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Pediatric Surgery International

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01-12-2016 | Original Article

Osmolality of enteral formula and severity of experimental necrotizing enterocolitis

Authors: Hiromu Miyake, Yong Chen, Yuhki Koike, Alison Hock, Bo Li, Carol Lee, Augusto Zani, Agostino Pierro

Published in: Pediatric Surgery International | Issue 12/2016

Abstract

Purpose

Administration of hyperosmolar formula is regarded as a risk factor for the development of necrotizing enterocolitis (NEC). However, there are limited number of reports about the relationship between formula osmolality and NEC. The aim of this study is to evaluate the effects of formula concentration in an experimental model of NEC.

Methods

We studied experimental NEC in C57BL/6 mice. NEC was induced by giving hypoxia, gavage administration of lipopolysaccharide and gavage formula feeding from postnatal day 5–9. We used two types of formula: (1) hyperosmolar formula (HF): 15 g Similac + 75 ml Esbilac (849 mOsm/kg); (2) diluted formula (DF): dilute hyperosmolar formula with an equal amount of water (325 mOsm/kg). Controls were fed by the mother. On postnatal day 9, the ileum was harvested and evaluated for severity of mucosal injury (hematoxylin/eosin staining) and inflammation (PCR for IL6 and TNFα mRNA expression).

Results

The incidence of NEC was same in both HF and DF (80%). The intestinal inflammatory response was similar between HF and DF (IL6: p = 0.26, TNFα: p = 0.69).

Conclusions

This study indicates the osmolality of enteral formula does not affect incidence of experimental NEC. This experimental study provides new insights into the relationship between formula feeding and NEC.

Neu J, Walker WA (2011) Necrotizing enterocolitis. N Engl J Med 364:255–264CrossRefPubMedPubMedCentral

Hall NJ, Eaton S, Pierro A (2013) Necrotizing enterocolitis: prevention, treatment and outcome. J Pediatr Surg 48:2359–2367CrossRefPubMed

Pearson F, Johnson MJ, Alison AL (2013) Milk osmolality: does it matter? Arch Dis Child Fetal Neonatal Ed 98:F166–F169CrossRefPubMed

Steele JR, Meskell RJ, Foy J et al (2013) Determining the osmolality of over-concentrated and supplemented infant formulas. J Hum Nutr Diet 26:32–37CrossRefPubMed

Barlow B, Santulli TV, Heird WC et al (1974) An experimental study of acute neonatal enterocolitis—the importance of breast milk. J Pediatr Surg 9:587–595CrossRefPubMed

Zani A, Cordischi L, Cananzi M et al (2008) Assessment of a neonatal rat model of necrotizing enterocolitis. Eur J Pediatr Surg 18:423–426CrossRefPubMed

Barness LA, Mauer AM, Holliday MA et al (1976) Commentary on breast-feeding and infant formulas, including proposed standards for formulas. Pediatrics 57:278–285

Santulli TV, Schullinger JN, Heird WC et al (1975) Acute necrotizing enterocolitis in infancy: a review of 64 cases. Pediatrics 55:376–387PubMed

Book LS, Herbst JJ, Atherton SO et al (1975) Necrotizing enterocolitis in low-birth-weight infants fed an elemental formula. J Pediatr 87:602–605CrossRefPubMed

10.

Torma MJ, DeLemos RA, Rogers JR et al (1973) Necrotizing enterocolitis in infants. Am J Surg 126:758–761CrossRefPubMed

11.

Willis DM, Chabot J, Radde IC et al (1977) Unsuspected hyperosmolality of oral solutions contributing to necrotizing enterocolitis in very-low-birth-weight infants. Pediatrics 60:535–538PubMed

12.

Wilcox DT, Fiorello AB, Glick PL (1993) Hypovolemic shock and intestinal ischemia: a preventive complication and incomplete formula labelling. J Pediatr 122:103–104CrossRefPubMed

13.

Brown JVE, Embleton ND, Harding JE et al (2016) Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev 5:CD000343

14.

Norris HT (1973) Response of the small intestine to the application of a hypertonic solution. Am J Pathol 73:747–764PubMedPubMedCentral

15.

Katz L, Hamilton JR (1975) Response of the young pig to intrajejunal perfusion with a hypertonic nutrient solution. J Pediatr 87:606–608CrossRefPubMed

16.

Goldblum OM, Holzman IR, Fisher SE (1981) Intragastric feeding in the neonatal dog. Its effect on intestinal osmolality. Am J Dis Child 135:631–633CrossRefPubMed

17.

Buchanan DE, Holzman IR (1987) Hyperosmolal feedings and gastrointestinal blood flow and oxygenation in newborn lambs. J Pediatr Gastroenterol Nutr 6:617–623CrossRefPubMed

18.

Zani A, Zani-Ruttenstock E, Peyvandi F et al (2016) A spectrum of intestinal injury models in neonatal mice. Pediatr Surg Int 32:65–70CrossRefPubMed

19.

American Academy of Pediatrics Section on Breastfeeding (2012) Breastfeeding and the use of human milk. Pediatrics 129:e827–e841CrossRef

Title: Osmolality of enteral formula and severity of experimental necrotizing enterocolitis
Authors: Hiromu Miyake
Yong Chen
Yuhki Koike
Alison Hock
Bo Li
Carol Lee
Augusto Zani
Agostino Pierro
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 12/2016
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-016-3998-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Osmolality of enteral formula and severity of experimental necrotizing enterocolitis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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