الفهرس 
PRETERM NEONATAL IMMUNE SYSTEM
Preterm adaptive immune systemOnly 14 pages are availabe for public view
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Abstract
Late onset sepsis and necrotizing enterocolitis are major
cause of mortality and morbidity in preterm neonates
mainly due to immaturity of their innate and adaptive immune
system.
Bovine Colostrum is the first milk that mammals produce
after parturition, it contains antimicrobials such as lactoferrin
and lactoperoxidases, immunological and growth factors.
Our study aimed to asses effect of oral bovine colostrum
in prevention of late onset sepsis and necrotizing enterocolitis
when used as gut priming in premature neonates as long as
neonate can tolerate oral intake.
Our study was conducted on 51 premature neonates
below 34 weeks gestational age, Mean gestational age 31.98 ±
2.04 weeks, admitted at Ain shams university NICUs.
The enrolled patients were subdivided into three groups;
breast milk group are infants with exclusive maternal breast
milk initially then predominant (maternal breast milk more than
75% of the total), bovine colostrum group are infants with
exclusive bovine colostrum then added with infant formula, and
infant formula group are infants with artificial formula initially
then predominantly artificial feeding (maternal breast milk less
than 25% of the total). For all neonates, history taken and clinical examination
done twice weekly for detection of any attack of sepsis or NEC
and every attack severity assessed by hematological scoring
system (Tollner and Rodwell), SNAPII scoring system and
Bell’s staging for NEC.
For all neonates, laboratory investigations withdrawn
includes complete blood count, C-reactive protein, blood
culture if sepsis suspected, and peripheral blood mononuclear
cells assessed in first 72 hours of life and after one week, to be
analyzed for cellular parameters by flow cytometry (CD4 T
cells, CD25, T-regulatory cells). Three subsets of CD4+ T cells
will be defined according to CD25 staining: CD25-, CD25 low,
and CD25 high. All of these cells are important in preterm
immune system homeostasis and prevention of sepsis and NEC.
Bovine colostrum high amounts of the insulin-like
growth factors (IGFs), weight increment in this study was
nearly equal in both breast milk and intervention bovine
colostrum group. Mean of weight increment was 93.53 ±43.60
and 92.06 ± 32.84 respectively, which was greater than weight
increment in artificial formula group with mean 64.12 ± 21.45.
In this study, neonates who received bovine colostrum
were less in feeding intolerance and incidence of NEC among
all studied groups, there was only one neonate who developed
feeding intolerance and there was no single attack of NEC.
Summary and Conclusion
106
While there were 4 neonates (23.5%) in infant formula
group who developed feeding intolerance and three neonates
(17.6%) who developed NEC Bell’s stage III.
Frequency of attacks of late onset sepsis and severity are
less in neonates who received bovine colostrum group, one
neonate developed sepsis in bovine colostrum group compared
to two neonates in breast milk group and four neonates in infant
formula group.
Attacks of sepsis were diagnosed by hematological
scoring system and confirmed by blood cultures, three neonates
17.6% in infant formula group had positive blood culture, while
there is only two neonates 11.8% had positive blood cultures in
intervention group who received bovine colostrum.
Mortality rate was least in neonates who received bovine
colostrum as there was no mortality in colostrum group while
there were three neonates had mortality (17.6%) in infant
formula group.
Incidence of ventilation was less in neonates, who
received bovine colostrum, as there was one neonate (5.9%)
who needed invasive ventilation while there were four 4
(23.5%) patients who needed invasive ventilation in control
infant formula group.
T-regulatory cells (Treg) are important in preterm
immune system homeostasis and prevention of sepsis and NEC. The increased risk of premature infants for inflammatory
intestinal complications such as NEC, may be due to a relative
lack or imbalance of Treg in the intestinal lamina propria.
There were no significant differences between the Treg
values of the 3 studied group bovine colostrum group, Reference
and control infants neither at the time initial sample (first 72
hours) nor at the time of follow-up sample (after one week).
However, when we evaluated the individual changes in
each group by time; there was significant increase in bovine
colostrum intervention group as regard expression of Cd4 +25
T cells in peripheral blood sample with median 13.3 (10.5-16.5)
to 18.6 (13.9-25.7) with p-Value=0.017.
Also in our study there is a highly significant rise in
intervention group who received bovine colostrum as regard
expression of Cd4 +25 high affinity, as Mean increased from
6.4 (3-7.2) to 8.4 (5.4-11.4) with p-Value=0.004.