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Gomez JA, Abela K, LoBiondo-Wood G. A Systemic Review of the Difference Between Diets for Preterm Infants Containing Raw Mother's Own Milk and Frozen or Pasteurized Mother's Own Milk. J Hum Lact 2024; 40:259-269. [PMID: 38328919 DOI: 10.1177/08903344241227941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Raw, never stored or pasteurized mother's own milk (MOM) is not always available to feed preterm infants; however, storage and pasteurization of MOM diminishes some bioactive components. It can be difficult to feed raw MOM to preterm infants due to transportation and storage of small volumes that might be pumped away from the infant, and a concern that they might harbor bacteria. However, the higher availability of bioactive components in raw MOM may provide benefits to preterm infants compared to frozen or pasteurized MOM. RESEARCH AIM To systematically review and summarize the results of studies on feeding raw MOM versus frozen or pasteurized MOM to preterm infants born at less than 37 weeks of gestation. METHODS Four databases were searched (Cochrane, Embase, Ovid MEDLINE, and Web of Science) for this systematic review. Of 542 studies identified, nine met inclusion criteria and were critically evaluated using the quality assessment tool for quantitative studies by the Effective Public Health Practice Project. Studies were organized using the Breastfeeding Challenges Facing Preterm Mother-Infant Dyads theoretical framework. RESULTS Included studies evaluated the outcomes of preterm infants fed raw versus pasteurized MOM (n = 7, 77.8%) or raw versus frozen MOM (n = 2, 22.2%). Researchers found that raw MOM did not increase infant infections and may have improved health and growth outcomes for study participants. CONCLUSION There is laboratory evidence supporting the safety and efficacy of the use of raw MOM for preterm infants. A raw MOM diet is recommended for preterm infants by professional organizations. Despite this, it may not be universally prioritized and could require purposeful implementation by each institution. Further research is needed to pursue the potential benefits of a raw MOM diet for preterm infants.
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Affiliation(s)
- Jessica Ann Gomez
- Department of Pediatrics/Neonatal-Perinatal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Karla Abela
- Department of Research, The University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, TX, USA
| | - Geri LoBiondo-Wood
- Bette P. Thomas Distinguished Professor for Innovative Healthcare Delivery, Director, Ph.D. Program, The University of Texas Health Science Center at Houston, Cizik School of Nursing, Houston, TX, USA
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Quitadamo PA, Zambianco F, Palumbo G, Wagner X, Gentile MA, Mondelli A. Monitoring the Use of Human Milk, the Ideal Food for Very Low-Birth-Weight Infants-A Narrative Review. Foods 2024; 13:649. [PMID: 38472762 DOI: 10.3390/foods13050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 03/14/2024] Open
Abstract
Aware of the utmost importance of feeding premature babies-especially those of lower weight-with human milk, as well as the need to monitor this important element of neonatal care, we focused on four aspects in this review. First of all, we reviewed the beneficial effects of feeding premature infants with breast milk in the short and long term. Secondly, we performed a quantitative evaluation of the rates of breastfeeding and feeding with human milk in Very-Low-Birth-Weight infants (VLBWs) during hospitalization in the Neonatal Intensive Care Unit (NICU) and at discharge. Our aim was to take a snapshot of the current status of human milk-feeding care and track its trends over time. Then we analyzed, on the one hand, factors that have been proven to facilitate the use of maternal milk and, on the other hand, the risk factors of not feeding with breast milk. We also considered the spread of human milk banking so as to assess the availability of donated milk for the most vulnerable category of premature babies. Finally, we proposed a protocol designed as a tool for the systematic monitoring of actions that could be planned and implemented in NICUs in order to achieve the goal of feeding even more VLBWs with human milk.
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Affiliation(s)
- Pasqua Anna Quitadamo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Federica Zambianco
- San Raffaele Faculty of Medicine, University of San Raffaele Vita-Salute, 20132 Milan, MI, Italy
| | - Giuseppina Palumbo
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Xavier Wagner
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Université Paris Cité, 79279 Paris, France
| | - Maria Assunta Gentile
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
| | - Antonio Mondelli
- Neonatal Intensive Care Unit, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
- Human Milk Bank, Casa Sollievo Della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy
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3
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Briere CE, Gomez J. Fresh Parent's Own Milk for Preterm Infants: Barriers and Future Opportunities. Nutrients 2024; 16:362. [PMID: 38337647 PMCID: PMC10857054 DOI: 10.3390/nu16030362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
While direct at-the-breast feeding is biologically optimal, Neonatal Intensive Care Unit (NICU) admission due to infant immaturity or illness often necessitates the expression and storage of parent's milk. The provision of freshly expressed (never stored) parent's own milk to preterm infants is not widely prioritized, and this article provides an exploration of NICU practices and their implications for feeding premature or ill infants with parent's own milk. In this article, we discuss the potential biological benefits of fresh parent's own milk, highlighting its dynamic components and the changes incurred during storage. Research suggests that fresh milk may offer health advantages over stored milk. The authors advocate for further research, emphasizing the need for standardized definitions. Research is needed on the biological impact of fresh milk, both short- and long-term, as well as defining and understanding healthcare economics when using fresh milk.
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Affiliation(s)
- Carrie-Ellen Briere
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA 01003, USA
- Institute of Nursing Research and Evidence-Based Practice, Connecticut Children’s, Hartford, CT 06106, USA
| | - Jessica Gomez
- Department of Pediatrics/Neonatal-Perinatal Medicine, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
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Nommsen-Rivers L, Black MM, Christian P, Groh-Wargo S, Heinig MJ, Israel-Ballard K, Obbagy J, Palmquist AEL, Stuebe A, Barr SM, Proaño GV, Moloney L, Steiber A, Raiten DJ. An equitable, community-engaged translational framework for science in human lactation and infant feeding-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 5. Am J Clin Nutr 2023; 117 Suppl 1:S87-S105. [PMID: 37173062 DOI: 10.1016/j.ajcnut.2023.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 05/15/2023] Open
Abstract
Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding of human milk biology. As part of addressing these gaps, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated the state of knowledge regarding the infant-human milk-lactating parent triad. However, to optimize the impact of newly generated knowledge across all stages of human milk research, the need remained for a translational research framework specific to the field. Thus, with inspiration from the simplified environmental sciences framework of Kaufman and Curl, Working Group 5 of the BEGIN Project developed a translational framework for science in human lactation and infant feeding, which includes 5 nonlinear, interconnected translational stages, T1: Discovery; T2: Human health implications; T3: Clinical and public health implications; T4: Implementation; and T5: Impact. The framework is accompanied by 6 overarching principles: 1) Research spans the translational continuum in a nonlinear, nonhierarchical manner; 2) Projects engage interdisciplinary teams in continuous collaboration and cross talk; 3) Priorities and study designs incorporate a diverse range of contextual factors; 4) Research teams include community stakeholders from the outset through purposeful, ethical, and equitable engagement; 5) Research designs and conceptual models incorporate respectful care for the birthing parent and address implications for the lactating parent; 6) Research implications for real-world settings account for contextual factors surrounding the feeding of human milk, including exclusivity and mode of feeding. To demonstrate application of the presented translational research framework and its overarching principles, 6 case studies are included, each illustrating research gaps across all stages of the framework. Applying a translational framework approach to addressing gaps in the science of human milk feeding is an important step toward the aligned goals of optimizing infant feeding across diverse contexts as well as optimizing health for all.
