TOP 19 - Impact of Early Human Milk–Derived Diets on Allergic Disease Development in Neonates Exposed to Acid Suppressive Therapy

Publication Number: 2771.TOP 19

Nishani R. Ekanayake, Maria Fareri Children's Hospital at Westchester Medical Center, Floral Park, NY, United States; Amy Reichlin, New York Medical College, Brooklyn, NY, United States

Background: The use of acid suppressive medications (ASM) has been increasingly recognized as a potential contributor to the development of allergic disease. They are overprescribed within neonatal intensive care units (NICUs) and to date no study has shown efficacy among the preterm population.
ASMs can induce gut dysbiosis, compromising gut barrier integrity, predisposing infants to severe complications such as necrotizing enterocolitis (NEC) and late-onset sepsis (LOS). Dysbiosis alters the gut–lung–brain axis, promoting activation of inflammatory pathways and immune dysregulation. This imbalance fosters a proinflammatory state characterized by microbial diversity shifts toward less beneficial bacteria. This results in heightened immune responsiveness and inflammation (Hufnagl et al., 2020). Such processes have been implicated in the pathogenesis of allergic disease.
In the neonatal population, the use of human milk and human milk–derived fortifiers (e.g., Prolacta) have demonstrated protective effects in establishing a healthy gut microbiome. This reduced inflammatory response is due to species specificity as opposed to cow milk protein diets.

Objective: This study evaluates the association between neonatal acid suppressive medication use and subsequent allergic disease development, especially in premature infants. In addition, we seek to examine whether early exposure of exclusive human milk–derived diets confer protection against allergy development in early childhood

Design/Methods: This retrospective study analyzed data from the IRB approved NICU developmental follow-up database at Maria Fareri Children’s Hospital. Our level IV NICU feeding protocol provides expressed or donor human milk fortified with Prolacta to premature infants until 34 weeks’ gestation or 1800g with parental consent. Infants diagnosed with allergic conditions (eczema, atopic dermatitis, food allergy, or allergic rhinitis) and exposed to ASMs during their NICU course were included. Both preterm and term neonates were evaluated.
Outpatient data evaluated ASM type and duration, diet, fortification (Prolacta, HMF, or formula-based), delivery mode, and antibiotic exposure. Participants were stratified by gestational age (extremely low, very low, and term). Statistical analyses include chi-square testing to examine associations between early ASM use and allergic disease, and logistic regression to assess whether human milk and Prolacta fortification confer protection against allergic progression in premature infants exposed to ASMs.