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Shrikant KN, Gracy NB, Pournami F, Prithvi AK, Panackal AV, Prabhakar J, Jain N. Reducing extrauterine growth restriction in very preterm neonates: A before-after intervention study. Nutr Clin Pract 2024. [PMID: 38837805 DOI: 10.1002/ncp.11165] [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: 02/14/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Focus on preterm nutrition strategies is imperative. Extrauterine growth restriction (EUGR) is a clinically relevant, but seemingly elusive consequence, often used to benchmark and compare outcomes. METHODS This before-after observational study was designed to study the effect of a multipronged updated "nutrition care bundle" in very preterm infants on rate of EUGR compared with a cohort from a previous period. Eligible participants were neonates born at <32 weeks' gestation who completed care in the unit; a retrospective group from a previous period and a prospective cohort after implementation of the bundle were included. The bundle constituted of three key areas: (1) aggressive parenteral nutrition with high-dose amino acids and lipids from day 1, (2) "rapid-escalation" enteral feed regimens including earlier introduction of human milk fortifier (at 40-ml/kg/day feeds), and (3) colostrum mouth paint and structured oromotor stimulation to promote oral feeding. EUGR was defined as a z score difference of >-1 in weight for postmenstrual age (PMA) at discharge and at birth. RESULTS Data of 116 infants were retrieved for the retrospective group; 103 infants were included in the prospective group. EUGR was reduced from 71% to 58% (P = 0.039) after implementation of the bundle. Infants in the prospective group achieved full oral feeds at earlier PMA (P < 0.001) and were discharged at earlier PMA (P = 0.002). CONCLUSIONS The proportion of neonates with EUGR was reduced significantly after implementation of the revised nutrition care bundle. Achievement of full oral feeds and discharge readiness were earlier in the prospective group.
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Affiliation(s)
| | | | - Femitha Pournami
- Department of Neonatology, KIMS Health, Trivandrum, Kerala, India
| | | | - Anila V Panackal
- Department of Neonatology, KIMS Health, Trivandrum, Kerala, India
| | - Jyothi Prabhakar
- Department of Neonatology, KIMS Health, Trivandrum, Kerala, India
| | - Naveen Jain
- Department of Neonatology, KIMS Health, Trivandrum, Kerala, India
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Esubalew H, Messelu MA, Tarekegn BT, Admasu AT, Abrha NN, Terefe B. Time to full enteral feeding and its predictors among very low birth weight (VLBW) neonates admitted to the neonatal intensive care units (NICU) in comprehensive specialized hospitals in Northwest Ethiopia. BMC Pediatr 2024; 24:366. [PMID: 38807061 PMCID: PMC11131264 DOI: 10.1186/s12887-024-04719-w] [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] [Received: 12/16/2023] [Accepted: 03/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Time to full enteral feeding is the time when neonates start to receive all of their prescribed nutrition as milk feeds. Delayed to achieve full enteral feeding had resulted in short- and long-term physical and neurological sequelae. However, there are limited studies to assess the time to full enteral feeding and its predictors among very low birth-weight neonates in Ethiopia. Therefore, this study aimed to assess the time to full enteral feeding and its predictors among very low birth-weight neonates admitted to comprehensive specialized hospitals in Northwest Ethiopia. METHODS A multi-center institutional-based retrospective follow-up study was conducted among 409 VLBW neonates from March 1, 2019 to February 30, 2023. A simple random sampling method was used to select study participants. Data were entered into EpiData version 4.2 and then exported into STATA version 16 for analysis. The Kaplan-Meier survival curve together with the log-rank test was fitted to test for the presence of differences among groups. Proportional hazard assumptions were checked using a global test. Variables having a p- value < 0.25 in the bivariable Cox-proportional hazard model were candidates for multivariable analysis. An adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CI) was computed to report the strength of association, and variables having a P-value < 0.05 at the 95% confidence interval were considered statistically significant predictor variables. RESULT The median time to full enteral feeding was 10 (CI: 10-11) days. Very Low Birth-Weight (VLBW) neonates who received a formula feeding (AHR: 0.71, 95% CI: 0.53, 0.96), gestational age of 32-37 weeks (AHR: 1.66, 95% CI: 1.23, 2.23), without Necrotizing Enterocolitis (NEC) (AHR: 2.16, 95% CI: 1.65, 2.84), and single birth outcome (AHR: 1.42, 95% CI: 1.07, 1.88) were statistically significant variables with time to full enteral feeding. CONCLUSION AND RECOMMENDATIONS This study found that the median time to full enteral feeding was high. Type of feeding, Necrotizing Enterocolitis (NEC), Gestational Age (GA) at birth, and birth outcome were predictor variables. Special attention and follow-up are needed for those VLBW neonates with NEC, had a GA of less than 32 weeks, and had multiple birth outcomes.
