الفهرس 
PRETERM NEONATAL IMMUNE SYSTEM
Preterm innate 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For all neonates, laboratory investigations withdrawn includes complete blood count, C-reactive protein, blood culture if sepsis suspected, and peripheral blood mononuclear cells assessed in first 72 hours of life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, which is 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.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.