/
Oral  I mmune Therapy (OIT) Oral  I mmune Therapy (OIT)

Oral I mmune Therapy (OIT) - PowerPoint Presentation

liane-varnes
liane-varnes . @liane-varnes
Follow
345 views
Uploaded On 2020-01-05

Oral I mmune Therapy (OIT) - PPT Presentation

Oral I mmune Therapy OIT Christopher Fields RDN LD For the Ohio Neonatal Nutritionists April 19 2018 Objectives Define Oral Immune Therapy OIT Describe differences in colostrum vs term milk Validate oropharyngeal delivery ID: 772028

infants colostrum care oit colostrum infants oit care administration oropharyngeal neonatal weight oral days birth milk mother

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "Oral I mmune Therapy (OIT)" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Oral Immune Therapy (OIT) Christopher Fields, RDN, LDFor the Ohio Neonatal NutritionistsApril 19, 2018

ObjectivesDefine Oral Immune Therapy (OIT)Describe differences in colostrum vs. term milkValidate oropharyngeal deliveryDescribe the suggested administration of OITEvaluate the evidence surrounding/supporting OITDescribe the QI project for OIT at TriHealthEvaluate the use of donor breast milk (DBM) for OITEvaluate the processes of ONN members surrounding OIT

What is OIT?The process of stimulating immune activity through delivery of mother’s own colostrum (MOC) to the oropharyngeal cavity of infants.

Overview of an articleGephart SM, Weller M. Colostrum as oral immune therapy to promote neonatal health. Advances in neonatal care. 2014; 14(1):44-51.

Preterm infants: the perfect stormImmature immune systemExaggerated inflammatory responseImmature gut IschemiaHypoxiaAcidosisPathogenic bacteriaUnderdeveloped lungs

A word on colostrumGephart, Weller, 2014, Rodriguez, 2009Produced during the first few days postpartum, when tight junctions of mammary epithelium are open Allows for higher concentrations of immunological factors to pass into milkAntigens specific to mother’s environment allow lymphocytes to secrete immunoglobulin into milk to be available to babyUnique immuno-therapy for babyHigher concentrations of immunological factors vs. term milk

A word on colostrumGephart, Weller, 2014, Rodriguez, 2009 AntimicrobialsIgA, IgG, IgM, lactoferrin, lysozymes, leukocytes, antiviral mucins, oligosaccharidesHormonesInsulin, prolactin, thyroid hormones, corticosteroids, oxytocin, calcitonin, erythropoietinGrowth factorsEpidermal growth factor, nerve growth factor, insulin-like growth factor, neurotensin, peptide YY, gastrin Anti-inflammatory factors Tumor necrosis factor, interleukins, interferon-g, prostaglandins, platelet activating factor

Colostrum vs. term milkRodriguez et al, 2009 ComponentColostrumTerm milkProtein (g/100 mL) 3.7 1.3 IL-6 ( pg /mL) 978.8 86.92 Fat (g/100 mL) 2.9 4.2 Lactose (g/100 mL) 57 4.7 IgM (mg/g protein) largest immunoglobulin bound in vascular system 304IgA (mg/g protein)secretory; intact for binding in intestines, lungs, genitourinary systems17520IgG (mg/g protein)major component of respiratory secretions32

Why oropharyngeal delivery?Gephart, Weller 2014, Rodriguez, 2009Direct delivery of cytokines to oropharyngeal-associated lymphoid tissue (OFALT) to stimulate immune system Mucosal absorption of protective biofactors results in higher urinary lactoferrin excretion, providing systemic protectionSecretory immunoglobulins provide mucus barrier from infective agents in oropharyngeal cavityLocal and systemic oligosaccharides absorption to modulate intestinal microbiomeAntioxidant protection to oropharyngeal cavity and systemic absorptionIntestinal growth factors absorbed into mucosa delivered via circulation to enterocytes