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Affiliation(s)
- Hilena Esubalew
- Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia.
| | - Mengistu Abebe Messelu
- College of Medicine and Health Sciences, Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
| | - Bethelihem Tigabu Tarekegn
- College of Medicine and Health Sciences, School of Nursing, Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia
| | - Aster Tefera Admasu
- College of Medicine and health Sciences, School of Medicine, Department of Biomedical Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Nigussie Abrha
- College of Medicine and Health Sciences, School of Nursing, Department of Emergency and Critical Care Nursing, Univiersity of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- College of Medicine and Health Sciences, School of Nursing, Department of Community Health Nursing, University of Gondar, Gondar, Ethiopia
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Zhang L, Zheng J, Ding F. Podocyte involvement in the pathogenesis of preterm-related long-term chronic kidney disease. Histol Histopathol 2024; 39:557-564. [PMID: 37994826 DOI: 10.14670/hh-18-675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
With the continuous advancement of neonatal intensive care technology, the survival rate of preterm infants is gradually increasing. However, this improvement in survival is accompanied by long-term prognostic implications in various systems. In the field of renal diseases, current epidemiological data indicate that preterm birth is a significant risk factor for the development of long-term chronic kidney disease (CKD). This not only imposes an economic burden on patients families but also severely impacts their quality of life. Understanding the underlying mechanisms involved in this process could offer potential strategies for early prevention and management of CKD. Although the nephron number hypothesis is currently widely accepted as a mechanism, there has been limited exploration regarding podocytes - one of the most important structures within nephrons - in relation to long-term CKD associated with preterm birth. Therefore, this review aims to summarize current knowledge on how prematurity influences CKD development overall, while specifically focusing on our current understanding of podocytes in relation to prematurity.
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Affiliation(s)
- Lulu Zhang
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, China
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin, China
| | - Jun Zheng
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, China
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin, China
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China.
| | - Fangrui Ding
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin, China
- Department of Neonatology, Nankai University Maternity Hospital, Tianjin, China
- Department of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China.
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Branagan A, Murphy C, O'Sullivan A, Bodnarova I, Feyereislova S, Berka I, Miletin J, Stranak Z. Influence of gastric residual assessment in preterm neonates on time to achieve enteral feeding (the GRASS trial)-Multi-centre, assessor-blinded randomised clinical trial. Eur J Pediatr 2024; 183:2325-2332. [PMID: 38427039 PMCID: PMC11035479 DOI: 10.1007/s00431-024-05483-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Gastric residual measurement is routinely performed in premature infants prior to feeding despite a lack of evidence of benefit. We aimed to evaluate if the exclusion of routine gastric residual measurement and evaluation has an impact on the time taken to achieve full enteral feeding in preterm neonates. METHODS International multi-centre randomised controlled trial. Clinically stable, appropriate for gestational age infants between 26+0 and 30+6 weeks of gestation and less than 1.5 kg birth weight were eligible. Infants were randomised to the intervention arm (no monitoring of gastric aspirates) or control arm (routine care). Primary outcome was the achievement of enteral feeds of 100 ml/kg/day by day 5 of life. RESULTS Ninety-five infants were recruited with 88 included in an intention-to-treat analysis, 45 in the intervention arm and 43 in the control arm. There was no imbalance in baseline characteristics. Thirty-three (73.3%) infants in the intervention group and 32 infants (74.4%) in the control group reached full feeds by day 5 of life (p = 0.91) with no difference in median time to full feeds. There were no statistically significant differences in survival or the major morbidities of prematurity. CONCLUSION There was no difference in time to attainment of enteral feeds of 100 ml/kg/day in premature infants when gastric residuals were not monitored. In the absence of a clinical benefit to routine monitoring, it may be appropriate to discontinue this practice and only monitor residuals when clinical concern of feeding intolerance or gastrointestinal pathology arises in this group of patients. TRIAL REGISTRATION NCT03111329- https://clinicaltrials.gov/ . Registered 06/04/2017. WHAT IS KNOWN • Previous randomized trials have shown little benefit to the performance of routine assessment of gastric residuals in preterm infants. Despite this, they continue to be performed due to concerns from observational data regarding development of NEC. Meta-analysis to date has failed to answer the question regarding NEC. WHAT IS NEW • In very low birth weight infants who are fed using modern feeding practice of faster feed advancement, to minimize use of central access and parenteral nutrition, exclusion of routine checks of gastric residuals did not increase the proportion of infants reaching full enteral feeds by day 5. No harm was seen when residual checks were not performed. • In the absence of a clinical benefit to the routine performance of gastric residuals in very low birth weight infants, it may be appropriate to discontinue their use and instead check residuals when clinical concern of pathology arises.