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Affiliation(s)
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Triangle Park, NC, USA
| | - Parul Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - M Jane Heinig
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Julie Obbagy
- Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Washington, DC, USA
| | - Aunchalee E L Palmquist
- Department of Maternal & Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison Stuebe
- Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | | | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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5
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AlQurashi A, Wani T, Alateeq N, Heena H. Effect of Counseling Service on Breastfeeding Practice among Saudi Mothers. Healthcare (Basel) 2023; 11:healthcare11060878. [PMID: 36981537 PMCID: PMC10048408 DOI: 10.3390/healthcare11060878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Objective: To assess the knowledge and practice of breastfeeding and the effects of lactation counseling, as a health promotion intervention, on breastfeeding duration and exclusive breastfeeding (EBF) among Saudi women. Methods: In this quasi-experimental design study, 664 mothers attending a women’s hospital from January 2017 to December 2018 were interviewed. Women were allocated into two groups, control and intervention groups, based on received lactation counseling. Interviews were performed using a structured questionnaire collecting data on the sociodemographic characteristics, knowledge, attitude and practice of breastfeeding mothers. A chi-squared test was used to determine the level of significance on breastfeeding practices among two groups. Propensity score matching was presented to control confounders, as women cannot be randomly assigned to lactation counseling. Results: Of 664 women, 592 were Saudi nationals, and the majority of mothers were literate (96.2%). A significantly higher number of mothers in the consultation group were employed as compared with the non-consultation group (p = 0.015). One third (33.3%) of the women practiced EBF, while 39.8% preferred mixed feeding for the first six months of the infant’s life. The consultation group demonstrated a significantly higher response rate in their knowledge on the benefits of breastfeeding in babies (increased intelligence; p < 0.05) and mothers (breast engorgement; p = 0.004), colostrum and its importance (p = 0.027) and effective breastfeeding practices (initiate breastfeeding within 30 min after birth (p = 0.01), baby needs 10–20 min between each feed (p = 0.009), breastfeeding should last for 6 months (p = 0.01)) compared with the non-consultation group. The age of weaning (5.3 ± 2.8 vs. 5.9 ± 3.2 months) was similar across both the groups. However, “the intended duration of BF” was higher in the non-consultation group, and the difference was statistically significant (p = 0.002). The mean weight and length of the baby at follow-up were similar in both groups, with no statistical significance. The duration of exclusive breastfeeding among two groups was not statistically significantly different (8.7 ± 6.9 vs. 8.1 ± 7.1 weeks). Mothers in the two groups were satisfied with their breastfeeding experience. The mean scores lie within the range of 4.2 to 5.0. Baby age (month), mother LoE, mother job and type of BF were controlled for, and the propensity-score-matched 62.5% sample from both the groups yielded the same results. Conclusions: Breastfeeding women in our study showed a fair knowledge of EBF. However, the duration of actual EBF was very short, and the counseling intervention showed no impact on EBF in our study population. We recommend interventions that are tailored to the needs of this population, while identifying factors that improve breastfeeding practice among mothers.
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Pados BF. State of the Science on the Benefits of Human Milk for Hospitalized, Vulnerable Neonates. Nurs Womens Health 2023; 27:121-140. [PMID: 36871597 DOI: 10.1016/j.nwh.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 03/06/2023]
Abstract
Research on human milk has increased dramatically in recent years. The purpose of this review is to describe the literature on the health benefits of human milk for hospitalized, vulnerable neonates. PubMed, CINAHL, and Embase were searched for research articles reporting the health outcomes of hospitalized neonates who were exposed to human milk. Human milk, particularly a mother's own milk, has the potential to reduce the risk of death and the risk and severity of necrotizing enterocolitis, infection, retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage, kidney disease, and liver disease. Dose and timing of human milk is important, with more human milk and earlier introduction having a greater impact on health. When a mother's own milk is not available, donor human milk provides benefits over infant formula.
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Ito M, Kato S, Saito M, Miyahara N, Arai H, Namba F, Ota E, Nakanishi H. Bronchopulmonary Dysplasia in Extremely Premature Infants: A Scoping Review for Identifying Risk Factors. Biomedicines 2023; 11:biomedicines11020553. [PMID: 36831089 PMCID: PMC9953397 DOI: 10.3390/biomedicines11020553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Over the years, bronchopulmonary dysplasia (BPD) affects the pulmonary function of infants, resulting in chronic health burdens for infants and their families. The aim of this scoping review was to screen available evidence regarding perinatal risk factors associated with the development and severity of BPD. METHODS The eligibility criteria of the studies were year of publication between 2016 and 2021; setting of a developed country; English or Japanese as the study language; and randomized controlled, cohort, or case-control design. The titles and abstracts of the studies were screened by independent reviewers. RESULTS Of 8189 eligible studies, 3 were included for severe BPD and 26 were included for moderate BPD. The risk factors for severe BPD were male sex, iatrogenic preterm birth, maternal hypertensive disorders of pregnancy (HDP), low gestational age, small-for-gestational-age (SGA) birth weight, mechanical ventilation on day 1, and need for patent ductus arteriosus (PDA) management. The risk factors for moderate or severe BPD included male sex, premature rupture of membranes, clinical chorioamnionitis, maternal HDP, SGA birth weight, bubbly/cystic appearance on X-ray, and PDA management. CONCLUSIONS We identified several risk factors for BPD. We plan to confirm the validity of the new classification using the existing dataset.
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Affiliation(s)
- Masato Ito
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita 010-8543, Japan
- Correspondence:
| | - Shin Kato
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8602, Japan
| | - Makoto Saito
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8546, Japan
| | - Naoyuki Miyahara
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe 350-8550, Japan
| | - Hirokazu Arai
- Department of Neonatology, Akita Red Cross Hospital, Akita 010-1495, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe 350-8550, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Sciences, St. Luke’s International University, Chuo 104-0044, Japan
- Tokyo Foundation for Policy Research, Tokyo 106-6234, Japan
| | - Hidehiko Nakanishi
- Research and Development Center for New Medical Frontiers, Department of Advanced Medicine, Division of Neonatal Intensive Care Medicine, Kitasato University School of Medicine, Sagamihara 252-0375, Japan
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8
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Huang J, Zheng Z, Zhao X, Huang L, Wang L, Zhang X, Lin X. Short-term effects of fresh mother's own milk in very preterm infants. MATERNAL & CHILD NUTRITION 2022; 19:e13430. [PMID: 36098334 PMCID: PMC9749607 DOI: 10.1111/mcn.13430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
Fresh mother's own milk (MOM) can protect preterm infants from many complications. Often MOM is pasteurized for safety, which can deactivate cellular and bioactive components with protective benefits. Questions remain regarding whether pasteurized MOM provides the same benefits as fresh MOM. The aim of this study was to evaluate the association and feasibility of feeding very preterm infants with fresh MOM. This prospective cohort study included 157 very preterm infants born before 32 weeks' gestational age and with a birthweight below 1500 g. Of these, 82 infants were included in the fresh MOM without any processing group and 75 infants were included in the pasteurized never-frozen MOM (PNFMOM) group. The mortality rate, survival rate without severe complication, incidence of complications, feeding indexes and growth velocities were compared to assess the association and feasibility of feeding fresh MOM. Compared with the PNFMOM group, the fresh MOM group had a higher survival rate without severe complications (p = 0.014) and a lower incidence of bronchopulmonary dysplasia (p = 0.010) after adjustment for confounders. The fresh MOM group regained birthweight earlier (p = 0.021), reached total enteral feeding earlier (p = 0.024), and received total parenteral nutrition for less time (p = 0.045). No adverse events associated with fresh MOM feeding were recorded. Feeding fresh MOM may reduce the incidence of complications in very premature infants. Fresh MOM was shown to be a feasible feeding strategy to improve preterm infants' outcomes.
