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Importância do leite humano na prevenção da enterocolite necrosante em recém-nascidos prematuros
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A enterocolite necrosante (ECN) é uma doença potencialmente fatal que afeta recém-nascidos (RN) prematuros, tendo taxas significativas de mortalidade e morbilidade e uma incidência crescente. Embora a sua etiologia seja ainda desconhecida, acredita-se que seja uma patologia de causa multifatorial. Entre os fatores implicados na sua patogénese estão a prematuridade, a fonte de leite dos RN e a sua microbiota intestinal. A imaturidade geral dos RN prematuros, associada às complicações decorrentes da assistência neonatal, torna estes RN mais suscetíveis a infeções e outras patologias, nomeadamente, a ECN.
Nos RN prematuros, para além de haver uma limitação das funções de defesa do intestino, a microbiota intestinal é significativamente diferente da microbiota intestinal dos RN de termo, havendo uma marcada ausência de bactérias benéficas, especialmente, bifidobactérias. Esta disbiose intestinal é, provavelmente, o fator mais preponderante na fisiopatologia da ECN, sendo responsável pela predisposição dos RN prematuros para esta patologia.
Não existindo ainda um tratamento totalmente eficaz para a ECN, a prevenção primária deve ser a prioridade. Assim, o leite humano surge como um importante fator protetor contra a ECN. Entre os benefícios do leite humano destacam-se o seu efeito anti-inflamatório, o aumento do fluxo sanguíneo microvascular intestinal, a manutenção da integridade da mucosa intestinal e, essencialmente, o seu efeito prebiótico, sendo que vários componentes, nomeadamente, os oligossacáridos do leite humano, têm sido implicados nestes efeitos. Vários estudos mostram que a microbiota intestinal dos RN alimentados com leite humano tem grande predomínio de bifidobactérias, comparativamente à microbiota dos RN alimentados com leite artificial.
Existe uma associação consistente entre a administração de leite humano e a redução da mortalidade, morbilidade e incidência associadas à ECN nos RN prematuros, sendo que o seu risco aumenta com a administração de leite artificial. A alimentação com leite humano é, portanto, uma estratégia efetiva na prevenção da ECN nos RN prematuros.
Necrotizing enterocolitis (NEC) is a potentially fatal disease that affects preterm infants, with significant mortality and morbidity rates and a rising incidence. Although its etiology is still unknown, it is believed to be a multifactorial disease. Prematurity, the source of the milk taken by the infants and their gut microbiota are among the factors implicated in its pathogenesis. The general immaturity of preterm infants, associated with complications resulting from neonatal care, makes these infants more susceptible to infections and other diseases as NEC. In preterm infants, in addition to a limitation of intestinal defense functions, the gut microbiota is significantly different from the gut microbiota of term infants, with a marked absence of beneficial bacteria, especially bifidobacteria. This intestinal dysbiosis is probably the most important factor in the pathophysiology of NEC, being responsible for the predisposition of preterm infants to this disease. As there is still no effective treatment for NEC, primary prevention should be the priority. Thus, human milk appears to be an important protective factor against NEC. Among the benefits of human milk are its anti-inflammatory effect, increased intestinal microvascular blood flow, maintenance of the integrity of the intestinal mucosa and, essentially, its prebiotic effect, with several components, namely human milk oligosaccharides, being implicated in these effects. Several studies show that the gut microbiota of infants fed with human milk has a higher prevalence of bifidobacteria than the microbiota of infants fed with artificial milk. There is a consistent association between the administration of human milk and the reduction of the mortality, morbidity and incidence associated with NEC in premature infants and its risk increases with the administration of artificial milk. Therefore, feeding with human milk is an effective strategy for the prevention of NEC in premature infants.
Necrotizing enterocolitis (NEC) is a potentially fatal disease that affects preterm infants, with significant mortality and morbidity rates and a rising incidence. Although its etiology is still unknown, it is believed to be a multifactorial disease. Prematurity, the source of the milk taken by the infants and their gut microbiota are among the factors implicated in its pathogenesis. The general immaturity of preterm infants, associated with complications resulting from neonatal care, makes these infants more susceptible to infections and other diseases as NEC. In preterm infants, in addition to a limitation of intestinal defense functions, the gut microbiota is significantly different from the gut microbiota of term infants, with a marked absence of beneficial bacteria, especially bifidobacteria. This intestinal dysbiosis is probably the most important factor in the pathophysiology of NEC, being responsible for the predisposition of preterm infants to this disease. As there is still no effective treatment for NEC, primary prevention should be the priority. Thus, human milk appears to be an important protective factor against NEC. Among the benefits of human milk are its anti-inflammatory effect, increased intestinal microvascular blood flow, maintenance of the integrity of the intestinal mucosa and, essentially, its prebiotic effect, with several components, namely human milk oligosaccharides, being implicated in these effects. Several studies show that the gut microbiota of infants fed with human milk has a higher prevalence of bifidobacteria than the microbiota of infants fed with artificial milk. There is a consistent association between the administration of human milk and the reduction of the mortality, morbidity and incidence associated with NEC in premature infants and its risk increases with the administration of artificial milk. Therefore, feeding with human milk is an effective strategy for the prevention of NEC in premature infants.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Enterocolite necrosante Leite humano Prematuridade Microbiota Pediatria