Breast milk may help prevent sepsis in premature infants

Washington DC: Breast milk provides the ideal nutrition for infants. It has a nearly perfect mix of vitamins, protein, and fat -- everything needed for the growth of the infant which is provided in a more easily digestible form. Breast milk contains antibodies that help infants fight bacteria. Breastfeeding lowers your baby's risk of having asthma or allergies. Babies who are breastfed exclusively for the first 6 months, without any formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea. They also have fewer hospitalizations and visits to the doctor.

The gut-originating pathogen Escherichia coli has been associated with a portion of cases of late-onset sepsis (LOS), a leading cause of neonatal mortality. Researchers at Washington University School of Medicine in St. Louis and Mayo Clinic in Rochester, Minn., have found that a component of breast milk may help protect premature babies from developing sepsis, which is a fast-moving, life-threatening condition triggered by infection.

They have found that a molecule called epidermal growth factor in breast milk activates receptors on intestinal cells to keep dangerous gut bacteria from migrating into the bloodstream, where such microbes can prompt sepsis. Their findings are submitted in the journal Proceedings of National Academy of Science.

"Late-onset sepsis is a major problem in premature babies," stated senior author Rodney D. Newberry, MD, a Washington University gastroenterologist and professor of medicine. "These findings give us a better understanding of one of the scenarios that triggers sepsis, and a potential new tool to combat this condition.", he added.

The study looked at late-onset sepsis, which strikes at least 72 hours after a baby is born and up to 60 days after birth and accounts for 26% of all deaths in infants born prematurely. About 10% of infants born preterm experience late-onset sepsis, and 30% to 50% of those who develop the infections die. Much of the focus on preventing late-onset sepsis relies on improving aseptic techniques, such as making sure a baby's skin is bacteria-free and that intravenous lines and other life-saving tubes don't harbor potentially deadly bacteria.

The researchers found that the culprit which caused bacteria to move into the blood are intestinal cells called goblet cells. These cells secrete mucus to help prevent harmful bacteria from getting into the gut, but they also chaperone bacteria out of the gut, across the immature intestinal lining of a preemie. That scenario provides an entryway for sepsis-causing bacteria to gain access to the bloodstream.

"The critical realization here is that bacteria from the gut can invade the bloodstream," stated co-investigator Phillip I. Tarr, MD, the Melvin E. Carnahan Professor of Pediatrics and director of the Pediatric Division of Gastroenterology, Hepatology, and Nutrition. "Understanding how bacteria move from the gut into the blood gives us an opportunity to do something about these infections. And the study suggests that breast milk, preferably a mother's own breast milk from her earliest days of breastfeeding, appears to be a very effective way to fend off these infections.", he added.

"This probably is not a strategy that we would use to treat an infection, but it may well be useful in the near future to prevent potentially deadly infections," stated Tarr.

Unlike antibiotics that tend to kill bacteria indiscriminately, breast milk containing higher amounts of epidermal growth factor would not kill harmful or beneficial bacteria in the gut but might keep such bacteria out of the bloodstream, concluded the authors.

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https://www.pnas.org/content/early/2020/03/10/1912022117