Department of Veterinary Clinical and Animal Sciences Livets svære start efter tidlig fødsel Thomas Thymann, MSc, DVM, PhD, Lektor Comparative Pediatrics and Nutrition Dept of Veterinary Clinical and Animal Sciences Faculty of Health and Medical Sciences University of Copenhagen Komparativ pædiatri og ernæring Foster Præmatur Termin Fravænning Fejlernæring Obesitas/ T2D Immediate postnatal survival, - what are the challenges and what do we do ? Oxygen, surfactant, Respiration and caffeine, ventilation pulmonary expansion Circulatory Adrenalin changes Dopamin Atropin Steroid Blood transfusion Blood pressure Fluid support and perfusion NSAID Provision Active thermoregulation of external heat Colostrum intake Immunization Germ free Antimicrobials Infection/sepsis Probiotics resistance Prebiotics Mothers Nutritionmilk Donor milk Formula, PN Whom signals to whom ? About what ? And when ? P.W. Nathanielsz Development of blood cortisol before birth Fetal cortisol (ng/ml) 140 Piglet Lamb Foal Calf 120 100 80 (modified from Silver & Fowden, 1995) 60 40 20 0 -30 -20 -18 -16 -14 -12 -10 -8 -6 -4 -2 0 Days before birth (days) BIRTH 2 6 Vægt af mave-tarmkanalen relativt til kropsvægten: Stor øgning omkring fødsel Stomach 5 4 Birth 3 80 Pancreas Small intestine 1,6 60 1,2 40 0,8 20 -30 -20 -10 0 10 20 30 40 -30 -20 -10 Alder før og efter fødsel (dage) 0 10 20 Sangild et al. 30 40 Variation i modenhed og vægt ved fødsel: Optimal fødsel: 115d 118d Store kuld 115d 116d 116d 113d 114d 115d Preterm Pig Intensive Care Unit Why? Controlled conditions Multiple interventions Detailed organ insights Exploratory treatments Ethics, economics, time Translational relevance? Respiratory support Temp./moisture control High sanitary conditions Ventilation control Parenteral/enteral nutrition 24 hour camera surveillance Distal intestine Præmatur gris Colostrum CaecumColon Præmatur gris - Formula NEC Præmaturitet, formula ernæring og kolonisering er risikofaktorer for necrotiserende enterocolitis (NEC) Gut responses TPN (n=6-14) Infant Formula (IF, n=8-15) Bovine Colostrum (BC, n=7-13) Small volume of formula → sub-clinical NEC- 0.20 lesions 15% 0.10 0.05 0% 0.00 NEC 150 300 50 40 0 Gut permeablity * 60 20 15% 7% Diarrhea Colostrum ≈ antimicrobial? 1500 * 1000 [ µmol/L] [ µmol/L] 100 * 400 * 93% 80 0.15 % of animals 60% ** Lac/Man-ratio * ** 100 200 500 100 0 IL-8 0 0 Lactose digestion Galactose absorbtion First nutrition after term and preterm birth - What are the long term consequenses ? Body weight (g) 4000 3500 Minimal Term litter 1: enteral MEN-BC for 5d Totallitter parenteral for 5d Term 1: TPN Minimal for 5d Preterm litterenteral 1: MEN-BC Total parenteral Preterm litter 1: TPN for 5d term preterm 3000 2500 2000 1500 1000 500 0 5 10 15 20 25 Days of life Kunstig ”opstart” af svage nyfødte grise – nytter det noget? 300 Tilvækst før fravænning (g) 200 100 0 100 Overlevelse (%) vægt v fød 80 Gns. fødselsvægt 850 g: n=90, kontrol n=90, 2 x sondefodring 60 40 20 0 "Skravl" grise kontrol "Skravl" grise 2xfodring Immediate postnatal survival, - what are the challenges and what do we do ? Oxygen, surfactant, Respiration and Opsummering: caffeine, ventilation pulmonary expansion Provision Active thermoregulation of external heat - Også de små grise har overlevelsespotentiale Circulatory Adrenalin Colostrum intake Immunization changes Dopamin Højest prioritet til minimering af varmetab Atropin Germ free Steroid Antimicrobials Infection/sepsis - Bovin kolostrum ok som støtte Blood transfusion Probiotics resistance Blood pressure Fluid support Prebiotics and perfusion NSAID Mothers Nutritionmilk Donor milk Formula, PN www.Neomune.ku.dk Comparative Pediatrics and Nutrition, Univ. of Copenhagen
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