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Affiliation(s)
- Jing Huang
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Zhi Zheng
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Xiao‐yan Zhao
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Li‐han Huang
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Lian Wang
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
| | - Xiao‐lan Zhang
- Department of NeonatologyXiamen Humanity HospitalXiamenChina
| | - Xin‐zhu Lin
- Department of Neonatology, Xiamen Maternal and Child Care Hospital, Women and Children's Hospital, School of MedicineXiamen UniversityXiamenChina
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Nutrition of Infants with Bronchopulmonary Dysplasia before and after Discharge from the Neonatal Intensive Care Unit. Nutrients 2022; 14:nu14163311. [PMID: 36014815 PMCID: PMC9414083 DOI: 10.3390/nu14163311] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) represents a severe sequela in neonates born very prematurely. The provision of adequate nutritional support in this high-risk population is challenging. The development of the lungs and physical growth are closely linked together in infants with BPD. Growth deficiency has been associated with pulmonary dysfunction, whereas improvement in respiratory status results in growth acceleration. Currently, there is not enough data regarding optimal nutritional strategies in this population. Nutrition in these infants should provide sufficient calories and nutrients to establish growth, avoid growth retardation and assist alveolarization of the lungs. Meticulous follow-up is mandatory during and after discharge from the Neonatal Intensive care Unit (NICU) to minimize growth retardation and improve lung function. Despite the significant literature supporting the contribution of growth and nutrition in the avoidance of BPD, there is limited research regarding interventions and management of infants with established BPD. Our aim was to review clinical strategies applied in everyday clinical practice and identify debates on the nutritional approach of newborns with BPD. Well-organized interventions and clinical trials regarding the somatic development and nutrition of infants with BPD are warranted.
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Sex differences in preterm nutrition and growth: the evidence from human milk associated studies. J Perinatol 2022; 42:987-992. [PMID: 35210540 DOI: 10.1038/s41372-022-01354-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/25/2022] [Accepted: 02/09/2022] [Indexed: 11/08/2022]
Abstract
Sexual dimorphism of the fetus manifests itself even during pregnancy. Preterm births are more common in pregnancies with male fetuses. Intrauterine and postnatal growth nomograms are sex-specific. The human milk composition in term infants appears to be sex-specific. Early nutrition has sex-specific effects and neurodevelopmental outcomes. A large same-sex twin study suggests that a mother's own milk (MOM) provides sex-specific growth advantages probably related to the calibration of a mother's milk based on her newborn's sex. Formula composition does not vary with infant sex, which may be one reason why body composition data favors the use of MOM over formula. However, given the lack of data on this subject, we need more detailed information on how the sex-specific micronutrients in MOM influence infant well-being. We also need more information to ascertain the sex differences in infants' macronutrient requirements, such as whether preterm females have higher fat requirements and preterm males have higher protein requirements for optimal growth and neurodevelopmental outcomes. This information may also influence milk banking and the use of donor human milk (DBM). Further research may help us determine if we should provide sex-specific DBM to those preterm infants who cannot get their MOM.
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11
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Simulated dynamic digestion reveals different peptide releases from human milk processed by means of holder or high temperature-short time pasteurization. Food Chem 2022; 369:130998. [PMID: 34507088 DOI: 10.1016/j.foodchem.2021.130998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 11/20/2022]
Abstract
High Temperature-Short Time (HTST) pasteurization was proposed as an alternative to Holder pasteurization (HOP) to increase the retention of specific human milk (HM) bioactive proteins. The present study explored whether HTST and HOP differently affect peptide release during simulated preterm infant gastrointestinal digestion. Raw (RHM), HOP- and HTST- pasteurized HM were digested using an in vitro dynamic system, and the identified peptides were analyzed by mass spectrometry and multivariate statistics. Before digestion, 158 peptides were identified in either RHM, HTST- or HOP- HM, mostly (84.4%) originating from β-casein (CASB). During gastric digestion, HOP-HM presented a greater number and more abundant specific CASB peptides. A delayed release of peptides was observed in RHM during the intestinal phase, with respect to both pasteurized HM. Although limited to gastric digestion, the HM peptidomic profile differed according to the pasteurization type, and the pattern of the HTST peptides showed a greater similarity with RHM.
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Lund AM, Domellöf M, Pivodic A, Hellström A, Stoltz Sjöström E, Hansen-Pupp I. Mother's Own Milk and Its Relationship to Growth and Morbidity in a Population-based Cohort of Extremely Preterm Infants. J Pediatr Gastroenterol Nutr 2022; 74:292-300. [PMID: 34759238 PMCID: PMC8788942 DOI: 10.1097/mpg.0000000000003352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 10/27/2021] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the relationships between intake of mother's own milk (MOM), compared with intake of pasteurized donor milk (DM), and postnatal growth, incidence of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD), in extremely preterm infants. METHODS Swedish population-based cohort of surviving extremely preterm infants born 2004 to 2007. Exposure to MOM and DM was investigated from birth until 32 weeks postmenstrual age (PMA) in 453 infants. Primary outcome variables were change in z-score (Δ) from birth to 32 weeks PMA for weight, length, and head circumference (HC). Secondary outcomes were incidence of ROP and BPD. Mixed models adjusting for confounders were used to investigate the association between exposures and outcomes. RESULTS Infants' mean gestational age (GA) was 25.4 weeks. Unadjusted, MOM (per 10 mL · kg-1 · day-1) was associated with Δweight and ΔHC with beta estimates of 0.03 z-score units (95% CI, 0.02-0.04, P < 0.001) and 0.03 z-score units (95% CI, 0.01-0.05, P = 0.003), respectively. After adjustment for predefined confounders, the association remained significant for Δweight and ΔHC. A similar pattern was found between Δweight and each 10% increase of MOM. Unadjusted, a higher intake of MOM (mL · kg-1 · day-1) was significantly associated to a lower probability of any ROP and severe ROP; however, these associations did not remain in the adjusted analyses. No associations were found between MOM (mL · kg-1 · day-1) and BPD. Moreover, no associations were found between DM and growth or morbidity outcomes. CONCLUSIONS An increased intake of MOM, as opposed to DM (and not formula feeding), was associated with improved postnatal weight gain and HC growth from birth until 32 weeks PMA in extremely preterm infants. Interventions aiming at increasing early intake of unpasteurized MOM for extremely preterm infants should be encouraged.
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Affiliation(s)
- Anna-My Lund
- Division of Paediatrics, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital
| | - Magnus Domellöf
- Division of Paediatrics, Department of Clinical Sciences, Umeå University
| | - Aldina Pivodic
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg
| | - Ann Hellström
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg
| | | | - Ingrid Hansen-Pupp
- Division of Paediatrics, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital
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Zhu Y, Chen X, Zhu J, Jiang C, Yu Z, Su A. Effect of First Mother's Own Milk Feeding Time on the Risk of Moderate and Severe Bronchopulmonary Dysplasia in Infants With Very Low Birth Weight. Front Pediatr 2022; 10:887028. [PMID: 35664879 PMCID: PMC9157587 DOI: 10.3389/fped.2022.887028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore the effect of mother's own milk (MOM) feeding time on the risk of moderate and severe bronchopulmonary dysplasia (BPD) in infants with very low birth weight (VLBW). METHODS Clinical data from 630 infants with VLBW were retrospectively analyzed. Participants were divided into the early mother's own milk (EMOM) feeding group (first mother's own milk feeding time ≤72 h after birth, n = 397) and the late mother's own milk (LMOM) feeding group (first mother's own milk feeding time >72 h after birth, n = 233). Differences in the incidence of moderate and severe BPD among the two groups were analyzed using the chi-square test. Effects of MOM feeding time on the incidence of moderate and severe BPD were evaluated using univariate and multivariate logistic regression analysis. RESULTS The incidences of moderate and severe BPD in the EMOM feeding group and the LMOM feeding group were 13.9% (55/397) and 21.0% (49/233), respectively (P = 0.019). Variate logistic regression analysis showed that the LMOM feeding group had an increased risk of moderate and severe BPD compared with the EMOM feeding group (OR = 1.656, 95% CI:1.083-2.532). The results of multivariate logistic regression analysis showed that the LMOM feeding group had an increased risk of moderate and severe BPD compared with the EMOM feeding group (OR = 1.894, 95% CI:1.127-3.185). CONCLUSION The first time of MOM feeding within 72 h after birth and the persistence of mother's own milk feeding during hospitalization can reduce the incidence of moderate and severe BPD in infants with VLBW.
