Perspective of Indonesian Pediatricians on the Role of PrebioticSupplemented Formula towards Immunity, Growth and Development in Preterm Infants: A Preliminary Data
Downloads
ABSTRACT
Background: Immature immune system in preterm infants is associated with gut dysbiosis and poses significant health risks to their growth and development. Current guidelines for managing preterm infants focuses solely on macro- and micronutrients, whereas preterm infants' gastrointestinal system requires optimalization to support nutrient absorption. Studies on the positive impacts of prebiotics as supplements have been conducted, but has not been implemented in Indonesia. Indonesian pediatricians' perspective on these findings needs to be assessed. Objectives: To describe the perspectives of Indonesian pediatricians on the role of gut microbiota balance in supporting immunity, growth, and development of preterm infants, and the role of breastmilk and prebiotic-supplemented formula in optimizing gut microbiota balance. Methods: A cross-sectional study was conducted on 114 Indonesian pediatricians using a previously-validated and previously-used questionnaire on the role of gut microbiota balance on preterm infants, as well as the role of breastmilk and prebiotic-supplemented formula in optimizing gut microbiota balance. Results: Most respondents agreed that gut microbiota balance supports immunity, growth, and development of preterm infants. Respondents also agreed that breastmilk contains nutrients that support gut microbiota balance and when breastmilk becomes unavailable, prebiotic-supplemented formula can be given as substitute. Conclusions: Indonesian pediatricians considered gut microbiota balance to be important for immunity, growth, and development of preterm infants, and breastmilk to be the most ideal source of nutrition for preterm infants in optimizing gut microbiota balance. When breastmilk is unavailable, prebiotic-supplemented formula can be considered as an alternative.
Blencowe H et al. National, regional and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 379, 2162–72 (2012).
Melville, J. M. & Moss, T. J. M. The immune consequences of preterm birth. Front. Neurosci. 21, 79 (2013).
McCormick, M. C., Litt, J. S., Smith, V. C. & Zupancic, J. A. F. Prematurity: An overview and public health implications. Annu. Rev. Public Health 32, 367–379 (2011).
Howson, C. P., Kinney, M. V, McDougall, L., Lawn, J. E. & Born Too Soon Preterm Birth Action Group. Born Too Soon: Preterm birth matters. Reprod. Health 10, 1–9 (2013).
Lee, J. K. F., Tan, L. T. H., Ramadas, A., Mutalib, N. S. A. & Lee, L. H. Exploring the role of gut bacteria in health and disease in preterm neonates. Int. J. Environ. Res. Public Health 17, 1–18 (2020).
Arboleya, S. et al. Establishment and development of intestinal microbiota in preterm neonates. FEMS Microbiol. Ecol. 79, 763–772 (2012).
Tirone, C. et al. Gut and Lung Microbiota in Preterm Infants: Immunological Modulation and Implication in Neonatal Outcomes. Front. Immunol. 10, 2910 (2019).
Underwood, M. A. & Sohn, K. The Microbiota of the Extremely Preterm Infant. Clin. Perinatol. 44, 407–427 (2017).
Lewis, E. D., Richard, C., Larsen, B. M. & Field, C. J. The Importance of Human Milk for Immunity in Preterm Infants. Clin. Perinatol. 44, 23–47 (2017).
Tudehope, D. I. Human milk and the nutritional needs of preterm infants. J. Pediatr. 162, S17-25 (2013).
Quigley, M., Embleton, N. D. & Mcguire, W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst. Rev. 2018, (2018).
Hegar, B. et al. The role of two human milk oligosaccharides, 2'-fucosyllactose and lacto-N-neotetraose, in infant nutrition. Pediatr. Gastroenterol. Hepatol. Nutr. 22, 330–340 (2019).
Garg, B. D., Balasubramanian, H. & Kabra, N. S. Physiological effects of prebiotics and its role in prevention of necrotizing enterocolitis in preterm neonates. J. Matern. Neonatal Med. 31, 2071–2078 (2018).
Basrowi, R. W., Sundjaya, T., Sitorus, N. L. & Masita, B. M. Perspective of Caesarean section delivery and its health risks on children among Indonesian pediatricians. World Nutr. J. 4, 55 (2020).