How is it done?Gephart, Weller, 2014Oropharyngeal administration 0.2 ml divided between both sides of cheeks via syringeLow-absorption cotton swab for administration (painting) to inside of cheeks, tongue, gums, and buccal cavityFresh colostrum (or refrigerated, not frozen)Provide as oral care, replacing Biotene® or sterile water, q3-4 hours

Feasibility studiesRodriguez et al, 2010Quasi-experimental designN=5 ELBW infants Intervention: 0.2 mL mother’s own colostrum (MOC), q2 hrs for 48 hours, beginning at 48 hours of lifeMeasures: feasibility, IgA and lactoferrin in urine and respiratory aspiratesResults: feasible; outcomes not measured; no adverse events reported Rodriguez et al. A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother’s colostrum to extremely low birth weight infants. Adv Neonatal Care. 2010;24(4):31-35

Feasibility studiesMontgomery, et al, 2010Prospective, descriptive study N=56 VLBW infantsIntervention: 0.2 mL MOC, q3 hrs as soon as availableMeasures: feasibility, administration of MOCResults: no adverse events, mother’s willing to supply increased by 10%, 75-80% adherence to administration Montgomery DP, Baer VL, Lambert DK, Christensen RD. Oropharyngeal administration of colostrum to very low birth weight infants: results of a feasibility trial. Neonatal Intensive Care. 2010;23(1):27-29

Colostrum for OITRodriguez et al, 2011Prospective, single-blind RCT N=15 ELBW infants (9 intervention, 6 placebo/control)Intervention: 0.2 mL MOC q2 hrs for 48 hoursMeasures: secretory IgA, lactoferrin, IL-10, days to 150 mL/kgResults: treatment group reached full enteral feeding volumes 10 d before placebo group; change in urine IgA (moderate effect) and lactoferrin (large effect) Rodriguez NA, Groer MW, Zeller JM, et al. A randomized controlled trial of the oropharyngeal administration of mother’s colostrum to extremely low birth weight infants in the first days of life. Neonatal Intensive Care. 2011;24(4):31-35.

Colostrum for OITThibeau et al, 2013 Retrospective pre-/post study of MV VLBW infants N=138 (70 pre-study, 68-post study)Intervention: Oral suction followed by MOC, 2 cotton swabs, saturated q4 hrsMeasures: feasibility, safety, LOS, ventilator daysResults: Median days on MOM increased from 15 d to 33 dNo significant difference in LOS or days on ventilatory support Thibeau S, Bourdeaux C. Exploring the use of mother’s own milk as oral care for mechanically ventilated very low birth-weight preterm infants. Adv Neonatal Care. 2013;13(3):190-197.

Colostrum for OITSeigel et al, 2013Retrospective cohort study N=369 ELBW (280 pre-study, 89 post)Intervention: 0.2 mL MOC q4 hrs for 5 days, beginning at 48 hours of lifeMeasures: Days to 100 mL/kg, days regained BW, weight at 36 wk CGA, NEC or SIPResults: Full enteral feedings, earlier, higher weight at 36 weeks, CGA, no differences in surgical NEC or SIP Seigel JK, Smith PB, Ashley PL, et al. Early administration of oropharyngeal solostrum on extremely low birth weight infants [published online ahead of print in June 27, 2013]. Breastfeed Med. Doi : 10.1089/bfm.2013.0025.

Colostrum for OITCaprio et al, 2013Descriptive pre-/post-test after feeding protocol N=58 infants < 1250 grams (pre- 39, post- 19)Intervention: MOC with feeding protocol
Measures: TPN days, TPN-related cholestasis, growthResults: Fewer TPN days with OIT, fewer central line days with OIT, lower max direct bilirubin with OIT, lower max alk phos with OIT, no significant differences in LOS or NEC Caprio M, Barr PA, Cruz H. Effects of establishing a feeding protocol to improve nutrition in preterm neonates. Paper presented at: Pediatric Academic Societies; May 6, 2013; Washington DC.

