Effect of early initiation of enteral nutrition on short-term clinical outcomes of very premature infants: A national multicenter cohort study in China

Effect of probiotics on necrotizing enterocolitis in preterm infants: a network meta-analysis of randomized controlled trials

BACKGROUND

Previous studies have suggested that probiotics may have potential benefits for preterm infants. Their efficacy seems to depend on the particular species or combinations used.

METHODS

To further investigate the effects of probiotics in preventing necrotizing enterocolitis (NEC) and other related outcomes in preterm infants, we conducted a network meta-analysis of 51 randomized controlled trials involving 11,661 participants.

RESULTS

Our study revealed that most probiotics can effectively reduce the incidence of NEC (at or beyond Bell's stage II). Lactobacillus (RR, 0.59; 95% CI: 0.29, 0.98), the combination of Bifidobacterium and Lactobacillus (RR, 0.47; 95% CI: 0.20, 0.87), and the combination of Bifidobacterium, Lactobacillus, and Streptococcus (RR, 0.17; 95% CI: 0.00, 0.84) were the only treatments that significantly reduced all-cause mortality compared to placebo. Lactobacillus can be effective in reducing the time preterm infants spend in the hospital (MD, -4.23; 95% CI: -7.62, -0.81) and reaching full enteral feeding (MD, -2.15; 95% CI: -3.70, -0.64).

CONCLUSIONS

The combination of Bifidobacterium, Lactobacillus, and Enterococcus was the most efficacious in reducing the mortality and incidence of NEC (Bell II or above) in preterm infants. Both prebiotics and Lactobacillus alone were found to be highly effective in reducing the length of hospitalization and the time needed to achieve full enteral feeding. No evidence suggests that probiotics affect sepsis risk.

TRIAL REGISTRATION

The study protocol was registered with PROSPERO (CRD42023460231) on March 10, 2023.

Improving Time to First Feeding for Preterm Infants: A Quality Improvement Approach

Introduction

Early initiation of enteral feeding is reported to reduce sepsis and mortality in preterm infants. Less than half of stable infants born <35 weeks gestational age with birth weight <2,000 g are fed within 24 hours of birth at our center.

Methods

The Specific, measureable, achievable, relevant, timely aim of this quality improvement project was to increase the initiation of enteral feeding within 24 hours of birth from 49% (baseline) to 75% among infants born <35 weeks gestational age with birth weight <2,000 g between November 2022 and December 2023. We identified the unavailability of a mother's own milk as a major barrier to early feeding initiation. Project interventions included antenatal lactation consultation, patient-dedicated breast pumps, standardized feeding orders, and multidisciplinary education. The outcome measure was the time to first enteral feeding, and the balancing measures were the diagnosis of necrotizing enterocolitis (NEC) and the use of formula for first feeding.

Results

The proportion of infants with feeding initiated within 24 hours of birth increased from 49% to 80% during the project period. The incidence of NEC was unchanged (1.9% before and during the project period). Both before and during the project, feedings were most frequently initiated with pasteurized donor human milk (49.7% versus 58.7%), followed by mother's own milk (37.8% versus 35.6%) and formula (12.5% versus 5.8%).

Conclusions

This quality improvement project increased the proportion of eligible infants fed within 24 hours of birth without a change in the incidence of NEC or an increase in formula use as first feeding.

How long does it take to start minimal enteral feeding in preterm Neonates admitted to NICUs in Southern Oromia, Ethiopia?

BACKGROUND

The timely initiation of trophic feeding (TF) is crucial for premature newborns, but challenging due to immaturity, respiratory instability, abdominal distension, resource scarcity, and healthcare worker expertise. Moreover, there is a dearth of information on predictors of full trophic feeding time. Therefore, this retrospective cohort study aimed to investigate the time it takes and its predictors to initiate minimal enteral feeding in preterm neonates in Southern Oromia, Ethiopia.

METHOD

A facility-based retrospective follow up study was conducted among 434 randomly selected preterm neonates admitted to NICU of Bule Hora University Teaching Hospital and Yabello General Hospital from January 1, 2021 to December 30, 2022. Data were extracted by a pretested structured checklist, entered into Epidata 3.1 and then transferred to Stata version 17 for analysis. Kaplan Meier survival curve and log rank test were used to estimate survival time and a statistical comparison respectively. Bivariable and multivariable cox proportional hazard model was fitted to identify predictors of time to initiate TF and their outputs are presented using Adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CIs).

RESULT

The overall incidence density of TF initiation was reported as 43.6 per 100 neonate-days. Moreover, the median (IQR) time to initiate TF was found to be 2 (1-4) days. Neonates delivered vaginally had a higher likelihood of early TF initiation (AHR: 1.64, CI: 1.26, 2.13), while those born between 32 and 34 weeks (AHR: 0.61, CI: 0.46, 0.81), VLBW neonates (AHR: 0.45, CI: 0.34, 0.60), neonates without KMC (AHR: 0.59, CI: 0.46, 0.79), and those in level II hospitals were less likely to start TF promptly (AHR: 0.78, CI: 0.62, 0.99). Furthermore, neonates with sepsis (AHR: 1.76, CI: 1.36, 2.28) and hypothermia (AHR: 1.51, CI: 1.19, 1.93) had delayed TF initiation.