Basrowi, R. W., Wasito, E. & Sundjaya, T. Perspective of Soy Formula and Fiber intake among Non-Cow's Milk Drinker Pediatric Patients; A Survey among Indonesian Health Care Practitioners. World Nutr. J. 4, 5 (2020).
Basrowi, R. W., Sundjaya, T., Krisnamurti, D. & Masita, B. M. General Practitioners' Perspective towards Healthy Ageing in Indonesia. Amerta Nutr. 4, 21 (2021).
The World Health Organization. Preterm birth. World Health Organization Fact Sheets https://www.who.int/news-room/fact-sheets/detail/preterm-birth (2018).
Barfield, W. D. Public Health Implications of Very Preterm Birth. Clin. Perinatol. 45, 565–577 (2018).
Raju, T. N. K. et al. Long-Term Healthcare Outcomes of Preterm Birth: An Executive Summary of a Conference Sponsored by the National Institutes of Health. J. Pediatr. 181, 309-318.e1 (2017).
Darlow, B. et al. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: A systematic review. Eur. J. Pain (United Kingdom) 16, 3–17 (2012).
Gallagher, K., Aladangady, N. & Marlow, N. The attitudes of neonatologists towards extremely preterm infants: A Q methodological study. Arch. Dis. Child. Fetal Neonatal Ed. 101, F31–F36 (2016).
Shattnawi, K. K. Healthcare Professionals' Attitudes and Practices in Supporting and Promoting the Breastfeeding of Preterm Infants in NICUs. Adv. Neonatal Care 17, 390–399 (2017).
Michael, G., Antunes, M., Shaik, S. & Turner, J. Health Practitioners Knowledge, Beliefs, and Attitudes Regarding the Use of Donor Human Milk in Neonatal Intensive Care. Matern. Pediatr. Nutr. 2, (2016).
Lenfestey, M. W. & Neu, J. Gastrointestinal Development: Implications for Management of Preterm and Term Infants. Gastroenterol. Clin. North Am. 47, 773–791 (2018).
Henderickx, J. G. E., Zwittink, R. D., Van Lingen, R. A., Knol, J. & Belzer, C. The preterm gut microbiota: An inconspicuous challenge in nutritional neonatal care. Front. Cell. Infect. Microbiol. 9, 85 (2019).
Zasada, M. et al. Development and maturation of the immune system in preterm neonates: Results from a whole genome expression study. Biomed Res. Int. 2014, e498318 (2014).
Luciano, A. A., Yu, H., Jackson, L. W., Wolfe, L. A. & Bernstein, H. B. Preterm labor and chorioamnionitis are associated with neonatal T cell activation. PLoS One 6, (2011).
Goedicke-Fritz, S. et al. Preterm birth affects the risk of developing immune-mediated diseases. Front. Immunol. 8, 1266 (2017).
Pascoe, M. J., Melzer, T. R., Horwood, L. J., Woodward, L. J. & Darlow, B. A. Altered grey matter volume, perfusion and white matter integrity in very low birthweight adults. NeuroImage Clin. 22, (2019).
Belfort, M. B. et al. Infant growth before and after term: Effects on neurodevelopment in preterm infants. Pediatrics 128, (2011).
Oudgenoeg-Paz, O., Mulder, H., Jongmans, M. J., van der Ham, I. J. M. & Van der Stigchel, S. The link between motor and cognitive development in children born preterm and/or with low birth weight: A review of current evidence. Neurosci. Biobehav. Rev. 80, 382–393 (2017).
Woythaler, M. A., McCormick, M. C. & Smith, V. C. Late preterm infants have worse 24-month neurodevelopmental outcomes than term infants. Pediatrics 127, e622–9 (2011).
Patel, R. M. Short- and Long-Term Outcomes for Extremely Preterm Infants. Am. J. Perinatol. 33, 318–328 (2016).
Turroni, F. et al. The infant gut microbiome as a microbial organ influencing host well-being. Ital. J. Pediatr. 46, 16 (2020).
Baldassarre, M. E. et al. Dysbiosis and prematurity: Is there a role for probiotics? Nutrients 11, (2019).
Vandenplas, Y. et al. Factors affecting early-life intestinal microbiota development. Nutrition 78, 110812 (2020).