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Affiliation(s)
- Yiming Zhu
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiaohui Chen
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Jingai Zhu
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Chengyao Jiang
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Zhangbin Yu
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ailing Su
- Department of Paediatrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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14
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Abstract
Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in infants and is associated with increased mortality, respiratory morbidity, neurodevelopmental impairment, and increased healthcare costs. In parallel with advances made in the field of neonatal intensive care, the phenotype of BPD has evolved from a fibrocystic disease affecting late preterm infants to one of impaired parenchymal development and dysregulated vascular growth predominantly affecting infants born before 29 weeks' gestational age. BPD has been shown to have significant lifelong consequences. Adults with BPD have been found to have abnormal lung function tests, reduced exercise tolerance, and may be at increased risk for developing chronic obstructive pulmonary disease. Evidence shows that BPD occurs secondary to genetic-environmental interactions in an immature lung. In this review, we evaluate the various clinical definitions, imaging modalities, and biomarker data that are helpful in making an early diagnosis of BPD. In addition, we evaluate recent evidence about the prevention and treatment of BPD. We discuss the invasive and non-invasive ventilation strategies and pharmacological agents used in the early, evolving, and established phases of BPD.
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Affiliation(s)
- Margaret Gilfillan
- Division of Neonatology, St Christopher's Hospital for Children, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Anita Bhandari
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vineet Bhandari
- Division of Neonatology, The Children's Regional Hospital at Cooper, Camden, NJ, USA
- Cooper Medical School of Rowan University, Camden, NJ, USA
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15
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Effects of Total Enteral Nutrition on Early Growth, Immunity, and Neuronal Development of Preterm Infants. Nutrients 2021; 13:nu13082755. [PMID: 34444915 PMCID: PMC8401306 DOI: 10.3390/nu13082755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022] Open
Abstract
The feeding of colostrum and mother's transitional milk improves immune protection and neurodevelopmental outcomes. It also helps with gut maturation and decreases the risks of infection. The supply of nutrients from human milk (HM) is not adequate for preterm infants, even though preterm mother's milk contains higher concentrations of protein, sodium, zinc, and calcium than mature HM. The human milk fortifiers, particularly those with protein, calcium, and phosphate, should be used to supplement HM to meet the necessities of preterm infants. The management of fluid and electrolytes is a challenging aspect of neonatal care of preterm infants. Trace minerals such as iron, zinc, copper, iodine, manganese, molybdenum, selenium, chromium, and fluoride are considered essential for preterm infants. Vitamins such as A, D, E, and K play an important role in the prevention of morbidities, such as bronchopulmonary dysplasia, retinopathy of prematurity, and intraventricular hemorrhage. Therefore, supplementation of HM with required nutrients is recommended for all preterm infants.
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16
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Pavlyshyn H, Sarapuk I, Casper C, Makieieva N. Kangaroo mother care can improve the short-term outcomes of very preterm infants. J Neonatal Perinatal Med 2021; 14:21-28. [PMID: 32568123 DOI: 10.3233/npm-200455] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Kangaroo mother care (KMC) is a cornerstone of preterm infant management. The purpose of this study was to estimate the effectiveness of daily prolonged KMC in very preterm infants and its influence on neonatal morbidity and short-term outcomes, and breastfeeding optimization. METHODS Research included 52 very preterm infants. According to the KMC duration newborns were divided into two groups; Group1 of 22 infants (42.3%) - KMC lasted more than 3 hours/day, Group 2 of 30 infants (57.7%) - KMC lasted less than 3 hours/day. RESULTS Nosocomial sepsis occurred less frequently in Group 1 versus Group 2 (OR = 10.50; 95% CI 1.23-89.67, p = 0.012). Incidences of BPD, NEC, IVH I-II grades, the duration of parenteral nutrition, and growth parameters have not been different between groups (p > 0.05). Breastfeeding rates at discharge prevailed in Group 1 (OR = 3.70; 95% CI 1.16-11.86, p = 0.025). The most important factors for nosocomial sepsis: combination of parenteral nutrition duration and daily prolonged KMC, as a preventing factor (p = 0.002). Combination of the neonatal intensive care unit (NICU) treatment duration, type of enteral feeding, and mother's age add as factors that have important influence on breastfeeding prolongation (p = 0.009). CONCLUSION Nosocomial infection prevention and breastfeeding optimization are profitable outcomes of daily prolonged KMC in very preterm infants. No significant differences in the BPD, NEC, IVH I-II grades incidences, duration of parenteral nutrition, and growth parameters were found between studied groups. Combination of long-lasting KMC and short-term parenteral nutritionis a significant factor for nosocomial sepsis prophylaxis.
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Affiliation(s)
- H Pavlyshyn
- I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - I Sarapuk
- I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - C Casper
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - N Makieieva
- Kharkiv National Medical University, Kharkiv, Ukraine
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17
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Lund A, Löfqvist C, Pivodic A, Lundgren P, Hård A, Hellström A, Hansen‐Pupp I. Unpasteurised maternal breast milk is positively associated with growth outcomes in extremely preterm infants. Acta Paediatr 2020; 109:1138-1147. [PMID: 31747093 PMCID: PMC9541184 DOI: 10.1111/apa.15102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/06/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022]
Abstract
AIM Extrauterine growth restriction is common among extremely preterm infants. We explored whether intake of unpasteurised maternal milk (MM) and pasteurised donor milk (DM) was associated with longitudinal growth outcomes and neonatal morbidities in extremely preterm infants. METHODS Observational study of 90 preterm infants born between 2013 and 2015 in Gothenburg, Sweden. Data were prospectively collected on nutritional and breast milk intakes during the first 28 days. RESULTS Ninety infants (39 girls and 51 boys) with a median gestational age of 25.3 (22.7-27.9) weeks were evaluated. MM intake (mL/kg/d) correlated positively with almost all z-scores for weight, length and head circumference at 28 postnatal days and at postmenstrual age (PMA) 32 and 36 weeks. After multivariable adjustment, MM intake and weight z-score at 28 postnatal days and at PMA 32 and 36 weeks remained significantly associated. Infants consuming ≥80% MM had more favourable weight z-scores at PMA 32 and 36 weeks. Intake of DM did not correlate with any growth outcomes. Infants without retinopathy of prematurity had a significantly higher intake of MM (mL/kg/d). CONCLUSION Unpasteurised MM was positively associated with longitudinal growth outcomes. Motivating mothers to provide their infants with their own milk after preterm birth should be emphasised.
