Welcoming a new baby into the world should be an exciting time if you're an expecting parent. But when your child is born premature, it's normal to worry about the possible health challenges and complications they may face.
Necrotizing enterocolitis, also known as NEC, is a rare condition that premature babies may develop during their first weeks of life. Though NEC can be managed, its effect on a child's health can be serious. NEC prevention may also be possible, according to new preliminary studies.
Emerging preclinical research from Johns Hopkins and Abbott suggests that when premature babies are fed breast milk, the presence of human milk oligosaccharides (HMOs) in the milk may help reduce their chances of developing NEC. We sat down with Rachael Buck, Ph.D., a research fellow at Abbott Nutrition, to discuss necrotizing enterocolitis and the promising research surrounding it.
What Is Necrotizing Enterocolitis?
NEC is a disease that can affect newborns by causing inflammation in their intestines. With NEC, bacteria inside the intestinal tract can leak into the intestinal wall. Babies with NEC require a period of gut rest, which means they are temporarily nourished by intravenous nutrition. NEC may be fatal, depending upon how severely NEC affects the newborn, Buck explains.
The specific cause of NEC is unknown, but it's most often seen in very low birth weight premature babies. In the United States, about 10% of babies who are born prematurely develop NEC. "While there are available NEC treatments, preventive strategies to aid infants at high risk for the disease are needed," says Buck.
One prevention strategy that's already showing promise involves the use of HMOs. In new preclinical research from Johns Hopkins and Abbott, HMOs were shown to effectively prevent instances of necrotizing enterocolitis in animal models.
What Are Human Milk Oligosaccharides?
Behind fat and lactose (carbohydrate), HMOs are the third most abundant component in breast milk. These are special prebiotics that feed beneficial bacteria and play a positive role in the development of the infant immune system. HMOs cannot be broken down or digested by your child, but they are digested by the beneficial bacteria that reside in their gut.
There are around 200 different HMOs in breast milk, but the most abundant one is 2'-FL HMO. A structurally identical version of the 2'-FL HMO that's present in breast milk can be found in certain Similac® formulas.
"For parents who cannot or choose not to breastfeed, or those who need to supplement, using an infant formula with HMO 2'-fucosyllactose (2'-FL HMO) can help to support a baby's developing immune system similar to breastfed infants," says Buck.
When breastfeeding isn't an option, some mothers opt to pump breast milk for their preterm babies, which is often given to them through a feeding tube. This allows them to still receive the immune benefits of HMOs from their mother.
How Do HMOs Help With NEC Prevention?
“We now know, for the first time, how HMOs protect against NEC — through toll-like receptor 4 inhibition, this is a critical development that sets the stage for us to conduct additional research and testing with the goal of developing feeding interventions that incorporate these potentially lifesaving ingredients to combat this disease.”
Rachael Buck, PhD, Director of pre-clinical research at Abbott
On a cellular level, NEC may be caused by the enhanced expression of certain proteins involved in inflammation, called toll-like receptor 4 (TLR4) in the intestines of premature infants. New research suggests that two HMOs — 2'-FL and 6'-SL — bind to TLR4 and dramatically curb intestinal inflammation. Other research suggests that premature infants who aren't breastfed have a 2.4 times greater risk of developing necrotizing enterocolitis.
"We now know, for the first time, how HMOs protect against NEC — through toll-like receptor 4 inhibition," explains Buck. "This is a critical development that sets the stage for us to conduct additional research and testing with the goal of developing feeding interventions that incorporate these potentially lifesaving ingredients to combat this disease."
"Future HMO research looks very promising and Abbott is committed to advancing this rich area of science-based nutrition," says Buck.
What Does the Future of Preemie Nutrition Look Like?
"HMOs are potentially lifesaving ingredients with respect to near-term and longer-term health outcomes in this vulnerable population," explains Buck. Although HMOs are not currently available in Similac's premature infant formulas, this is an active area of research for Buck's team. "We are committed to optimizing these formulas based on clinical research in preterm infants," she adds.
If your baby is born prematurely, understanding that mother’s own breastmilk is best for your baby is key to delivering not only nutrients, but also HMOs and other immune-protective factors. And since breastmilk protects against NEC, work closely with your baby’s physician and dietitian to understand how to support a good breastmilk supply, so that your preterm baby gets as much breastmilk as possible.
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How HMOs Can Support Infant Cognition
Human milk oligosaccharides (HMOs) are unique prebiotics found naturally in breast milk that feed the good bacteria in the gut where approximately 70% of the immune system exists. While there are hundreds of different HMOs available in breast milk, the most abundant and well-researched among them is 2'-Fucosyllactose (2'-FL). New findings from Abbott published in the Journal of Nutrition & Food Science suggests that HMOs may help support cognition and motor development in infants. The study found that 2'-FL and 6-sialyllactose (6'-SL) HMOs together may be helpful in brain development. For the study, researchers collected a total of 82 human milk samples from women at one month postpartum to determine the impact of mothers’ weight and medical risk factors on breast milk composition. The women were asked to record weight and other variables, including gestational diabetes and smoking habits. The results of the research showed that higher levels of 6'-SL HMO in breast milk was linked to higher cognitive and motor skills scores in breastfed infants at 18 months, regardless of the mothers’ weight, diabetic status or other variables. And, greater levels of both 2'-FL and 6'-SL HMOs together were associated with higher motor skills scores at 6 and 18 months of age. Gross and fine motor skills are essential aspects of a child’s overall development. They allow a child to explore his or her environment, play with objects, demonstrate affection by reaching and holding, and demonstrate independence through mobility. This research suggests HMOs may also be important in supporting brain development in babies.