|Burrin, Douglas - Doug|
Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/18/2002
Publication Date: 9/1/2002
Citation: Sangild, P.T., Petersen, Y.M., Schmidt, M., Elnif, J., Petersen, T.K., Buddington, R.K., Greisen, G., Michaelsen, K.F., Burrin, D.G. 2002. Preterm birth affects the intestinal response to parenteral and enteral nutrition in newborn pigs. Journal of Nutrition. 132(9):2673-2681. Interpretive Summary: Poorly developed intestinal function is a major limitation in the normal nutritional support of premature infants. These infants typical experience feeding problems and increased chances of infection due to the immaturity of the gut. One factor that has limited medical progress in the treatment of this problem is that scientist have not had a good animal model to use. The normal piglet is a good model for the human infant, because the design and function of their gut is very similar to human infants. Thus, the aim of this study was to develop a system to study prematurely born piglets to see if they could be used as a model for premature human infants. We studied premature and term piglets and examined their response to normal feeding by mouth, (oral feeding) compared to providing nutrients by a tube into the blood (parenteral feeding). We found that enteral feeding stimulated gut growth in both the premature and term piglets. However, the premature piglets did have a poorly developed intestine as determined by the ability to absorb antibodies and digest and absorb milk sugar. This study is critically important because it demostrates that the premature piglet can be used as a model to study how nutrition and different drugs can be used to enhance intestinal development of premature infants.
Technical Abstract: Maturation of gastrointestinal (GI) function in neonates is stimulated by enteral nutrition, whereas parenteral nutrition induces GI atrophy and malfunction. We investigated whether preterm birth alters the GI responses to parenteral and enteral nutrition. Pigs were delivered either preterm (107 d gestation) or at term (115 d gestation) and fed total parenteral nutrition (TPN) or enteral sow's milk (ENT) for 6 d after birth. Immaturity of the preterm pigs was documented by reduced blood pH, oxygen saturation and neutrophil granulocyte function, impaired intestinal immunoglobulin G uptake from colostrum, and altered relative weights of visceral organs (small intestine, liver, spleen, pancreas, and adrenals). For both ages at delivery, increases occurred in pancreatic weight (30-75%) and amylase activity (0.5- to 13-fold) after birth, but much more in ENT than in TPN pigs (P < 0.05). Six days of TPN feeding was associated with reduced intestinal weight for both delivery groups (60% of values in ENT, P < 0.001), but only in term TPN pigs was the weight lower than at birth (-20%, P < 0.05). Likewise, it was only in term TPN pigs that intestinal maltase activity increased, compared with ENT, and the absorption of glucose and proline decreased. Only in preterm pigs did TPN feeding increase lactase activity (+50% compared with ENT, P < 0.05). For both delivery ages, the mRNA of lactase-phloridzin hydrolase and sodium-coupled glucose transporter 1 were increased in TPN, compared with ENT. In conclusion, the trophic effect of enteral vs. parenteral nutrition on the GI tract is also present after preterm birth, but the postnatal maturation of many GI functions is modified, compared with term birth. The effects of nutritional regimen on the maturation of the gut epithelium in neonates depend on gestational age at birth.