A Research Into The Impact Of Oral Swabbing With Mother’s Own Colostrum On The Immunity Of VLBWI(ELBWI)

ObjectiveThe aim of this study was to measure the content variations of related immune material in serum by daubing the two sides of buccal and sublingual mucosa of very low birth weight infants with the special sterile cotton swab soaked mother’s colostrum on the first days of life and verify the effectiveness of this nursing method.In addition,this paper analyzed the effect for colostrum application on establishment of normal flora colonization in intestinal tract and oral cavity.MethodsProspective cohort study design was adapted.According to inclusion and exclusion criteria,100 VLBWI/ELBWI(gestational age(GA)<32 weeks and/or birth weight(BW)<1,500 g)were enrolled and admitted to the level III NICU of Women ’s Hospital School Of Medicine Zhejiang University from June,2017 to October,2017.Once mother ’s own milk was obtained,colostrum administration was carried out immediately through using uniform approach.There were no specific treatments for the infants who did not receive colostrum.This experiment was finished on the fifth day after birth and the patients were divided into control group and colostrum group in accordance with application of colostrum or not.Blood samples,throat swabs and stool samples werecollected respectively at the 1th and 5th day after birth.we evaluated everyone’s measured content of hemic Secretory Immunoglobulin A(sIgA)and lactoferrin(LTF)and attempted to assess fecal and oral microflora.The datas were analyzed with statistics.Results1、The completion of colostrum applicationIn our study,52 VLBWI(ELBWI)were enrolled in the colostrum group,compared to 46 participants in the control group.And 53%of mothers could provide colostrum for patients,38%of whom were able to insist on finishing this intervention.(Ideal swabbing times was ≥20).The first colostrum administrations occurred 45+18 hours(mean±SD)after birth(range,5 to 78 hours).The mean number of swabbing was 17.17±9.82.2、Serological related examination results(1)The change of blood sIgA on D1 and D5 in colostrum group increased slightly,but there was no statistical difference(P=0.1357).There was a slight decrease trend in the change of blood sIgA on D1 and D5 in control group and there was no statistical difference(P=0.1682).(2)The change of blood LTF in colostrum group was slightly increased on D1 and D5,but there was no statistical difference(P=0.145).The changes of blood LTF values on D1 and D5 in control group showed a significant downward trend(P=0.0304).3、the bacteria cultivation results of stool samples(1)At birth,using the conventional bacteria cultivation technique,we detected the following bacterias in total 98 cases of meconiums(the detection rate is 15.31%).Streptococcus(1 case),enterococcus(3cases),enteroaerogen(1 case),klebsiella pneumoniae(lcase)and gram-positive cocci(lcase)were found in the colostrum group;Streptococcus(3cases),enterococcus(3cases),staphylococcus(1 case),and gram-positivecocci(1case)were detected in the control group;(2)There were following bacterias at the fifth day after birth(D5):staphylococcus(19 cases),enterococcus(14cases),gram-positive cocci(5cases),streptococcus(3cases),candida(3cases),enteroaerogen(1 case)and klebsiella pneumoniae(1 case,a small amount is planted)were found in the colostrum group;Staphylococcus(16cases),enterococcus(6cases),streptococcus(2cases),candida(1case),enteroaerogen(1case),Rose cook bacteria(1case)and gram-positive cocci(1case)were detected in the control group.The variety and number of bacterias increased with advancing time.At first,the detection rate of staphylococcus was 36.54%in the colostrum group and 34.78%in the control group.There was no statistically significant difference between them(P=0.856).Secondly,The detection rate of enterococcus was 26.92%in the colostrum group and 13.04%in the control group.There was no statistically significant difference between them(P=0.089).(3)Bifidobacterium and lactobacillus were not detected during the observation period.(4)One case appeared in the colostrum group:After swabbing,we found the amount of klebsiella pneumoniae show a decreasing trend(+++→a few).4、the bacteria cultivation results of oral samples(1)At birth,using the conventional bacteria cultivation technique,we detected thefollowing bacterias in total 98 cases of throat swab(the detection rate is 27.55%).Streptococcus(8cases),staphylococcus(1 case),enterobacterium(1 case),Burkholderia cepacia(1case),klebsiella pneumoniae(1case),Actinobacillus ureae(1case)and gram-positive cocci(1case)were found in the colostrum group;Streptococcus(10cases),staphylococcus(1 case),gardnerella vaginosis(1 case),enterococcus(1 case)and gram-positive cocci(3cases)were detected in the control group;(2)There were following bacterias at the fifth day after birth(D5):Streptococcus(41 cases),enterococcus(1 case),gram-positive cocci(13cases),staphylococcus(8cases),Rosecookbacteria(1case),enterobacterium(1case),gram-positive bacilli(1case),bacillus(1case)and klebsiella pneumoniae(1case,a small amount is planted)were detected in the control group;Streptococcus(23 cases),Rosecookbacteria(3cases),staphylococcus(9cases),gram-positive cocci(7cases),Rosecookbacteria(3cases)and gram-positive bacilli(1case)were detected in the control group.The variety number of bacterias increased with advancing time.The detection rate of streptococcus was 78.85%in the colostrum group and 50.00%in the control group.There was statistically significant difference between them(P=0.003).(3)After swabbing,we found three cases appeared in the colostrum group:the amount of klebsiella pneumoniae showed a decreasing trend(+++→a few);the amount of Burkholderia cepacia changed from a few to negative;the amount of enteroaerogen went from +++ to +.ConclusionsOur findings showed that there is still large room for improvement on the time when colostrum was first obtained;The cheeks and sublingual mucous membranes of infants with colostrum can effectively absorb lactoferrin in colostrum on the first days of life and avoid the decrease of lactoferrin concentration in blood,thus promoting immunity levels in premature infants to some extent;Colostrum application had limited effect on the colonizing model of intestinal flora,but it contributed to the normal colonization of oral flora.