Colostrum for OITMcFadden, 2012RCT with 3 groups N=29 (11, 10, 8, respectively)Intervention: OIT, sterile water, salineMeasures: Difference in colonization of mouthResults: No differencesMcFadden B. Oral colostrum in the preterm neonate: effect of oral care. In: Proquest Dissertations and Thesis. Vol 117. Texas Women’s University, Denton, Texas, 2012.

What is TriHealth doing? PDSA 1Qualifying infants: All NPO and gavage-fed infantsDetermination of amount and administrationUse of low-absorption cotton swabs 0.2 ml fresh/not frozen- mom’s milk at least 1x/shiftInstruction sheet prepares for nursing Comments for improvement collectedIntroduction of protocol to attending MDs and one teamSelection of two infants Definition/rationale sheet prepared for moms Use of colostrum containers

What is TriHealth doing? PDSA 2OIT instruction sheet revised based on nursing feedbackOrdered 1 ml syringes for OITIncreased OIT amount to 0.3 ml Introduction of protocol to second teamTwo infants added to QI from second teamInstruction sheet for nursing revisedComments collected for improvementBegin work on OIT order set within EPICOrder for OIT in Timeless Medical Women & Infants

What is TriHealth doing? PDSA 3Return to 0.2 ml for OITAdding OIT orders for all babies born < 1000 grams BW Discussed issues with mom’s milk being frozen upon receipt in milk roomOIT instruction sheet revisedDevelopment of OIT tracking sheet for nursing

Process Map for TriHealth

Donor Milk for OIT?Responses from PEDIRDSome are using DBMSome are using PremieLact from ProlcataSome maintain strict mother’s own milk (MOM)Some question using fortified MOM

What are you doing?MOC for OIT?DBM for OIT?Fortified milk for OIT? Volumes?Administration techniques?Buy-in from staff, moms?

ReferencesRodriguez NA et al. Oropharyngeal administration of colostrum to extremely low birth weight infants: theoretical perspectives. Journal of Perinatology. 2009; 29(1):1-7.Gephart SM, Weller M. Colostrum as oral immune therapy to promote neonatal health. Advances in neonatal care. 2014; 14(1):44-51.Rodriguez et al. A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother’s colostrum to extremely low birth weight infants. Adv Neonatal Care. 2010;24(4):31-35.Montgomery DP, Baer VL, Lambert DK, Christensen RD. Oropharyngeal administration of colostrum to very low birth weight infants: results of a feasibility trial. Neonatal Intensive Care. 2010;23(1):27-29 Rodriguez NA, Groer MW, Zeller JM, et al. A randomized controlled trial of the oropharyngeal administration of mother’s colostrum to extremely low birth weight infants in the first days of life. Neonatal Intensive Care. 2011;24(4):31-35. Thibeau S, Bourdeaux C. Exploring the use of mother’s own milk as oral care for mechanically ventilated very low birth-weight preterm infants. Adv Neonatal Care. 2013;13(3):190-197. Seigel JK, Smith PB, Ashley PL, et al. Early administration of oropharyngeal solostrum on extremely low birth weight infants [published online ahead of print in June 27, 2013]. Breastfeed Med. Doi : 10.1089/bfm.2013.0025. Caprio M, Barr PA, Cruz H. Effects of establishing a feeding protocol to improve nutrition in preterm neonates. Paper presented at: Pediatric Academic Societies; May 6, 2013; Washington DC. McFadden B. Oral colostrum in the preterm neonate: effect of oral care. In: Proquest Dissertations and Thesis. Vol 117. Texas Women’s University, Denton, Texas, 2012.Gardner SL, Carter BS, Enzman-Hines MI, Hernandez JA. Merstein & Garnder’s Handbook of Neonatal Intensive Care. 8th edition. St. Louis, MO: Elseiver ; 2016.