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Affiliation(s)
- Anna‐My Lund
- Department of Clinical Sciences, Paediatrics Skåne University Hospital Lund University Lund Sweden
| | - Chatarina Löfqvist
- Section for Opthalmology Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Aldina Pivodic
- Section for Opthalmology Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Pia Lundgren
- Section for Opthalmology Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Anna‐Lena Hård
- Section for Opthalmology Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Ann Hellström
- Section for Opthalmology Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Ingrid Hansen‐Pupp
- Department of Clinical Sciences, Paediatrics Skåne University Hospital Lund University Lund Sweden
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18
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Sun H, Cao Y, Han S, Cheng R, Liu L, Liu J, Xia S, Zhang J, Li Z, Cheng X, Yang C, Pan X, Li L, Ding X, Wang R, Wu M, Li X, Shi L, Xu F, Yu F, Pan J, Zhang X, Li L, Yang J, Li M, Yan C, Zhou Q, Lu J, Wei M, Wang L, Yang L, Ye XY, Unger S, Kakulas F, Lee SK. A randomized controlled trial protocol comparing the feeds of fresh versus frozen mother's own milk for preterm infants in the NICU. Trials 2020; 21:170. [PMID: 32046760 PMCID: PMC7014600 DOI: 10.1186/s13063-019-3981-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022] Open
Abstract
Background Necrotizing enterocolitis (NEC) is the leading cause of death among preterm infants born at < 30 weeks’ gestation. The incidence of NEC is reduced when infants are fed human milk. However, in many neonatal intensive care units (NICUs), it is standard practice to freeze and/or pasteurize human milk, which deactivates bioactive components that may offer additional protective benefits. Indeed, our pilot study showed that one feed of fresh mother’s own milk per day was safe, feasible, and can reduce morbidity in preterm infants. To further evaluate the benefits of fresh human milk in the NICU, a randomized controlled trial is needed. Methods Our prospective multicenter, double-blinded, randomized, controlled trial will include infants born at < 30 weeks’ gestation and admitted to one of 29 tertiary NICUs in China. Infants in the intervention (fresh human milk) group (n = 1549) will receive at least two feeds of fresh human milk (i.e., within 4 h of expression) per day from the time of enrollment until 32 weeks’ corrected age or discharge to home. Infants in the control group (n = 1549) will receive previously frozen human milk following the current standard protocols. Following informed consent, enrolled infants will be randomly allocated to the control or fresh human milk groups. The primary outcome is the composite outcome mortality or NEC ≥ stage 2 at 32 weeks’ corrected age, and the secondary outcomes are mortality, NEC ≥ stage 2, NEC needing surgery, late-onset sepsis, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), weight gain, change in weight, increase in length, increase in head circumference, time to full enteral feeds, and finally, the number and type of critical incident reports, including feeding errors. Discussion Our double-blinded, randomized, controlled trial aims to examine whether fresh human milk can improve infant outcomes. The results of this study will impact both Chinese and international medical practice and feeding policy for preterm infants. In addition, data from our study will inform changes in health policy in NICUs across China, such that mothers are encouraged to enter the NICU and express fresh milk for their infants. Trial registration Chinese Clinical Trial Registry; #ChiCTR1900020577; registered January 1, 2019; http://www.chictr.org.cn/showprojen.aspx?proj=34276
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Affiliation(s)
- Huiqing Sun
- Department of Neonatology, Children's Hospital affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhuwaihuan Road, Zhengzhou, 450018, Henan, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, Shanghai, China
| | - Shuping Han
- Department of Pediatrics, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfei Lane, Mochou Road, Qinhuai District, Nanjing, 210004, Jiangsu, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Gulou District, Nanjing, 210008, Jiangsu, China
| | - Ling Liu
- Department of Neonatology, Guizhou Maternity and Child Health Care Hospital, 63 Ruijin South Road, Guiyang, 530003, Guizhou, China
| | - Jiangqin Liu
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, 2699 Gaoke West Road, Pudong New Area, Shanghai, 201204, China
| | - Shiwen Xia
- Department of Neonatology, The Women and Children's Health-Care Hospital of Hubei Province, 745 Wuluo Road, Jiedaokou, Hongshan District, Wuhan, 430070, Hubei, China
| | - Jiajie Zhang
- Department of Neonatology, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, 450003, Henan, China
| | - Zhankui Li
- Department of Neonatology, Northwest Women and Children Hospital, 1616 Yanxiang Road, Qujiang New District, Xian, 710061, Shanxi, China
| | - Xiuyong Cheng
- Department of Neonatology, The first affiliated hospital of Zhengzhou University Zhengzhou, 1 East Jianshe Road, Zhengzhou, 450052, Henan, China
| | - Chuanzhong Yang
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, 2004 Hongjing Road, Futian District, Shenzhen, 518017, Guangdong, China
| | - Xinnian Pan
- Department of Neonatology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Long Li
- Department of Neonatology, Xinjiang Uiger Municipal People's Hospital, Tianchi Road, Urumqi, 830000, Xinjiang, China
| | - Xin Ding
- Department of Neonatology, Children's Hospital of Soochow University, 92 Zhongnan Street, SIP, Suzhou, 215025, Jiangsu, China
| | - Rensheng Wang
- Department of Neonatology, Xiamen Children's Hospital, 92-98 Yibin Road, Huli District, Xiamen, 361006, Fujian, China
| | - Mingyuan Wu
- Department of Neonatology, Women's Hospital School of Medicine Zhejiang University, 1 Xueshi Road, Hangzhou, 31006, Zhejiang, China
| | - Xiaoying Li
- Department of Neonatology, Qilu Children's Hospital of Shandong University, 430 Jingshi Road, Lixia District, Jinan, 250022, Shandong, China
| | - Liping Shi
- Department of Neonatology, Children's Hospital School of Medicine Zhejiang University, 3333 Binsheng Road Binjiang District, Zhejiang, 310003, Hangzhou, China
| | - Falin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfuqian Street, Zhengzhou, 450052, Henan, China
| | - Fengqin Yu
- Department of Neonatology, Women and Children Hospital of Zhengzhou, 41 Jinshui Road, Zhengzhou, 450012, Henan, China
| | - Jiahua Pan
- Department of Neonatology, Anhui Provincial Hospital, 17 Qijiang Road, Hefei, 230001, Anhui, China
| | - Xiaolan Zhang
- Department of Neonatology, Xianmen Humanity Hospital, 3777 Xianyue Road, Xiamen, 361000, China
| | - Li Li
- Department of Neonatology, Children's Hospital of Capital Institute of Pediatrics, 2 Yabao Road, Chaoyang District, Beijing, 100020, China
| | - Jie Yang
- Department of Neonatology, Guangdong Women and Children Hospital, Guangzhou Medical University, 521-523, Xing Nan Road, Panyu, Guangzhou, 510000, China
| | - Mingxia Li
- Department of Neonatology, First Affiliated Hospital of Xinjiang Medical University, 137 Road, Urumqi, 830054, Xinjiang, China
| | - Changhong Yan
- Department of Neonatology, Jiangxi Children's Hospital, 122 Yangming Road, Nanchang, Jiangxi, China
| | - Qi Zhou
- Department of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, Shanghai, China
| | - Jiao Lu
- Department of Neonatology, Shanghai General Hospital and Shanghai Jiaotong University, University 650, New Songjiang Road, Song Jiang, Shanghai, 201600, China
| | - Mou Wei
- Department of Neonatology, Guangzhou Women and Children's Medical Center, 9 Jinsui Road, Tianhe District, Guangzhou, 510623, Guangdong, China
| | - Laishuan Wang
- Department of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, Shanghai, China
| | - Ling Yang
- Department of Neonatology, Children's Hospital of Hainan Province, 75 South Longkun Road, Haikou, 570206, Hainan Province, China
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue Rm 8-500, Toronto, ON, M5G 1X6, Canada
| | - Sharon Unger
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue Rm 8-500, Toronto, ON, M5G 1X6, Canada.,Department of Paediatrics, Sinai Health System, 600 University Avenue, Room 19-2310, Toronto, Ontario, M5G 1X5, Canada
| | - Foteini Kakulas
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia (M570), School of Medicine and Pharmacology, 35 Stirling Highway, 6009 Perth, Crawley, Western Australia, Australia
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue Rm 8-500, Toronto, ON, M5G 1X6, Canada. .,Department of Paediatrics, Sinai Health System, 600 University Avenue, Room 19-2310, Toronto, Ontario, M5G 1X5, Canada. .,Departments of Pediatrics, Obstetrics & Gynecology, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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19
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Bührer C, Fischer HS, Wellmann S. Nutritional interventions to reduce rates of infection, necrotizing enterocolitis and mortality in very preterm infants. Pediatr Res 2020; 87:371-377. [PMID: 31645057 DOI: 10.1038/s41390-019-0630-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
Observational studies demonstrating reduced rates of infections, necrotizing enterocolitis (NEC), and mortality in preterm infants fed their own mother's milk, as opposed to formula, have prompted endeavors to achieve similar effects with the right choice of food and food additives. In a systematic review of meta-analyses and randomized controlled trials (RCTs), we considered nutritional interventions aimed at reducing the rates of infections, NEC, or mortality in very preterm infants. The overall effects of particular interventions were presented as risk ratios with 95% confidence intervals. In RCTs, pasteurized human donor milk, as opposed to formula, reduced NEC but not infections or mortality. No differences emerged between infants receiving human or bovine milk-based fortifiers. Pooled data of small trials and a recent large RCT suggested that bovine lactoferrin reduced rates of fungal sepsis without impact on other infections, NEC, or mortality. Pooled data of RCTs assessing the use of prebiotic oligosaccharides found reduced infection but not mortality. Enteral L-glutamine (six RCTs) lowered infection rates, and enteral L-arginine (three RCTs) reduced NEC. A meta-analysis sensitivity approach found multiple-strain (but not single-strain) probiotics to be highly effective in reducing NEC and mortality. Thus, selected food components may help to improve outcomes in preterm infants.
