Enteral feeding interventions for optimal fetal and neonatal health: towards novel preventive strategies for necrotizing enterocolitis

Preterm birth, defined as birth before 37 weeks of gestation, is a major worldwide health concern. It is often caused by inflammation of the fetal membranes, i.e. chorioamnionitis, which can lead to a systemic inflammatory reaction in the fetus. Both are important independent risk factors for adverse postnatal outcomes, including the severe neonatal gut disease necrotizing enterocolitis (NEC). Breastmilk feeding is known to reduce NEC risk. This is mainly due to breast milk’s many bioactive components that can modulate mechanisms involved in NEC pathogenesis, such as intestinal barrier function and gut inflammation. However, to date, preventive enteral feeding interventions that make use of these bioactive components have seldom been proven clinically effective. The present thesis contributes to a novel framework for improving such preventive nutritional interventions through the acknowledgement of the multifactorial pathophysiology of NEC and its postulated prenatal onset.