Purpose and Goal: CEARP #1099

  • Describe the immunological properties of colostrum.
  • Describe the benefits of using colostrum for oral care in the NICU.

None of the planners, faculty or content specialists has any conflict of interest or will be presenting any off-label product use. This presentation has no commercial support or sponsorship, nor is it co-sponsored.

Requirements for Successful Completion

  • Successfully complete the post-test.
  • Complete the evaluation form.

Date

  • May 2014 - May 2016

Learning Objectives

  • Describe the immunological properties of colostrum.
  • Describe the benefits of using colostrum for oral care in the NICU.

Introduction

  • In the US, 1 out of 8 infants is born premature.
  • Infants weighing <1,500 grams are at high risk.
  • Complications include:
    • Chronic lung disease
    • Retinopathy of prematurity
    • Overwhelming sepsis
    • Necrotizing enterocolitis
     
  • All start with an immature inflammatory response.

Colostrum

  • Colostrum is the first milk produced.
  • It is known to contain:
    • Proteins
    • Amino acids
    • Cytokines
    • Immunoglobulin A
     
  • Colostrum has been shown to decrease infection.
    • Antimicrobial protection
    • Anti-inflammatory protection
     
  • Colostrum stimulates the immune system.
    • Stimulates the immune response
    • Stimulates development of the immune system
     
  • Early colostrum feeds can:
    • Reduce complications
    • Improve progression to full enteral feeds
    • Deliver powerful immune boosting nutrition
         

Nutritional Components

  • Proteins
    • Alpha-lactalbumin
    • Beta-lactoglobulin
     
  • Carbohydrates
    • Lactose
    • Glucose
     
  • Lipids
    • Triglycerides
    • Fat-soluble vitamins
    • Carotenoids
    • Fatty acids
    • Phospholipids
     
  • Micronutrients
  • Minerals
    • Calcium
    • Phosphorous
    • Magnesium
    • Iron
     
  • Water-soluble vitamins
  • Trace elements

Immunological Properties

  • Prebiotics
    • Stimulate growth of beneficial microflora
     
  • Oligosaccharides
    • Stimulate growth of beneficial microflora
     
  • Lactoferrin
    • Major whey protein
    • Prebiotic and anti-infective properties
     

Anti-Infective Properties

  • Secretory immunoglobulin A
    • Protects against bacteria and viruses
    • Inhibits pathogen binding to gut mucosa
     
  • Lactoferrin
    • Protects against multiple pathogens
      • Bacteria, fungi, viruses, protozoa
       
    • Essential component of immune response
    • Directly disrupts pathogen cell wall membranes
     
  • Lysozyme
    • Major protein
      • Anti-infective properties
      • Anti-inflammatory properties
       
    • Proven bactericidal effects
      • Causes bacterial cell wall lysis
       
     
  • Oligosaccharides
    • Protect against bacteria and viruses
    • Prevent pathogens from binding to host cells
     
  • White blood cells
    • 90% of WBC in colostrum are phagocytes.
      • Macrophages
      • Neutrophils
       
    • Phagocytes ingest and destroy pathogens
    • Known to release immunoglobulin A
    • Dramatically destroyed by freezing
     
  • Pancreatic secretory trypsin inhibitor
    • Newly identified amino acid peptide
    • Protects against excessive digestion
    • Promotes intestinal cell wall healing
     
  • Xanthine oxidase
    • Essential enzyme
    • Located on outer surfaces of fat globules
    • Attracts and binds pathogens away from target cells
     
  • Other factors
    • Bifidus factor
    • Free fatty acids
    • Mucins
    • Glucosaminoglycans
    • Complement c3
     

Anti-Inflammatory Properties

  • Cytokines
    • Essential protein hormones
    • Mediate and regulate inflammatory responses
    • Inhibit specific pro-inflammatory cytokines
     
  • Antioxidants
    • Provide protection against free oxygen radicals
    • Prevent oxidative stress
    • Oxidative stress believed to be associated with:
      • Bronchopulmonary dysplasia
      • Retinopathy of prematurity
      • Necrotizing enterocolitis
       
     
  • Antiproteases
    • Produced by inflammatory cells
    • Provide protection against pathogen proteases
     

Immune Protection and Therapy

  • Colostrum contains many type of protective agents.
  • It is known to have protective effects on gastric mucosa.
    • Components provide protection against infection.
    • Components facilitate gastric repair if mucosa is damaged.
     
  • Protective agents are inversely proportional to gestational age.
  • Colostrum changes in response to exposure to antigens.
    • Antigens stimulate the secretion of immunoglobulin into milk.
    • Skin-to-skin holding increases infant-specific antigen protection.
     

Oral Immune Therapy

  • Colostrum feeds may not be possible for all infants.
  • An alternative method of administering colostrum
    • Oropharyngeal administration
    • Colostrum may be absorbed by oral mucosa.
    • Cytokines interact with oropharyngeal tissue.
    • Oligosaccharides provide barrier protection.
     
  • Providing oral care with colostrum can offer protection.

Colostrum Oral Care

  • Usually done daily
    • May be done once or twice a day
    • May be done with hands-on care as tolerated
     
  • Small amounts of freshly expressed colostrum
    • Dripped into buccal cavity
    • Wiped into buccal cavity
      • Sterile cotton swabs
      • Sterile gauze pads
       
     
  • Oral care is not given as an enteral feeding.
    • Does not involve swallowing
     
  • General protocol is to use:
    • 0.2 ml fresh colostrum
    • Divided between both cheeks
    • Can be done by parents
     
  • Administration can include:
    • Cheeks
    • Tongue
    • Gums
    • Buccal area
     
  • Colostrum oral care is:
    • Easy
    • Inexpensive
    • Well tolerated 
     

References

  1. Kim, J.H. & Froh, E.B. 2012. What Nurses Needs to Know Regarding Nutritional and Immunological Properties of Human Milk. Journal of Obstetric, Gynecologic and Neonatal Nursing, 41 (1), p. 122-137.
  2. Gephart, S.M. & Weller, M. 2014. Colostrum as Oral Immune Therapy to Promote Neonatal Health. Advances in Neonatal Care, 14 (1), p. 44-51.
  3. Rodriguez, N.A., Meier, P.P., Groer, M.W., Zeller, J.M., Engstrom, J.L. & Fogg, L. 2010. A Pilot Study to Determine the Safety and Feasibility of Oropharyngeal Administration of Own Mother's Colostrum to Extremely Low-Birth-Weight Infants. Advances in Neonatal Care, 10 (4), p. 206-212.
  4. Thibeau, S. & Boudreaux, C. 2014. Exploring the Use of Mothers' Own Milk as Oral Care for Mechanically Ventilated Very Low Birth Weight Preterm Infants. Advances in Neonatal Care, 13 (3), P. 190-197.
  5. Rodriguez, N.A., Meier, P.P., Groer, M.W. & Zeller, J.M. 2008. Oropharyngeal Administration of Colostrum to extremely Low Birth Weight Infants: Theoretical Perspectives. Journal of Perinatology, 29 (1), p. 1-7.

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