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Affiliation(s)
- Christoph Bührer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Hendrik S Fischer
- Department of Neonatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sven Wellmann
- Division of Neonatology, University Children's Hospital Regensburg (KUNO), University of Regensburg, Regensburg, Germany
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20
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Abstract
Human milk provides not only ideal nutrition for infant development but also immunologic factors to protect from infection and inflammation. For the newborn preterm infant, the natural delivery of milk is not attainable, and instead pumped maternal milk, donor human milk, and human milk fortification are mainstays of clinical care. Current research demonstrates a decreased risk of necrotizing enterocolitis with maternal milk and donor human milk when individually compared to formula and with a complete human milk diet of maternal milk supplemented with donor human milk. The incidence of severe retinopathy of prematurity is decreased with an exclusive human milk diet, and this decrease is more pronounced with human milk-based compared to bovine milk-based human milk fortifier. The incidence of other morbidities such as late-onset sepsis and bronchopulmonary dysplasia is decreased with higher dose of human milk though significant differences are not apparent in exclusive human milk diet studies.
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Affiliation(s)
- Sarah N Taylor
- Yale School of Medicine, PO Box 208064, New Haven, Connecticut, 06520-8064, USA.
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21
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Sun H, Han S, Cheng R, Hei M, Kakulas F, Lee SK. Testing the feasibility and safety of feeding preterm infants fresh mother's own milk in the NICU: A pilot study. Sci Rep 2019; 9:941. [PMID: 30700726 PMCID: PMC6353969 DOI: 10.1038/s41598-018-37111-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022] Open
Abstract
Necrotizing enterocolitis (NEC) is the leading cause of death among infants born at <30 weeks’ gestation, but donor human milk can reduce the incidence of NEC. Unfortunately, freezing or pasteurizing human milk deactivates beneficial bioactive components. We evaluated the feasibility, safety, and impact of feeding very preterm infants fresh (unprocessed) mother’s own milk within 4 hours of expression. In our multicentre prospective cohort analytic study, we fed 109 control and 98 intervention infants previously frozen donor or mother’s own milk; only the intervention group was fed fresh mother’s own milk once daily from enrollment until 32 weeks’ corrected age. Control group mothers could not commit to provide fresh milk daily and were less likely receive antenatal corticosteroids than mothers in the intervention group. In the intervention group, 87.5% (98/112) of mothers were able to provide at least one feed of fresh milk a day. No critical incidents or non-compliance with the protocol were reported. The duration of mechanical ventilation and total parenteral nutrition use were shorter in the intervention group than controls (P < 0.01) but the length of hospital stay was similar (P = 0.57). Although the study might be underpowered, the intervention group had lower unadjusted rates of the composite outcome NEC ≥ stage 2 or mortality (8% vs 20%, P = 0.04), sepsis (22% vs 38%, P = 0.02), retinopathy of prematurity (17% vs 39%, P < 0.01) and bronchopulmonary dysplasia (32% vs 47%, P < 0.01) than the control. These results indicated that feeding fresh mother’s own milk once daily was safe, feasible, and may reduce morbidity.
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Affiliation(s)
- Huiqing Sun
- Department of Neonatology, Children's Hospital of Zhengzhou University, Zhengzhou, China.,Department of Neonatology, Henan Children's Hospital, Zhengzhou, China.,Department of Neonatology, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Shuping Han
- Department of Pediatrics, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mingyan Hei
- Department of Pediatrics, The Third Xiangya Hospital of Central South University, Changsha, China.,Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Foteini Kakulas
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada. .,Department of Paediatrics, Department of Obstetrics & Gynecology, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. .,Department of Paediatrics, Sinai Health System, Toronto, Ontario, Canada.
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22
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Eliminating Risk of Intubation in Very Preterm Infants with Noninvasive Cardiorespiratory Support in the Delivery Room and Neonatal Intensive Care Unit. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5984305. [PMID: 30733962 PMCID: PMC6348842 DOI: 10.1155/2019/5984305] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/09/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022]
Abstract
Introduction Avoiding intubation and promoting noninvasive modes of ventilator support including continuous positive airway pressure (CPAP) in preterm infants minimizes lung injury and optimizes neonatal outcomes. Discharge home on oxygen is an expensive morbidity in very preterm infants (VPI) with lung disease. In 2007 a standardized bundle was introduced for VPI admitted to the neonatal care unit (NICU) which included delayed cord clamping (DCC) at birth and noninvasive ventilation as first-line cardiorespiratory support in the delivery room (DR), followed by bubble CPAP upon NICU admission. Objective Our goal was to evaluate the risk of (1) intubation and (2) discharge home on oxygen after adopting this standardized DR bundle in VPI born at a regional perinatal center and treated in the NICU over a ten-year period (2008-2017). Materials and Methods We compared maternal and neonatal demographics, respiratory care processes and outcomes, as well as neonatal mortality and morbidity in VPI (< 33 weeks gestation) and extremely low birth weight (ELBW, < 1000 g) subgroup for three consecutive epochs: 2008-2010, 2011-2013, and 2014-2017. Results Of 640 consecutive inborn VPI, 55% were < 1500 g at birth and 23% were ELBW. Constant through all three epochs, DCC occurred in 83% of VPI at birth. There was progressive increase in maternal magnesium during the three epochs and decrease in maternal antibiotics during the last epoch. Over the three epochs, VPI had less risk of DR intubation (23% versus 15% versus 5%), NICU intubation (39% versus 31% versus 18%), and invasive ventilation (37% versus 30% versus 17%), as did ELBW infants. Decrease in postnatal steroid use, antibiotic exposure, and increase in early colostrum exposure occurred over the three epochs both in VPI and in ELBW infants. There was a sustained decrease in surfactant use in the second and third epochs. There was no significant change in mortality or any morbidity in VPI; however, there was a significant decrease in pneumothorax (17% versus 0%) and increase in survival without major morbidity (15% versus 41%) in ELBW infants between 2008-2010 and 2014-2017. Benchmarked risk-adjusted rate for oxygen at discharge in a subgroup of inborn VPI (401-1500 g or 22-31 weeks of gestation) is 2.5% (2013-2017) in our NICU compared with > 8% in all California NICUs and > 10% in all California regional NICUs (2014-2016). Conclusion Noninvasive strategies in DR and NICU minimize risk of intubation in VPI without adversely affecting other neonatal or respiratory outcomes. Risk-adjusted rates for discharge home on oxygen remained significantly lower for inborn VPI compared with rates at regional NICUs in California. Reducing intubation risk in ELBW infants may confer an advantage for survival without major morbidity. Prenatal magnesium may reduce intubation risk in ELBW infants.
