肠外营养期间提供羊水可增加早产新生猪体重而对肠道结构、功能、免疫、微生物学影响有限
由于少量肠内输注人乳可以降低早产儿肠外营养继发喂养不耐受和坏死性小肠结肠炎的风险，故丹麦哥本哈根大学、丹麦技术大学、瑞斯医院的学者假设喂养羊水（哺乳动物胎儿的自然肠内饮食）将具有类似效果，并改善在接受肠外营养的早产新生儿生长和胃肠成熟，然后过渡到喂奶。
为了验证上述假设，妊娠约90%时剖腹产分娩的27头猪被给予肠外营养和肠内输注羊水（AF组，n=13，24～72mL/kg/d）或无口服补充（NPO组，n=14）直至第5天血、组织、粪便被采样后。
结果发现，AF组与NPO组相比，体重增加高2.7倍。AF组猪表现出胃排空较慢、食物诱导的胃抑制肽和胰高血糖素样肽2释放减少、肠微生物群改变、肠通透性降低，对胃肠重量、黏膜比例、绒毛高度、血浆瓜氨酸、己糖吸收能力和消化酶无影响。AF组猪肠白介素（IL）-1β水平和IL-1B、IL-8的表达均增加，而对血液生化和氨基酸水平的影响最小。
因此，接受肠外营养的早产猪对出生后5天内肠内输注羊水耐受良好。在开始喂奶前，肠内提供羊水可接受肠外营的养早产幼猪生长并改善水化。此外，这可能改善胃肠动力和完整性，尽管大多数胃肠成熟指标并无变化。
JPEN J Parenter Enteral Nutr. 2016;40(4):552-66.
Provision of Amniotic Fluid During Parenteral Nutrition Increases Weight Gain With Limited Effects on Gut Structure, Function, Immunity, and Microbiology in Newborn Preterm Pigs.
Ostergaard MV, Shen RL, Stoy AC, Skovgaard K, Krych L, Leth SS, Nielsen DS, Hartmann B, Bering SB, Schmidt M, Sangild PT
University of Copenhagen, Frederiksberg C, Denmark; Technical University of Denmark, Frederiksberg C, Denmark; University of Copenhagen, Copenhagen N, Denmark; Rigshospitalet, Copenhagen O, Denmark.
BACKGROUND: Small enteral boluses with human milk may reduce the risk of subsequent feeding intolerance and necrotizing enterocolitis in preterm infants receiving parenteral nutrition (PN). We hypothesized that feeding amniotic fluid, the natural enteral diet of the mammalian fetus, will have similar effects and improve growth and gastrointestinal (GI) maturation in preterm neonates receiving PN, prior to the transition to milk feeding.
MATERIALS AND METHODS: Twenty-seven pigs, delivered by cesarean section at ~90% of gestation, were provided with PN and also fed boluses with amniotic fluid (AF; n = 13, 24-72 mL/kg/d) or no oral supplements (nil per os [NPO]; n = 14) until day 5 when blood, tissue, and fecal samples were collected for analyses.
RESULTS: Body weight gain was 2.7-fold higher in AF vs NPO pigs. AF pigs showed slower gastric emptying, reduced meal-induced release of gastric inhibitory peptide and glucagon-like peptide 2, changed gut microbiota, and reduced intestinal permeability. There were no effects on GI weight, percentage mucosa, villus height, plasma citrulline, hexose absorptive capacity, and digestive enzymes. Intestinal interleukin (IL)-1β levels and expression of IL1B and IL8 were increased in AF pigs, while blood biochemistry and amino acid levels were minimally affected.
CONCLUSION: Enteral boluses of AF were well tolerated in the first 5 days of life in preterm pigs receiving PN. Enteral provision of AF before the initiation of milk feeding may stimulate body growth and improve hydration in preterm infants receiving PN. Furthermore, it may improve GI motility and integrity, although most markers of GI maturation remain unchanged.
PMID: 25613990
DOI: 10.1177/0148607114566463
