Иммуномодулирующий и регенеративный потенциалы грудного молока, недоношенность и детское сердце (обзор литературы)

 Расширение в современных условиях фундаментальных знаний по вопросам физиологии лактации, биологии стволовых клеток и экзосом грудного молока, нюансам взаимодействия организма матери и ребёнка, начиная от внутриутробного периода, заканчивая постнатальным развитием,  требует от научного сообщества и практикующих врачей прогрессивного, динамичного взгляда при анализе известных, общепринятых клинических явлений и закономерностей (развитие иммунной системы младенцев и детей раннего возраста, естественное и искусственное вскармливание, особенности постнатального развития и роста органов и тканей детей, рождённых недоношенными). Компоненты триады «мать - грудное молоко - младенец» тесно связаны друг с другом и влияют на траекторию развития младенца. Грудное молоко кормящей женщины по современным представлениям является «живой, метаболической/эндокринной сигнальной системой», может рассматриваться как «иммунный орган», значимый для постнатального роста и программирования организма недоношенного ребёнка. Не меньшую ценность для постнатального развития в период новорождённости и раннего детства имеет активно обсуждаемое в специальной литературе явление - «микрохимеризм», вызванный грудным вскармливанием и играющий по современным представлениям ключевую роль в развитии иммунной системы и организма в целом Течение постнатального онтогенеза сердечно-сосудистой системы при отсутствии протективного (иммуномодулирующего и регенеративного) эффекта грудного молока кормящей женщины на спонтанное, некорректируемое воздействие неблагоприятных факторов недоношенности приводит, с высокой вероятностью, к ремоделированию и дисфункции сердца у рождённых недоношенными детей, а в отдалённой перспективе - и у взрослых. Поскольку молодые люди, родившиеся недоношенными, демонстрируют уникальный кардиальный фенотип, характеризующийся уменьшенным бивентрикулярным объемом, относительно более низкой систолической и диастолической функциями, непропорциональным увеличением мышечной массы, клинически проявляющийся повышенным риском сердечно-сосудистых заболеваний, гипертонией и снижением толерантности к физической нагрузке, то целесообразно считать преждевременные роды хроническим заболеванием. Следовательно, именно естественное вскармливание, реализующее эволюционно целесообразный защитный механизм для детского сердца, следует относить к фундаментальным факторам, выполняющим жизненно важную роль в профилактике сердечно-сосудистых заболеваний у рождённых недоношенными детей и взрослых

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