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PROTECTIVE GUT & NUTRITION STRATEGIES Scientific data prepared by Dr. Ragia Labieb Presented by: Perwin Aly Waly Neonatology resident N.I.C.U _ Ain Shams University June 2009
Important questions   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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Aggressive Nutrition ,[object Object]
Potential Benefits of Early Aggressive Nutrition   ,[object Object],[object Object]
WHAT IS MSG??? ,[object Object],[object Object]
Advantages of Aggressive  Nutrition ,[object Object],[object Object]
The Optimal Nutritional Goal for Preterm Neonates   ,[object Object]
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Total Parenteral Nutrition ( TPN )   QUALITY&QUANTITY
Protein Mass ,[object Object],[object Object],[object Object]
Fat mass ,[object Object],[object Object]
[object Object],[object Object],Amino Acids
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[object Object],[object Object],Practical tips
Message ,[object Object]
PLS  DON’T   ,[object Object]
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MINIMAL ENTERAL NUTRITION ( MEN )
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SAFETY ,[object Object],[object Object]
Safety ,[object Object],[object Object]
EFFICACY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],All studies
These advantages of MEN included ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Slide 2h Why do we prefer human milk
The intestine is the primary immune organ in the body because it contains 60% of the total immunoglobulins and more than 10 6  lymphocytes/gm tissue. Role of the gut in immune functions Kelly D Trends in immunology 2005
Immature Conditions of the Neonate’s Immune System   Immune system is shifted towards the Th2 pathway to protect the foetus from the mother’s system  Limited exposure of antigens  in utero Still no memory has been build up
A ntibodies alone   serve to transmit the mother's immunologic experience to the   fetus and infant; these, and not  the fetal  T cells, protect the child   while its own immune system matures Zinkernagel RM NEJM 2001
Breast feeding or formulas ,[object Object],[object Object],[object Object]
Why do we prefer human milk ,[object Object],[object Object]
Benefits of breast feeding for the infant ,[object Object],[object Object],[object Object],[object Object],Slide 2.1
Colostrum ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Slide 2.5
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Commensal Probiotic Fermented milk Pr e biotic supplementation Pr o biotic supplementation Enhance intestinal epithelial barrier Anti-inflammatory effects in intestinal epithelial cells Balanced  Th1/Th2 response promoting tolerance and reducing inflamatory, auto-immune and allergic diseaeses Interrest of commensal probiotic stimulation
[object Object],Das UN 2002 & Isaacs CE 2005 lipids
T he protective effect of breast feeding against atopy might be attributed to its high content in ω-6 . In addition, its modulatory influences on Th1 and Th2 responses. Th e  favorable action on Th1 and Th2 responses may depend on the ratio between  ω -3 and  ω -6 fatty acids. A higher ratio of  ω -6 to  ω -3 favors an enhancement in the Th1 response, whereas a decrease in the ratio between  ω -6 to  ω -3 may favor the Th2 response .   lipids Das UN 2002
nucleotides Agget P 2003; Field CJ 2005; Yu V 2002; Carver JD 2003 ,[object Object],[object Object],[object Object],[object Object],[object Object]
SO Risks of artificial feeding    Interferes with bonding    More diarrhoea and respiratory infections    Malnutrition & Vitamin A deficiency    More allergy and    milk intolerance    Increased risk of  some chronic  diseases    Overweight    Lower scores on   intelligence tests    May become   pregnant sooner    Increased risk of anaemia,   ovarian and breast cancer Adapted from: Breastfeeding counseling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6).   Slide 2.26
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PT Or FT Formula ??? ,[object Object],[object Object]
Summary  & conclusion A newborn’s immune system needs special measures of protection and support Breast milk strengthens an infant’s immune system, leading to less infections and allergies
Summary  & conclusion ,[object Object]
5/2 UNICEF/HQ92-0369/ Roger Lemoyne, Thailand   Beginning Breastfeeding within  ONE   .   hour :   ( Beginning life with “life”)
Thank you

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Protective Gut And Nutritional Stratigies

  • 1. PROTECTIVE GUT & NUTRITION STRATEGIES Scientific data prepared by Dr. Ragia Labieb Presented by: Perwin Aly Waly Neonatology resident N.I.C.U _ Ain Shams University June 2009
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  • 12. Total Parenteral Nutrition ( TPN ) QUALITY&QUANTITY
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  • 29. Slide 2h Why do we prefer human milk
  • 30. The intestine is the primary immune organ in the body because it contains 60% of the total immunoglobulins and more than 10 6 lymphocytes/gm tissue. Role of the gut in immune functions Kelly D Trends in immunology 2005
  • 31. Immature Conditions of the Neonate’s Immune System Immune system is shifted towards the Th2 pathway to protect the foetus from the mother’s system Limited exposure of antigens in utero Still no memory has been build up
  • 32. A ntibodies alone serve to transmit the mother's immunologic experience to the fetus and infant; these, and not the fetal T cells, protect the child while its own immune system matures Zinkernagel RM NEJM 2001
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  • 38. Commensal Probiotic Fermented milk Pr e biotic supplementation Pr o biotic supplementation Enhance intestinal epithelial barrier Anti-inflammatory effects in intestinal epithelial cells Balanced Th1/Th2 response promoting tolerance and reducing inflamatory, auto-immune and allergic diseaeses Interrest of commensal probiotic stimulation
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  • 40. T he protective effect of breast feeding against atopy might be attributed to its high content in ω-6 . In addition, its modulatory influences on Th1 and Th2 responses. Th e favorable action on Th1 and Th2 responses may depend on the ratio between ω -3 and ω -6 fatty acids. A higher ratio of ω -6 to ω -3 favors an enhancement in the Th1 response, whereas a decrease in the ratio between ω -6 to ω -3 may favor the Th2 response . lipids Das UN 2002
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  • 42. SO Risks of artificial feeding  Interferes with bonding  More diarrhoea and respiratory infections  Malnutrition & Vitamin A deficiency  More allergy and milk intolerance  Increased risk of some chronic diseases  Overweight  Lower scores on intelligence tests  May become pregnant sooner  Increased risk of anaemia, ovarian and breast cancer Adapted from: Breastfeeding counseling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6). Slide 2.26
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  • 45. Summary & conclusion A newborn’s immune system needs special measures of protection and support Breast milk strengthens an infant’s immune system, leading to less infections and allergies
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  • 47. 5/2 UNICEF/HQ92-0369/ Roger Lemoyne, Thailand Beginning Breastfeeding within ONE . hour : ( Beginning life with “life”)

Editor's Notes

  1. Furthermore in newborns, the immune response of thymus-derived immune cells, the so-called T-lymphocytes, is skewed towards a reaction which is associated with an increased risk to develop an allergic state, the Th2 pathway. This reaction includes the synthesis of the antibody Immunoglobulin E (IgE), which is involved in the allergic reaction. In adults, the mature and healthy immune system is skewed towards the Th1 pathway, which is steered towards an efficient anti-microbial response including IgG synthesis.
  2. We have seen that ...