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 k.chmelova@nhs.net

Andrea C Masi²
Clinical Researcher

Janet E Berrington^1,2
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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Keywords

necrotising enterocolitis; human milk oligosaccharides; breast milk; supplementation

Key points

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

Also published in Infant:

VOLUME 16/ISSUE 1, JANUARY 2020

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.