초극소 재태 주령 미숙아에서 구강 내 초유 투여에 대한 이중 맹검 무작위 대조 임상시험

Abstract

Objective: To determine the immunologic effects of oropharyngeal colostrum administration in extremely premature infants. Methods: We conducted a double-blind, randomized, placebo-controlled trial involving 48 preterm infants born before 28 weeks gestation. Subjects received 0.2 mL of their mothers colostrum or sterile water via oropharyngeal route every 3 hours for 3 days beginning at 48 to 96 hours of life. To measure concentrations of secretory immunoglobulin A, lactoferrin, and several immune substances, urine and saliva were obtained during the first 24 hours of life, at 8 and 15 days. Clinical data during hospitalization were collected. Results: Urinary levels of secretory immunoglobulin A at 1 week (71.4 vs. 26.5 ng/g creatinine, P = 0.04) and 2 weeks (233.8 vs. 48.3 ng/g creatinine, P = 0.006), and lactoferrin at 1 week (3.5 vs. 0.9 μg/g creatinine, P = 0.01) were significantly higher in colostrum group. Urine interleukin-1β level was significantly lower in colostrum group at 2 weeks (55.3 vs. 91.8 μg/g creatinine, P = 0.01). Salivary transforming growth factor-β1 (39.2 vs. 69.7 μg/mL, P = 0.03) and interleukin-8 (1.2 vs. 4.9 ng/mL, P = 0.04) were significantly lower at 2 weeks in colostrum group. A significant reduction in the incidence of clinical sepsis was noted in colostrum group (50% vs. 92%, P = 0.003). Conclusions: This small study suggests that oropharyngeal administration of colostrum may decrease clinical sepsis, inhibit secretion of pro-inflammatory cytokines, and increase levels of circulating immune-protective factors in extremely premature infants. Larger studies to confirm these findings are warranted.