The Role of Human Milk in Necrotizing Enterocolitis

Abstract

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency of premature infants, and accounts for significant morbidity and mortality worldwide (Kliegman et al., 1984; Uauy et al., 1991). Although the etiology of intestinal inflammation and necrosis that characterizes this disease remains poorly understood, studies have suggested that human milk feedings reduce its’ incidence significantly (Lucas et al., 1990). As compared to neonatal formula, mother’s milk has a myriad of bioactive components that provide immunoprotection and host defense that presumably contribute to the beneficial effects (Goldman, 2000; Goldman et al., 1990; Hanson, 1999). One key component of breast milk may be PAF-acetylhydrolase (PAF-AH), a specific PAF degrading enzyme that is deficient in human newborns, and has been shown in animal models to markedly alter the development of neonatal NEC (Caplan et al., 1990a; Caplan et al., 1997b; Farr et al., 1983). Since data strongly support the role of endogenous PAF in the initiation of intestinal injury (Hsueh et al., 1994; Hsueh et al., 1987), the presence or absence of PAF-AH may be a critical factor in the pathophysiology of the neonatal disease.