Infant Journal
for neonatal and paediatric healthcare professionals

Human milk oligosaccharides and necrotising enterocolitis

Human milk is known to reduce the risk of necrotising enterocolitis (NEC) in preterm infants, but mechanisms are poorly understood. Human milk oligosaccharides (HMOs) are complex sugars produced by the mammary gland and present in variable amounts in different breast milks. Animal models show HMOs impact on development of NEC and human
preterm infant studies show a specific HMO, called
disialyllacto-N-tetraose (DSLNT), is present in maternal milk in lower amounts in infants who go on to develop NEC. This article reviews the role of HMOs in NEC development and the clinical data in preterm infants, and considers the possible next steps for supplementation in preterm infants.

Kristina Chmelova1
Neonatal Research and Transport Fellow

Andrea C Masi2
Clinical Researcher

Janet E Berrington1,2
Consultant Neonatologist

1Department of Neonatology, Newcastle upon Tyne Hospitals NHS Foundation Trust
2Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne

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necrotising enterocolitis; human milk oligosaccharides; breast milk; supplementation
Key points
  1. Although NEC is a major cause of mortality and morbidity in preterm infants, its pathogenesis remains unclear.
  2. HMOs are complex sugars in breast milk that cannot be digested by humans. Their composition varies widely from woman to woman.
  3. DSLNT is one HMO that may protect against NEC.
  4. Supplementation and synthesis of HMOs are subjects for future research.

Also published in Infant:

Full milk feeding from day one for preterm infants
The FEED1 trial will investigate whether full milk feeds from day 1 in infants born at 30+0 to 32+6 weeks’ gestation reduces the length of hospital stay when compared to intravenous fluids or parenteral nutrition with gradual milk feeding. Early establishment of milk feeding in preterm infants could reduce risks of infection and improve growth. Achieving fully nutritional volumes of milk feeds earlier and improving growth without infections or necrotising enterocolitis may help the infant to be ready for home sooner.