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Infant Formula, but not Breastmilk, May Kill Intestinal Cells
Premature infants are susceptible to a number of different short and long term health problems. This is because various systems in the infant’s body have not fully matured. The lungs and digestive tract can be particularly worrisome when an infant is born too early. These health concerns can be fatal if the newborn does not receive proper care. One condition, called necrotizing enterocolitis, is particularly common in premature infants.

Necrotizing enterocolitis is an affliction in which the cells of the intestinal wall are killed. This condition normally affects premature infants; however, the precise cause of the necrotizing enterocolitis is unknown. The condition can be fatal, with approximately 25% of infants who contract the disease dying. It is believed that the digestive tract of a premature infant, not being fully developed, may be more susceptible in premature infants to damage from bacteria or even food. It has long been known that premature infants that have been fed formula are at a higher risk for developing necrotizing enterocolitis than premature infants who have been fed breast milk, but the reasons for this are not fully known. To determine what causes necrotizing enterocolitis and how to prevent it in premature infants, scientists have researched the different microbiota in the guts of premature infants, and have looked at the effects of different food sources on cells obtained from premature infants. Scientists have already found that breast milk-fed babies have a different array of bacteria in their intestines compared to forumula-fed babies. The different bacteria present may be involved in the development or prevention of necrotizing enterocolitis.

Recently, researchers tested to see whether digested food could cause damage to intestinal cells. They utilized nine different infant formulas, designed specifically for either premature infants or full term infants, and human breast milk. The formulas and breast milk were digested with enzymes from the pancreas and intestinal fluid. The digested formulas and breast milk were then incubated with several cell types from the intestines, including intestinal epithelial cells, intestinal endothelial cells, and neutrophils, which are a type of white blood cell involved in the innate immune system. They then measured if the formula and milk digests killed any of the cells, and how long this killing took. All of the infant formulas tested resulted in rapid cytotoxity, while the breast milk did not cause such severe damage to cells. For example, the digested formula caused death in forty-seven to ninety-nine percent of the neutrophils, while breast milk only resulted in about six percent of the neutrophils.

Researchers had previously shown that adult intestinal cells could be killed by digested food as well. This killing was attributed to the formation of free fatty acids from digestion of food. The free fatty acids were also attributed with cell killing in the above study by digested infant formula. Even though free fatty acids can be formed by many types of digested food and kill intestinal cells from premature infants and adults, premature infants are the most likely group to contract necrotizing enterocolitis. Scientists attribute this to a layer of mucus in adult intestines that protects cells from the cytotoxic effects of free fatty acids. This layer may be absent or immature in premature infants, so their intestinal cells are not protected. The researchers proposed that human breast milk is specially designed so as not to create as many damaging free fatty acids, and is therefore well tolerated by the immature intestines present in premature infants.

This research indicates a very specific potential benefit of breast milk for premature infants. Many neonatal units are beginning to focus more on providing breastfeeding support to new mothers and babies. This could help prevent many serious conditions, such as necrotizing enterocolitis, particularly in premature or other sick infants. However, some premature infants may not be able to breastfeed due to physical limitations from being born too soon. Donated or expressed breast milk from the mother are good options to help the infant thrive and prevent necrotizing enterocolitis, though this may not always be feasible for every family. The development of formulas for premature infants that does result in the production of free fatty acids could therefore help prevent the development of necrotizing enterocolitis in premature infants that are unable to receive breast milk.

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I believe this is an opportunity to share the benefits of breastfeeding, which is part of the natural acts a mother can do.

Here’s an easy and fun mnemonic to remember about its advantages:
Best for babies and mommies – human milk for human baby, reduces mommy’s risk for cancer
Reduces risk of childhood obesity and allergies – it has the right amount of nutrients
Economical – there is no waste and no expenses needed to produce as long as mommy is healthy
Antibodies – babies get greater immunity against infection
Stool inoffensive – babies can never get constipated as breast milk is easy on their tummy
Temperature is ideal and constant – unlike infant formula which needs to be warmed
Fresh milk - never goes sour in the breast since it is sterile and pure
Emotional bonding – develops a special relationship with baby
Easy once established – easy to prepare and digest
Digested easily – within two to three hours
Immediately available – no need for other preparations unlike infant formula
Nutritionally balanced – has the right needs for baby
Gastroenteritis greatly reduced – is not harsh on baby’s stomach

There are however, conditions that may hinder a mother to properly breastfeed her child or breastfeed as a whole. These are the following:
a. When the infant is diagnosed with galactosemia, a metabolic disorder;
b. When the mother:
• Has HIV
• Is on antiretroviral drugs
• Has untreated and sputum positive TB
• Is on illicit drugs
• Is infected by the human T-cell lymphotropic virus type I or II
• Is on prescribed cancer chemotherapy agents
• Is on radiation therapy

Infant formulas may vary in their calorie count, nutrients, taste, cost, and their ability to be digested. The following are specific types of infant formulas:
1. Standard milk-based
2. Soy-based
3. Hypoallergenic
4. Lactose-free
5. Special

There are also three forms of formulas when purchased: ready-to-use, powdered formulas, and concentrated liquid formulas.

I hope breastfeeding will be encouraged more in delivery rooms and nurseries.
Lyka Candelario, RN
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