Colostrum as Oral Immune Therapy to Promote Neonatal Health

Gephart, Sheila M. PhD, RN; Weller, Michelle BSN, RN, IBCLCAdvances in Neona­tal Care:Feb­ru­ary 2014 — Vol­ume 14 — Issue 1 — p 44–51

Abstract

It is well known that the immune response is blunt­ed and under­de­vel­oped in the pre­ma­ture infant, but human milk sup­ports the infant’s growth, func­tion, and effec­tive­ness. Thus, own mother’s colostrum (OMC) admin­is­tered oropha­ryn­geal­ly has poten­tial to deliv­er oral immune ther­a­py (C-OIT) even before enter­al feed­ings have begun. Colostrum inter­acts with lym­phoid tis­sue in the orophar­ynx and gut. Colostrum as oral immune ther­a­py is deliv­ered by swab­bing the cheeks in the first days of life. Lit­tle for­mal study has eval­u­at­ed its effec­tive­ness. How­ev­er, small stud­ies demon­strate that it is a prac­tice that is safe, fea­si­ble, and well tol­er­at­ed even by the small­est pre­ma­ture infants. Encour­ag­ing pre­lim­i­nary evi­dence sup­ports the effect of C-OIT to reduce the time to full enter­al feed­ings. Effects on oth­er out­comes is unclear, in part because exist­ing stud­ies are under­pow­ered to detect sig­nif­i­cant dif­fer­ences on out­comes like necro­tiz­ing ente­ro­col­i­tis, sep­sis, and death. Anoth­er lim­i­ta­tion in the evi­dence base is that adher­ence to the inter­ven­tion and the num­ber of dos­es of colostrum infants received in the stud­ies is not con­sis­tent­ly made clear. More well-designed stud­ies are need­ed to demon­strate the impact on neona­tal com­pli­ca­tions and how C-OIT sup­ports the infant’s immune devel­op­ment. Qual­i­ty improve­ment and time series reports of dif­fer­ences pre- and postim­ple­men­ta­tion of OMC giv­en oral­ly should min­i­mal­ly include sta­tis­tics for adher­ence to the inter­ven­tion and/or the num­ber of dos­es an infant received as a covari­ate. Even so, OMC is an immune ther­a­py that pos­es lit­tle risk yet offers like­ly cost-effec­tive ben­e­fit for vul­ner­a­ble infants.