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Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, Bertino E, Gaya A, Gebauer C, Grovslien A, Moro GE, Weaver G, Wesolowska AM, Picaud JC. Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification. Front Pediatr 2019; 7:76. [PMID: 30968003 PMCID: PMC6439523 DOI: 10.3389/fped.2019.00076] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/25/2019] [Indexed: 01/03/2023] Open
Abstract
Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the usual feeding volumes leading to slow growth with the risk of neurocognitive impairment and other poor health outcomes such as retinopathy and bronchopulmonary dysplasia. HM should be supplemented (fortified) with the nutrients in short supply, particularly with protein, calcium, and phosphate to meet the high requirements of this group of babies. In this paper the European Milk Bank Association (EMBA) Working Group on HM Fortification discusses the existing evidence in this field, gives an overview of different fortification approaches and definitions, outlines the gaps in knowledge and gives recommendations for practice and suggestions for future research. EMBA recognizes that "Standard Fortification," which is currently the most utilized regimen in neonatal intensive care units, still falls short in supplying sufficient protein for some VLBW infants. EMBA encourages the use of "Individualized Fortification" to optimize nutrient intake. "Adjustable Fortification" and "Targeted Fortification" are 2 methods of individualized fortification. The quality and source of human milk fortifiers constitute another important topic. There is work looking at human milk derived fortifiers, but it is still too early to draw precise conclusions about their use. The pros and cons are discussed in this Commentary in addition to the evidence around use of fortifiers post discharge.
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Affiliation(s)
- Sertac Arslanoglu
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Clair-Yves Boquien
- PhAN, Institut National de la Recherche Agronomique (INRA), Université de Nantes, CRNH-Ouest, Nantes, France
| | - Caroline King
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Delphine Lamireau
- Lactariums de Bordeaux-Marmande, Pôle Pédiatrique, Centre Hospitalo-Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Paola Tonetto
- Neonatal Unit of Turin University, City of Health and Science of Turin, Turin, Italy
| | - Debbie Barnett
- Greater Glasgow and Clyde Donor Milk Bank, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Enrico Bertino
- Neonatal Unit of Turin University, City of Health and Science of Turin, Turin, Italy
| | - Antoni Gaya
- Banc de Teixits, Fundaciò Banc Sang i Teixits de les Illes Balears, Palma de Mallorca, Spain
| | - Corinna Gebauer
- Abteilung Neonatologie Klinik und Poliklinik für Kinder und Jugendliche, Leipzig, Germany
| | - Anne Grovslien
- Neonatal Unit, Milk Bank, Oslo University Hospital, Oslo, Norway
| | - Guido E Moro
- Associazione Italiana Banche del Latte Umano Donato (AIBLUD), Milan, Italy
| | - Gillian Weaver
- Hearts Milk Bank, Rothamsted Research Institute, Harpenden, United Kingdom
| | | | - Jean-Charles Picaud
- CarMeN Unit, INSERM U1060, INRA U1397, Claude Bernard University Lyon 1, Pierre Bénite, France.,Division of Neonatology, Hôpital de la Croix-Rousse, Lyon, France
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Verd S, Ginovart G. Human milk is perhaps the single most under-rated strategy to prevent bronchopulmonary dysplasia. Arch Dis Child Fetal Neonatal Ed 2018; 103:F599-F600. [PMID: 29730596 DOI: 10.1136/archdischild-2018-314949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Sergio Verd
- Pediatric Unit, La Vileta Surgery, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Gemma Ginovart
- Neonatal Unit, Department of Pediatrics, Hospital de la Santa Cruz y San Pablo, Barcelona, Spain
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Parm Ü, Štšepetova J, Eelmäe I, Merila M, Ilmoja ML, Metsvaht T, Lutsar I, Soeorg H. Genetic relatedness of Gram-negative bacteria colonizing gut and skin of neonates and mother's own milk. J Perinatol 2018; 38:1503-1511. [PMID: 30206349 DOI: 10.1038/s41372-018-0220-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/27/2018] [Accepted: 08/21/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We described colonization of mother's own milk with Gram-negative bacteria and its relationship with neonatal colonization. STUDY DESIGN Gram-negative bacteria isolated from weekly collected stool, skin and mother's own milk of hospitalized preterm (n = 49) and healthy term neonates (n = 20) were genotyped. Colonization-related factors were determined by logistic regression. RESULTS Gram-negative bacteria were isolated from mother's own milk of 22.4% (n = 11) and 15% (n = 3) of mothers of preterm and term neonates, respectively. According to pulsed-field gel electrophoresis genetically similar strains were present in mother's own milk and gut of 8.2% (n = 4) of mother-preterm neonate, but none of mother-term neonate pairs. In three of four late-onset sepsis caused by Gram-negative bacteria, colonization of gut, but not mother's own milk, with invasive species preceded late-onset sepsis. CONCLUSIONS Colonization of mother's own milk with Gram-negative bacteria is uncommon and transmission to neonatal gut may occur in less than one-tenth of neonate-mother pairs.
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Affiliation(s)
- Ülle Parm
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.,Tartu Health Care College, Tartu, Estonia
| | - Jelena Štšepetova
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Imbi Eelmäe
- Paediatric Intensive Care Unit, Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Mirjam Merila
- Neonatal Unit, Children's Clinic, Tartu University Hospital, Tartu, Estonia
| | - Mari-Liis Ilmoja
- Department of Anaesthesiology and Intensive Care, Tallinn Children's Hospital, Tallinn, Estonia
| | - Tuuli Metsvaht
- Paediatric Intensive Care Unit, Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia
| | - Irja Lutsar
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Hiie Soeorg
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, University of Tartu, Tartu, Estonia.
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Higher intake of coagulase-negative staphylococci from maternal milk promotes gut colonization with mecA-negative Staphylococcus epidermidis in preterm neonates. J Perinatol 2018; 38:1344-1352. [PMID: 30076401 DOI: 10.1038/s41372-018-0183-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/27/2018] [Accepted: 07/11/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We aimed to determine factors associated with gut colonization of preterm neonates with coagulase-negative staphylococci (CoNS) from maternal milk (MM). STUDY DESIGN CoNS isolated from weekly collected stool and MM of hospitalized preterm (n = 49) and healthy term neonates (n = 20) were genotyped. Colonization-related factors were determined by Cox proportional hazards regression. RESULT Gut colonization with mecA-negative Staphylococcus epidermidis from MM was less prevalent (40.8% vs. 95%) and delayed (median age 15.5 vs. 2 days) in preterm compared with term neonates. Enhanced colonization was associated with higher intake of CoNS from MM (hazard ratio (95% confidence interval) 1.006 (1.00-1.01) for 106 colony-forming units), lower proportion of mecA-positive predominant NICU strains in gut (0.09 (0.01-0.49) for 1%) and lower incidence of late-onset CoNS sepsis (5% vs. 34% in those without colonization). CONCLUSION Enteral feeding with larger proportion of unpasteurized MM and limiting spread of predominant strains may promote colonization with CoNS from MM.
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27
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Abstract
PURPOSE OF REVIEW This review provides a concise summary of recent literature pertaining to emerging therapies for bronchopulmonary dysplasia (BPD). To provide context for the presented therapies, a brief overview of recently proposed changes to the definition of BPD and the concept of expanded respiratory outcomes is included. RECENT FINDINGS New or redefined respiratory outcomes are required to improve accuracy in evaluating new therapies and correlating results with long-term clinical outcomes of importance. Dexamethasone is no longer the only steroid-based therapy showing promise for impacting BPD. Early trials indicate hydrocortisone, inhaled budesonide, and a budesonide-surfactant combination may be of benefit to preterm infants. Additionally, simple approaches like increasing utilization of mother's own milk may deserve more emphasis. Of significant interest is the traction stem cell therapies are acquiring as one of the more anticipated treatments for BPD. A new preclinical meta-analysis demonstrates the benefits of mesenchymal stromal cell therapy in animal models while the results of early clinical trials remain eagerly awaited. SUMMARY BPD continues to be the most frequently occurring significant morbidity for extremely preterm infants, yet highly effective therapies remain elusive. Promising new treatments are on the horizon, but only continued efforts to complete well-designed clinical trials will determine the true impact of these emerging therapies.
