Diet‐dependent Mucosal Colonization and Interleukin‐1β Responses in Preterm Pigs Susceptible to Necrotizing Enterocolitis

Abstract

ABSTRACT Objectives: Intestinal colonization challenges the neonatal innate immune system, especially in newborns with an immature immune response lacking the supportive bioactive components from mother's milk. Accordingly, formula‐fed preterm pigs frequently show bacterial overgrowth, mucosal atrophy, and gut lesions reflecting necrotizing enterocolitis (NEC) within the first days after birth. We hypothesized that NEC development is related to a diet‐dependent bacterial adherence and a subsequent proinflammatory cytokine response in the gut mucosa immediately after introduction of enteral food. Materials and Methods: Premature piglets (92% gestation) received 2 to 3 days of total parenteral nutrition followed by 0, 8, or 17 hours of enteral formula or sow's colostrum feeding. Results: Following 8 hours, but not 17 hours, of colostrum feeding, a reduced number of intestinal samples with adherent bacteria (both Gram‐negative and Gram‐positive bacteria) was counted compared with 0 or 8 hours of formula feeding. Besides a more dense colonization, formula feeding leads to higher intestinal interleukin‐1β (IL‐1β) levels and more NEC‐like lesions from 8 hours onward. The load of adherent bacteria was especially high in NEC lesions. Toll‐like receptor 4 was detected in enteroendocrine, neuronal, and smooth muscle cells, potentially mediating the increase in IL‐1β levels by Gram‐negative bacteria. Conclusions: Formula feeding facilitates bacterial adherence and the development of a proinflammatory state of the intestine, which may be among the key factors that predispose formula‐fed preterm neonates to NEC.