enterocolitis in preterm infants receiving parenteral nutrition (PN). We hypothesized that feeding amniotic fluid, the natural enteral diet of the mammalian fetus, will have similar effects and improve growth and gastrointestinal (GI) maturation in preterm neonates receiving PN, prior to the transition to milk feeding.
  
  
  
  Twenty-seven pigs, delivered by cesarean section at ~90% of gestation, were provided with PN and also fed boluses with amniotic fluid (AF; n = 13, 24-72 mL/kg/d) or no oral supplements (nil per os [NPO]; n = 14) until day 5 when blood, tissue, and fecal samples were collected for analyses.
  
  
  
  Body weight gain was 2.7-fold higher in AF vs NPO pigs. AF pigs showed slower gastric emptying, reduced meal-induced release of gastric inhibitory peptide and glucagon-like peptide 2, changed gut microbiota, and reduced intestinal permeability. There were no effects on GI weight, percentage mucosa, villus height, plasma citrulline, hexose absorptive capacity, and digestive enzymes. Intestinal interleukin (IL)-1β levels and expression of IL1B and IL8 were increased in AF pigs, while blood biochemistry and amino acid levels were minimally affected.
  
  
  
  Enteral boluses of AF were well tolerated in the first 5 days of life in preterm pigs receiving PN. Enteral provision of AF before the initiation of milk feeding may stimulate body growth and improve hydration in preterm infants receiving PN. Furthermore, it may improve GI motility and integrity, although most markers of GI maturation remain unchanged.
authors.affiliation: Department of Nutrition, Exercise and Sports and Department of Clinical Veterinary and Animal Science, University of Copenhagen, Frederiksberg C, Denmark.
authors.forename: Mette Viberg
authors.initials: MV
authors.lastname: Østergaard
authors.affiliation: Department of Nutrition, Exercise and Sports and Department of Clinical Veterinary and Animal Science, University of Copenhagen, Frederiksberg C, Denmark.
authors.forename: Rene Liang
authors.initials: RL
authors.lastname: Shen
authors.affiliation: Department of Nutrition, Exercise and Sports and Department of Clinical Veterinary and Animal Science, University of Copenhagen, Frederiksberg C, Denmark Innate Immunology Group, National Veterinary Institute, Technical University of Denmark, Frederiksberg C, Denmark.
authors.forename: Ann Cathrine Findal
authors.initials: AC
authors.lastname: Støy
authors.affiliation: Innate Immunology Group, National Veterinary Institute, Technical University of Denmark, Frederiksberg C, Denmark.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Skovgaard
authors.affiliation: Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Krych
authors.affiliation: Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark.
authors.forename: Stine Sofie
authors.initials: SS
authors.lastname: Leth
authors.affiliation: Department of Food Science, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark.
authors.forename: Dennis Sandris
authors.initials: DS
authors.lastname: Nielsen
authors.affiliation: NNF Center for Basic Metabolic Research, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen N, Denmark.
authors.forename: Bolette
authors.initials: B
authors.lastname: Hartmann
authors.affiliation: Department of Nutrition, Exercise and Sports and Department of Clinical Veterinary and Animal Science, University of Copenhagen, Frederiksberg C, Denmark.
authors.forename: Stine Brandt
authors.initials: SB
authors.lastname: Bering
authors.affiliation: Department of Nutrition, Exercise and Sports and Department of Clinical Veterinary and Animal Science, University of Copenhagen, Frederiksberg C, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Nutrition, Exercise and Sports and Department of Clinical Veterinary and Animal Science, University of Copenhagen, Frederiksberg C, Denmark Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen Ø, Denmark pts@nexs.ku.dk.
authors.forename: Per Torp
authors.initials: PT
authors.lastname: Sangild
mesh_terms: D000653:Amniotic Fluid; D000818:Animals; D000831:Animals, Newborn / Q000254:growth & development*; D002585:Cesarean Section / Q000662:veterinary; D020345:Enterocolitis, Necrotizing; D005260:Female; D005749:Gastric Inhibitory Polypeptide / Q000378:metabolism; D005769:Gastrointestinal Motility; D041981:Gastrointestinal Tract / Q000254:growth & development / Q000382:microbiology / Q000502:physiology*; D005865:Gestational Age; D053767:Glucagon-Like Peptide 2 / Q000378:metabolism; D007109:Immunity; D010288:Parenteral Nutrition / Q000662:veterinary*; D011247:Pregnancy; D047928:Premature Birth / Q000662:veterinary*; D034421:Sus scrofa; D015430:Weight Gain
chemical_list: D053767:Glucagon-Like Peptide 2; D005749:Gastric Inhibitory Polypeptide
keywords: amniotic fluid; immature intestine; minimal enteral nutrition; preterm birth