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Miller J, Tonkin E, Damarell RA, McPhee AJ, Suganuma M, Suganuma H, Middleton PF, Makrides M, Collins CT. A Systematic Review and Meta-Analysis of Human Milk Feeding and Morbidity in Very Low Birth Weight Infants. Nutrients 2018; 10:nu10060707. [PMID: 29857555 PMCID: PMC6024377 DOI: 10.3390/nu10060707] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/30/2022] Open
Abstract
This systematic review and meta-analysis synthesised the post-1990 literature examining the effect of human milk on morbidity, specifically necrotising enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) and neurodevelopment in infants born ≤28 weeks' gestation and/or publications with reported infant mean birth weight of ≤1500 g. Online databases including Medline, PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched, and comparisons were grouped as follows: exclusive human milk (EHM) versus exclusive preterm formula (EPTF), any human milk (HM) versus EPTF, higher versus lower dose HM, and unpasteurised versus pasteurised HM. Experimental and observational studies were pooled separately in meta-analyses. Risk of bias was assessed for each individual study and the GRADE system used to judge the certainty of the findings. Forty-nine studies (with 56 reports) were included, of which 44 could be included in meta-analyses. HM provided a clear protective effect against NEC, with an approximate 4% reduction in incidence. HM also provided a possible reduction in LOS, severe ROP and severe NEC. Particularly for NEC, any volume of HM is better than EPTF, and the higher the dose the greater the protection. Evidence regarding pasteurisation is inconclusive, but it appears to have no effect on some outcomes. Improving the intake of mother's own milk (MOM) and/or donor HM results in small improvements in morbidity in this population.
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MESH Headings
- Enteral Nutrition
- Enterocolitis, Necrotizing/etiology
- Enterocolitis, Necrotizing/physiopathology
- Enterocolitis, Necrotizing/prevention & control
- Evidence-Based Medicine
- Humans
- Infant
- Infant Formula
- Infant Nutritional Physiological Phenomena
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/prevention & control
- Infant, Very Low Birth Weight
- Milk, Human
- Neonatal Sepsis/etiology
- Neonatal Sepsis/physiopathology
- Neonatal Sepsis/prevention & control
- Neurodevelopmental Disorders/etiology
- Neurodevelopmental Disorders/physiopathology
- Neurodevelopmental Disorders/prevention & control
- Premature Birth/diet therapy
- Premature Birth/physiopathology
- Severity of Illness Index
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Affiliation(s)
- Jacqueline Miller
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia.
| | - Emma Tonkin
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia.
| | - Raechel A Damarell
- Nutrition and Dietetics, Flinders University, Adelaide, SA 5001, Australia.
| | - Andrew J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, SA 5006, Australia.
| | - Machiko Suganuma
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
| | - Hiroki Suganuma
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
| | - Philippa F Middleton
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
| | - Carmel T Collins
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, SA 5006, Australia.
- Adelaide Medical School, Discipline of Paediatrics, The University of Adelaide, Adelaide, SA 5006, Australia.
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Villamor-Martínez E, Pierro M, Cavallaro G, Mosca F, Kramer BW, Villamor E. Donor Human Milk Protects against Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:E238. [PMID: 29461479 PMCID: PMC5852814 DOI: 10.3390/nu10020238] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 12/19/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is the most common complication after preterm birth. Pasteurized donor human milk (DHM) has increasingly become the standard of care for very preterm infants over the use of preterm formula (PF) if the mother's own milk (MOM) is unavailable. Studies have reported beneficial effects of DHM on BPD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on the effects of DHM on BPD and other respiratory outcomes. Eighteen studies met the inclusion criteria. Meta-analysis of RCTs could not demonstrate that supplementation of MOM with DHM reduced BPD when compared to PF (three studies, risk ratio (RR) 0.89, 95% confidence interval (CI) 0.60-1.32). However, meta-analysis of observational studies showed that DHM supplementation reduced BPD (8 studies, RR 0.78, 95% CI 0.67-0.90). An exclusive human milk diet reduced the risk of BPD, compared to a diet with PF and/or bovine milk-based fortifier (three studies, RR 0.80, 95% CI 0.68-0.95). Feeding raw MOM, compared to feeding pasteurized MOM, protected against BPD (two studies, RR 0.77, 95% CI 0.62-0.96). In conclusion, our data suggest that DHM protects against BPD in very preterm infants.
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Affiliation(s)
- Eduardo Villamor-Martínez
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), 6202 AZ Maastricht, The Netherlands.
| | - Maria Pierro
- Neonatal Intensive Care Unit, Alessandro Manzoni Hospital, 23900 Lecco, Italy.
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
| | - Boris W Kramer
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), 6202 AZ Maastricht, The Netherlands.
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), 6202 AZ Maastricht, The Netherlands.
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Fischer Fumeaux CJ, Denis A, Prudon MB, Plaisant F, Essomo Megnier-Mbo CM, Fernandes L, Touzet S, Claris O, Laborie S. Early Use of Mother's Own Raw Milk, Maternal Satisfaction, and Breastfeeding Continuation in Hospitalised Neonates: A Prospective Cohort Study. Neonatology 2018; 113:131-139. [PMID: 29186707 DOI: 10.1159/000480535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite the critical importance of breast milk for preterm and sick neonates, there is no consensus regarding the use of raw mother's own milk (MOM) in neonatal units. OBJECTIVES This study aimed to describe the use of raw MOM in hospitalised neonates before day 7 (early use), and to investigate: (i) related factors, (ii) maternal satisfaction, and (iii) the association with breastfeeding continuation. METHODS This prospective cohort included 516 neonates intended to be breastfed in 2 French neonatal units. Neonates receiving raw MOM before day 7 were compared to those who did not. The association between early use of MOM and breastfeeding continuation at hospital discharge, and up to 6 months later, was measured by logistic regression. RESULTS More than one-third (36.2%) of breastfed neonates did not receive any MOM during their first week, mainly due to organisational constraints and staff reluctance. Maternal satisfaction related to early raw MOM use was high (96%), and was coupled with a more frequent maternal feeling of being supported in breastfeeding (p = 0.003). There was a significant association between early use of MOM and breastfeeding continuation at discharge (OR 2.92, 95% CI 1.94-4.40, p < 0.0001), which persisted 6 months later (OR 2.70, 95% CI 1.21-6.03, p = 0.023). This association appeared independent in multivariable analyses (at discharge: aOR 2.03, 95% CI 1.27-3.25, p = 0.003; 6 months later: aOR 2.46, 95% CI 1.02-5.92, p = 0.045). CONCLUSION While the early use of raw MOM in hospitalised neonates can be limited by multiple factors, it appears supportive for mothers, and might represent a simple opportunity to improve breastfeeding in neonatal units.
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Affiliation(s)
- Céline J Fischer Fumeaux
- Department of Woman Mother Child, Clinic of Neonatology, University Hospital of Lausanne, Lausanne, Switzerland
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31
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Deepak J, Eduardo B. Prevention of bronchopulmonary dysplasia: current strategies. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:841-851. [PMID: 28774356 PMCID: PMC7390045 DOI: 10.7499/j.issn.1008-8830.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
Bronchopulmonary dysplasia (BPD) is one of the few diseases affecting premature infants that have continued to evolve since its first description about half a century ago. The current form of BPD, a more benign and protracted respiratory failure in extremely preterm infants, is in contrast to the original presentation of severe respiratory failure with high mortality in larger premature infants. This new BPD is end result of complex interplay of various antenatal and postnatal factors causing lung injury and subsequent abnormal repair leading to altered alveolar and vascular development. The change in clinical and pathologic picture of BPD over time has resulted in new challenges in developing strategies for its prevention and management. While some of these strategies like Vitamin A supplementation, caffeine and volume targeted ventilation have stood the test of time, others like postnatal steroids are being reexamined with great interest in last few years. It is quite clear that BPD is unlikely to be eliminated unless some miraculous strategy cures prematurity. The future of BPD prevention will probably be a combination of antenatal and postnatal strategies acting on multiple pathways to minimize lung injury and abnormal repair as well as promote normal alveolar and vascular development.
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Affiliation(s)
- Jain Deepak
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33101, USA
| | - Bancalari Eduardo
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33101, USA
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