Kumbhare, S. V., Patangia, D. V., Patil, R. H., Shouche, Y. S. & Patil, N. P. Factors influencing the gut microbiome in children: from infancy to childhood. J. Biosci. 44, (2019).
Sim, K. et al. The neonatal gastrointestinal microbiota: The foundation of future health? Arch. Dis. Child. Fetal Neonatal Ed. 98, (2013).
Staude, B. et al. The Microbiome and Preterm Birth: A Change in Paradigm with Profound Implications for Pathophysiologic Concepts and Novel Therapeutic Strategies. Biomed Res. Int. 2018, (2018).
Carlson, A. L. et al. Infant Gut Microbiome Associated With Cognitive Development. Biol. Psychiatry 83, 148–159 (2018).
Lu, J. & Claud, E. C. Connection between gut microbiome and brain development in preterm infants. Dev Psychobiol 61, 739–751 (2019).
Hanson, C., Sundermeier, J., Dugick, L., Lyden, E. & Anderson-Berry, A. L. A. L. Implementation, process, and outcomes of nutrition best practices for infants <1500 g. Nutr. Clin. Pract. 26, 614–624 (2011).
Lee, K. A., Hayes, B. C. & Lee, K. A. Head size and growth in the very preterm infant: a literature review. Res. Reports Neonatol. 5, 1–7 (2015).
Walsh, V. & McGuire, W. Immunonutrition for Preterm Infants. Neonatology 115, 398–405 (2019).
Ford, S. L. et al. Improved feeding tolerance and growth are linked to increased gut microbial community diversity in very-low-birth-weight infants fed mother's own milk compared with donor breast milk. Am. J. Clin. Nutr. 109, 1088–1097 (2019).
Underwood, M. A., Mukhopadhyay, S., Lakshminrusimha, S. & Bevins, C. L. Neonatal intestinal dysbiosis. J. Perinatol. 40, 1597–1608 (2020).
Chi, C., Buys, N., Li, C., Sun, J. & Yin, C. Effects of prebiotics on sepsis, necrotizing enterocolitis, mortality, feeding intolerance, time to full enteral feeding, length of hospital stay, and stool frequency in preterm infants: a meta-analysis. Eur. J. Clin. Nutr. 73, 657–670 (2019).
Moukarzel, S. & Bode, L. Human Milk Oligosaccharides and the Preterm Infant: A Journey in Sickness and in Health. Clin. Perinatol. 44, 193–207 (2017).
Srinivasjois, R., Rao, S. & Patole, S. Prebiotic supplementation in preterm neonates: Updated systematic review and meta-analysis of randomised controlled trials. Clin. Nutr. 32, 958–965 (2013).
Salminen, S., Stahl, B., Vinderola, G. & Szajewska, H. Infant formula supplemented with biotics: Current knowledge and future perspectives. Nutrients 12, 1–20 (2020).
Van Den Berg, J. P., Westerbeek, E. A. M., Bröring-Starre, T., Garssen, J. & Van Elburg, R. M. Neurodevelopment of preterm infants at 24 months after neonatal supplementation of a prebiotic mix: A randomized trial. J. Pediatr. Gastroenterol. Nutr. 63, 270–276 (2016).
Lecouffe, N. E. et al. Neurodevelopmental outcome during the first year of life in preterm infants after supplementation of a prebiotic mixture in the neonatal period: A follow-up study. Neuropediatrics 45, 22–29 (2014).
Botteman, M. F. et al. Economic value of atopic dermatitis prevention via partially-hydrolyzed whey-based infant formula (PHF-W) use in high-risk, non-exclusively breastfed, Indonesian urban infants: results of a cost-effectiveness model. World Nutr. J. 2, 43 (2019).
AMERTA NUTR by Unair is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
1. The journal allows the author to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions
3. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution Share-Alike (CC BY-SA).
4. The Creative Commons Attribution Share-Alike (CC BY-SA) license allows re-distribution and re-use of a licensed work on the conditions that the creator is appropriately credited and that any derivative work is made available under "the same, similar or a compatible license”. Other than the conditions mentioned above, the editorial board is not responsible for copyright violation.