Effects of anticipated neonatal surgical intervention on maternal milk cytokine production.
BACKGROUND
Maternal stress on neonatal outcomes of infants admitted to the NICU is incompletely understood. We previously demonstrated breast milk derived cytokines remain biologically active in the neonatal intestine. We hypothesized that the need for neonatal surgical intervention would be stimulus leading to maternal cytokine production thus affecting neonatal outcome.


METHODS
Discarded expressed breast milk (EBM) in the first 3weeks following delivery was analyzed for IL-23 and IL-10 by ELISA. Variables analyzed included: the need for a pediatric surgical procedure, the need for cardiac surgical procedure, no surgical interventions, and survival. All values are expressed as mean±SEM. Statistical analysis utilized Kruskal and Mann-Whitney test.


RESULTS
EBM from mothers whose infants required any surgical procedure (n=19) revealed significant elevation in IL-10 but not IL-23 compared to nonsurgical EBM (n=18). Subdivided by procedure type, there was no difference between those undergoing a cardiac (n=9) versus pediatric surgical (n=10) procedure in both IL-10 and IL-23. Mothers whose infants requiring surgical intervention or whose infants did not survive in the first 3weeks of life had elevation of IL-10.


CONCLUSIONS
Results suggest maternal stress impacts the cytokine profile of breast milk.


METHODS
Level III.
Department of Surgery, Children's Mercy Hospital, Kansas City, MO. Electronic address: rrentea@cmh.edu.
Rebecca M
RM
Rentea
Division of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
Amy J
AJ
Wagner
Division of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
David M
DM
Gourlay
Division of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
Melissa
M
Christensen
Department of Pediatrics and Critical Care, Albert Einstein College Medicine, Montefiore Medical Center, New York, NY.
Jennifer L
JL
Liedel
D059031:Anticipation, Psychological; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016753:Interleukin-10 / Q000096:biosynthesis*; D053759:Interleukin-23 / Q000096:biosynthesis*; D008895:Milk, Human / Q000378:metabolism*; D009035:Mothers / Q000523:psychology*; D013315:Stress, Psychological / Q000378:metabolism*; D013514:Surgical Procedures, Operative / Q000523:psychology*
C508609:IL10 protein, human; D053759:Interleukin-23; D016753:Interleukin-10
Cardiac surgery; Cytokine; Il-10; Il-23; Inflammation; Necrotizing enterocolitis