CONCLUSION

We observed a significant low rate of early TF initiation and higher death rate of preterm newborn in our study as compared to the global. Preterm neonates with lower GA, no KMC, and a VLBW are more likely to have a delayed initiation. Our results highlight that staff training on identifying neonates suitable for TF, and ensuring adequate resources for KMC in all NICU levels should be considered.

Retinopathy of Prematurity in Eight Portuguese Neonatal Intensive Care Units: Incidence, Risk Factors, and Progression-A Prospective Multicenter Study

BACKGROUND/OBJECTIVES

Retinopathy of prematurity (ROP) is a retinal neovascular disease affecting preterm infants. Identifying risk factors for its development and progression is critical for effective screening and prevention. This study aimed to analyze the incidence of ROP and identify key risk factors for its development and progression.

METHODS

We conducted a prospective, observational cohort study on 455 neonates (gestational age [GA] < 32 weeks or birth weight < 1500 g) across eight Portuguese NICUs.

RESULTS

ROP incidence was 37.8%, with 4.6% requiring treatment. Multivariate analysis identified low GA and the number of red blood cell (RBC) transfusions as significant factors for ROP development and progression. After adjusting for these variables, platelet transfusions, high maximum fraction of inspired oxygen (FiO2) in the second week, and surfactant use remained significantly associated with ROP development, while early and late sepsis, maternal chronic hypertension, and delayed enteral nutrition were associated with progression to ROP requiring treatment.

CONCLUSIONS

These findings underscore the importance of addressing low GAs and adult RBC transfusions in ROP risk management and suggest that maximum FiO2, platelet transfusions, and sepsis also play crucial roles. Larger studies are needed to validate these results and explore preventive interventions, particularly regarding the impact of multiple adult RBC transfusions on fetal hemoglobin percentages.

Construction and validation of a risk prediction model for extrauterine growth restriction in preterm infants born at gestational age less than 34 weeks

Objective

This study aimed to develop and validate a model for predicting extrauterine growth restriction (EUGR) in preterm infants born ≤34 weeks gestation.

Methods

Preterm infants from Guangxi Maternal and Child Health Hospital (2019-2021) were randomly divided into training (80%) and testing (20%) sets. Collinear clinical variables were excluded using Pearson correlation coefficients. Predictive factors were identified using Lasso regression. Random forest (RF), support vector machine (SVM), and logistic regression (LR) models were then built and evaluated using the confusion matrix, area under the curve (AUC), and the F1 score. Additionally, calibration curves and decision curve analysis (DCA) were plotted to assess the performance and practical utility of the models.

Results

The study included 387 infants, with no significant baseline differences between training (n = 310) and testing (n = 77) sets. LR identified gestational age, birth weight, premature rupture of membranes, patent ductus arteriosus, cholestasis, and neonatal sepsis as key EUGR predictors. The RF model (19 variables) demonstrated an accuracy of greater than 90% during training, and superior AUC (0.62), F1 score (0.80), and accuracy (0.72) in testing compared to other models.

Conclusions

Gestational age, birth weight, premature rupture of membranes, patent ductus arteriosus, cholestasis, and neonatal sepsis are significant EUGR predictors in preterm infants ≤34 weeks. The model shows promise for early EUGR prediction in clinical practice, potentially enhancing screening efficiency and accuracy, thus saving medical resources.

Hyperglycemia in pregnancy did not worsen the short-term outcomes of very preterm infants: a propensity score matching study

Background

Hyperglycemia in pregnancy (HGP) has generally been considered a risk factor associated with adverse outcomes in offspring, but its impact on the short-term outcomes of very preterm infants remains unclear.

Methods

A secondary analysis was performed based on clinical data collected prospectively from 28 hospitals in seven regions of China from September 2019 to December 2020. According to maternal HGP, all infants were divided into the HGP group or the non-HGP group. A propensity score matching analysis was used to adjust for confounding factors, including gestational age, twin or multiple births, sex, antenatal steroid administration, delivery mode and hypertensive disorders of pregnancy. The main complications and the short-term growth status during hospitalization were evaluated in the HGP and non-HGP groups.

Results

A total of 2,514 infants were eligible for analysis. After matching, there were 437 infants in the HGP group and 874 infants in the non-HGP group. There was no significant difference between the two groups in main complications including respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, patent ductus arteriosus, culture positive sepsis, intraventricular hemorrhage, periventricular leukomalacia, anemia, feeding intolerance, metabolic bone disease of prematurity, or parenteral nutrition-associated cholestasis. The incidences of extrauterine growth retardation and increased growth retardation for weight and head circumference in the non-HGP group were all higher than those in the HGP group after matching (P < 0.05).

Conclusions

HGP did not worsen the short-term outcomes of the surviving very preterm infants, as it did not lead to a higher risk of the main neonatal complications, and the infants' growth improved during hospitalization.