Title : The use of oro-pharyngeal therapy with mother’s own milk (OPT-MOM) to protect extremely premature infants against infectious morbidities
Abstract:
Purpose for the Session is to provide a general overview of Oro-Pharyngeal Therapy with Mother’s Own Milk (OPT-MOM). This novel intervention can serve as an oral immune therapy to mimic the protective effects of amniotic fluid exposure for extremely premature infants.
Background: Extremely premature infants are at high risk for acquiring late-onset sepsis and necrotizing enterocolitis (NEC); which are associated with significant mortality, costly morbidities, and the potential for adverse long-term neurodevelopmental outcomes. Born before the last trimester of pregnancy, these infants experience an abrupt cessation of amniotic fluid exposure and their oropharynx is no longer bathed with protective biofactors, which stimulate the immune system and promote intestinal maturation. Many of these biofactors are highly concentrated in the milk (especially colostrum) expressed by women who deliver extremely premature infants; which suggest an important biological function for facilitating extra-uterine transition. Unfortunately, clinical instability precludes enteral feeding for extremely premature infants in the first days of life. The post-birth fasting leads to intestinal atrophy and abnormal intestinal microbiota which contribute to the pathogenesis of late-onset sepsis and NEC. Once started, enteral feeds of mother’s milk are administered via a nasogastric tube, which bypasses the infant’s oropharynx. Oropharyngeal exposure to protective (milk) biofactors does not occur until the infant begins per oral feeds; typically at 32 weeks corrected gestational age. Thus, post-birth oropharyngeal exposure to protective biofactors is delayed for up to 10 weeks for the smallest extremely premature infants; born as early as 22/23 weeks gestation. This deficit has never been addressed in neonatology and may be contributing substantially to prematurity-associated infectious morbidities, including late-onset sepsis and NEC. OroPharyngeal Therapy with Mother’s Own Milk (OPT-MOM) is a natural, easy and inexpensive (ex-utero) substitute for amniotic fluid exposure for the extremely premature infant and can protect the infant via distinct (biofactor) mechanisms including
- Immunostimulatory effects of cytokine interaction with immune cells within the oropharyngeal-associated lymphoid tissues.
- Passive mucosal absorption of protective (immune and trophic) bio factors.
- Barrier protection against pathogens in the oropharynx.
- Anti-inflammatory protection.
- Local and systemic effects of oligosaccharides, and
- Protective effects of antioxidants.
Our pilot studies established feasibility for the OPT-MOM approach and emerging evidence from other investigators suggests that infants who receive this intervention may have
- Enhanced immune status, including higher concentrations of salivary sIgA, urinary sIgA, and serum IgA, higher concentrations of salivary lactoferrin, urinary lactoferrin, and reduced inflammatory markers {lower concentrations of urinary IL-1β, salivary TGFβ-1, and salivary IL-8 }
- Enhanced oral micro biota
- A reduced risk for clinical sepsis
- A reduced time to reach full enteral feedings
- Enhanced maturation of oral feeding skills
- Enhanced breastfeeding outcomes
- Improved growth at hospital discharge
- A reduced length of hospital stay.
During this presentation, compelling evidence from animal and human studies to support the OPT-MOM approach will be discussed and preliminary results of a current multi-center RCT will be presented. Clinical implications for nurses and future directions for multidisciplinary research will also be discussed.
Audience Take Away:
- Neonatal nurses, Obstetric/Maternity Nurses, Pediatric nurses, Midwives, Nurse Practitioners, Nurse Educators and Clinical Specialists can share this information with parents of extremely premature infants. Research has shown that mothers who provide milk for this intervention benefit psychologically, because they do not feel helpless and instead feel valued as an important member of the team caring for the premature infant.
- Nurses (all those mentioned above) who attend this presentation will be able to “share the science” with professional colleagues including physicians, nurses, lactation consultants and specialists, dieticians and other clinicians who care for premature infants. Although the focus of this presentation is the extremely premature population, this intervention can be utilized for any newborn that is unable to feed per oral. This intervention has been safely utilized in infants with complex anomalies including omphalocele, in infants with cardiac disease, and also post-surgical infants, therefore pediatric critical care nurses and surgical nurses may benefit as well.
- Nurses who attend this presentation may become motivated to spear-head a quality improvement project, or implement an evidence-based protocol in their unit and measure patient health outcomes pre and post implementation.
- Nurses, especially faculty, who attend this session, will be able to conduct their own research. They may become interested in replicating studies that will be presented. Also, as described above, they may choose to implement a new unit-based protocol and measure outcomes such as infection rates, length of hospital stay, costs to hospital etc., pre and post implementation of the new protocol. Nurses can also use the information they learn to teach nursing students, novice nurses, and other clinicians about the immunology of human milk. They will be able to “share the science” about breastmilk immunology with parents, using lay terms that parents will easily understand.
