Christos Costalos

Enteral feeding of premature infants with Saccharomyces boulardii

BACKGROUND Saccharomyces boulardii (SB) is a yeast that acts both as a probiotic and as a polyamine producer. Probiotics prevent the overgrowth of pathogens in the gut while polyamines enhance intestinal maturation. The aim of this randomized study was to investigate the ability of SB to modify the gut microbial ecology and its function. METHODS A total of 87 healthy babies with gestational age 28-32 weeks were studied. They were randomly assigned to receive a preterm formula to which SB or maltodextrins was added for 30 days. Evaluations were made on the following: SB tolerance and weight gain, faecal flora analysis, intestinal D-xylose absorption and faecal lipid excretion. RESULTS SB was well tolerated by the infants. There was no difference in weight gain between the two groups. Median log of colony forming units per gram of faeces for Escherichia coli and enterococci was significantly lower in the SB group [E. coli: 2.67 (0.045) vs. 2.75 (0.058), P<0.001; enterococci: 2.14 (0.359) vs. 2.19 (0.138), P<0.05]. On the other hand, the number of bifidobacteria and staphylococci in the stools was significantly higher in the SB group [bifidobacteria: 2.65 (0.083) vs. 2.27 (0.075), P<0.001; staphylococci: 1.23 (0.869) vs. 0.6 (0.281), P<0.001]. D-Xylose and lipid absorption was not improved by SB [median blood D-xylose: 1.5 (0.4) mmol/l vs. 1.35 (0.3) mmol/l, P>0.1; median stool steatocrit: 64% (3.05%) vs. 65% (2.72%) P>0.5]. CONCLUSIONS An SB-supplemented formula is well tolerated by preterm infants, it has a beneficial effect on stool flora bringing it closer to that of breast fed babies but it does not improve D-xylose or lipid gut absorption.

The effect of antenatal corticosteroids on gut peptides of preterm infants—a matched group comparison: Corticosteroids and gut development

BACKGROUND Postnatal glucocorticosteroid administration has trophic effects on the gastrointestinal tract of preterm infants. The aim of the present study was to investigate whether antenatal glucocorticosteroids affect the secretion of gastrointestinal peptides that are involved in the regulation of secretion, motility and mucosal protection of the gastrointestinal tract. METHODS Plasma levels of gastrin, motilin and vasoactive intestinal peptide (VIP) were estimated in 28 preterm infants with a mean birth weight of 1280 g, and mean gestational age of 30.5 weeks, whose mothers had received a full course of antenatal glucocorticosteroids (GC group) and in 17 preterm infants with mean birth weight of 1200 g, mean gestational age of 30.2 weeks, whose mothers had not received corticosteroids (control group). GI peptides were estimated on two occasions: (a) Immediately after birth and (b) following the initiation of enteral feeding. RESULTS Gastrin levels in the GC group were significantly higher both immediately after birth (early measurement) and also after receiving enteral feeding (late measurement) (p<0.001, p<0.05, respectively) but the increase in plasma gastrin concentration was identical in both groups (32 vs. 33 pg/ml). Motilin levels in the GC group were also significantly higher as compared to the control group but only in the late measurement (p<0.001). Gastrin and motilin levels in both groups were significantly higher in the late measurement as compared to the early measurement (GC group: p<0.001, p<0.001, respectively; CONTROLS p<0.001, p<0.01, respectively). There was no significant difference in VIP levels between the two groups both in the early and the late measurements. CONCLUSION Antenatal glucocorticoids (GCs) stimulate gastrin secretion in the fetus but not in the neonate. Contrary to this, corticosteroid effect on motilin is seen only postnatally following the introduction of enteral feeding. Glucocorticosteroids appear to have no effect on VIP levels. Plasma gastrin and motilin levels increase significantly following the introduction of enteral feeding regardless of the use of steroids.

The effect of low-dose erythromycin on whole gastrointestinal transit time of preterm infants.

UNLABELLED The aim of the study was to determine the effect of a low oral dose of erythromycin on whole gastrointestinal transit time [WGTT]. Erythromycin [EM] [1.5 mg/kg, 6 hourly] or placebo was given first over 7 days in a double blind randomized crossover study of 21 preterm infants with feed intolerance. Median [range] birth weight was 1420 [690, 2200] g and postconceptual age 32. 5 [20, 36.4] weeks. WGTT was assessed on day 3 of each treatment, by timing the transit of carmine red through the gut. Treatments were compared using Students paired t test. RESULTS WGTT was significantly shorter following EM treatment as compared to placebo: mean [SD] 10.16 [4.6] h vs. 15. 9 [7.2] h, p<0.01. CONCLUSION Oral low-dose EM significantly shortens WGTT of feed-intolerant preterm infants.

Motilin and Gastrin Secretion and Lipid Profile in Preterm Neonates Following Prebiotics Supplementation A Double-Blind Randomized Controlled Study

BACKGROUND Gut hormones play an important role in the adaptation of the immature neonatal gut, and their secretion may be modulated by prebiotics. Furthermore, prebiotics are well known for their hypolipidemic potentials. We tested the hypothesis that prebiotics could alter motilin and gastrin secretion and reduce lipids in healthy preterms. METHODS A total of 167 newborns were randomized to either a prebiotics enriched formula containing dietary oligosaccharides (short-chain galacto-oligo-saccharides/long-chain fructo-oligo-saccharides [scGOS/lcFOS]), at a concentration of 0.8 g/100 ml, or a common preterm formula. Day 1 and 16 basal motilin, gastrin concentrations, and lipids were evaluated together with growth parameters, gastric residue, bowel habits, and feeding tolerance. Adverse events including necrotizing enterocolitis (NEC) and septicemia were also recorded. RESULTS Mean motilin increase and day 16 mean values were greater for the intervention, compared with the control group (P = .001, P = .005, respectively), while gastrin remained high in both groups. Mean cholesterol and low density lipoprotein (LDL) increase were significantly greater in the control, compared with the intervention (P = .037, and P = .001) group. Day 16 LDL levels were significantly higher in the control group. Mean weight was increased in the control group, while gastric residue was less and stool frequency was increased in the intervention group. NEC and septicemia were not statistically different between groups. CONCLUSION A prebiotics enriched formula resulted in significant surge of motilin relating to reduced gastric residue, compared with a common preterm formula. Mean cholesterol change was lower, while LDL was not increased in the prebiotics group, compared with the control group.

21 Mb deletion in chromosome band 13q22.2q32.1 associated with mild/moderate psychomotor retardation, growth hormone insufficiency, short neck, micrognathia, hypotonia, dysplastic ears and other dysmorphic features.

We report on a 9-month old boy carrying a 21 Mb de novo 13q interstitial deletion. The imbalance was detected by chromosomal analysis and investigated by Fluorescence In Situ Hybridization (FISH) and Comparative Genomic Hybridization (array-CGH) using two different platforms: a BAC microarray with 516 kb resolution (Cytochip) and a 15 kb resolution oligonucleotide microarray (Agilent 244K). The deletion has been estimated to span 21.46 Mb on chromosomal bands 13q22.2-13q32.1. The patient has mild/moderate psychomotor retardation, growth hormone insufficiency, hypertelorism, short neck, micrognathia, hypotonia, dysplastic ears and other dysmorphic features. Further investigation revealed that the abnormality is de novo and causative of the patients phenotype. The described patient is unique among similar rare cases with different deletion breakpoints. It is the first case of 13q22.2q32.1 deletion where the breakpoints are clearly defined, indicating the importance of detailed clinical description and high-resolution genomic analysis for characterization of rare genetic syndromes.