PURPOSE OF THE STUDY.
To determine the cytokine responses to milk protein in preterm infants from initial presentation with necrotizing enterocolitis (NEC) to full enteral feedings.
This study followed up a cohort of 14 preterm infants in a large UK NICU who presented with acute NEC.
Blood was collected at 3 time points: acute NEC presentation, feeding reinitiation, and full feeding. Various laboratory techniques were used to assess cytokine responses after cells were incubated with differing amounts of cow’s milk protein; cohort results were compared with those of healthy controls.
Twelve neonates (median postconceptional age: 27 weeks; range: 24–35 weeks) who survived acute NEC completed the study. All subjects had ingested cow’s milk before acute NEC presentation. Th1 (interferon-γ), Th2 (interleukin-4), and regulatory (interleukin-10 and transforming growth factor-β1) cytokine responses to milk proteins were elevated at presentation and increased further at time of feeding reinitiation (P < .005). However, at full feeding, only transforming growth factor-β1 increased further compared with feeding reinitiation (P < .005).
Milk protein–induced lymphocyte and mucosal barrier responses play a key role in local immunologic disruption in the preterm infant. The shift from proinflammatory to regulatory cytokines coincided with clinical recovery.
Perhaps the phrase “until the cows come home,” which first appeared in 1829, applies to preterm infants. More evidence is mounting that cow’s milk can induce an inflammatory reaction resulting in NEC and is eerily similar based on cytokine profiles to food protein–induced enterocolitis. Just like the cow left to graze for months before returning, providers should consider delaying introduction of cow's milk in preterm infants.
- Copyright © 2013 by the American Academy of Pediatrics