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Affiliation(s)
- A Branagan
- The Coombe Women and Infants University Hospital, Dublin 8, Ireland.
| | - C Murphy
- The Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - A O'Sullivan
- The Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - I Bodnarova
- Institute for the Care of Mother and Child, Prague, Czech Republic
| | - S Feyereislova
- Institute for the Care of Mother and Child, Prague, Czech Republic
| | - I Berka
- Institute for the Care of Mother and Child, Prague, Czech Republic
- 3rd School of Medicine, Charles University, Prague, Czech Republic
| | - J Miletin
- The Coombe Women and Infants University Hospital, Dublin 8, Ireland
- Institute for the Care of Mother and Child, Prague, Czech Republic
- UCD School of Medicine, University College Dublin, Dublin, Ireland
- 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Z Stranak
- Institute for the Care of Mother and Child, Prague, Czech Republic
- 3rd School of Medicine, Charles University, Prague, Czech Republic
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Schwab I, Wullenkord R, Eyssel F, Dresbach T, Scholten N. Lactation support in neonatal intensive care units in Germany from the mothers' perspective - a mixed-method study of the current status and needs. BMC Pregnancy Childbirth 2024; 24:282. [PMID: 38627697 PMCID: PMC11022450 DOI: 10.1186/s12884-024-06339-9] [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: 11/02/2023] [Accepted: 02/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Establishing successful lactation in mothers of very low birth weight (VLBW, <1500g) infants requires structured lactation support. Little is known about mothers' perspectives on lactation support in German neonatal intensive care units (NICUs). METHODS This paper features a convergent mixed-method approach that includes a retrospective, cross-sectional questionnaire and interview data to showcase mothers' perceptions of lactation support in NICUs. Content analysis of the interviews (n = 12) and a descriptive analysis of quantitative data (n = 533) were performed to illustrate the current status and need for lactation support in German NICUs. RESULTS The results show that lactation support in German NICUs is often inadequate and does not comply with recommendations based on the existing literature to encourage pumping and breastfeeding in mothers. The data imply that even if lactation is successfully initiated in most cases, it is often not maintained over time, which may be due to a lack of personal support and consistent information. CONCLUSION The overall structures and institutional guidelines for lactation support should be encouraged to promote nutrition with mother´s own milk in German NICUs.
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Affiliation(s)
- Isabella Schwab
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair for Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, 50933, Cologne, Germany
| | - Ricarda Wullenkord
- CITEC Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, Germany.
| | - Friederike Eyssel
- CITEC Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, Germany
| | - Till Dresbach
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair for Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, 50933, Cologne, Germany
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吴 梓, 张 漪, 周 茜, 刘 沁, 程 实, 夏 世. [Risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:343-349. [PMID: 38660897 PMCID: PMC11057302 DOI: 10.7499/j.issn.1008-8830.2310145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/27/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To investigate the risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA). METHODS A retrospective collection of clinical data was conducted on preterm infants with a gestational age of <34 weeks who were diagnosed with hsPDA and treated at the Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, from January 2018 to June 2023. The subjects were divided into two groups based on the treatment approach: the ibuprofen group (95 cases) and the ibuprofen plus surgery group (44 cases). The risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA were identified by binary logistic regression analysis. RESULTS The binary logistic regression analysis revealed that an increased diameter of the ductus arteriosus, a resistance index (RI) value of the middle cerebral artery ≥0.80, and prolonged total invasive mechanical ventilation time were risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). Receiver operating characteristic curve analysis showed that a ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days had significant predictive value for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). The combined predictive value of these three factors was the highest, with an area under the curve of 0.843, a sensitivity of 86.5%, and a specificity of 75.0% (P<0.05). CONCLUSIONS A ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days are risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA, and they are of significant predictive value for the necessity of surgical treatment following the failure of ibuprofen treatment.
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Affiliation(s)
| | | | | | - 沁 刘
- 华中科技大学同济医学院附属湖北妇幼保健院超声科,湖北武汉430070
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Visscher MO, Taleghani A, Nurre M, Meganathan K, Strange R, Kinnett M, Narendran V. Assessment of diaper dermatitis using a novel electronic health record-embedded scale. J Perinatol 2024; 44:501-507. [PMID: 37985814 DOI: 10.1038/s41372-023-01824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Quantify the evolution and severity of neonatal skin injury, specifically diaper skin compromise, by embedding a validated skin integrity evaluation into the electronic health record (EHR). METHODS Retrospective longitudinal cohort analysis of 747 patients stratified by gestation: 22-27, 28-31, 32-24, and 35-37 weeks, from birth to discharge. Primary outcomes were time to first perineal erythema, duration as percent days with erythema, and severity as maximum score. Data were analyzed using generalized linear models and multiple linear regression methods. RESULTS Seventy percent had erythema and, of these, 34% had at least one high score with bleeding. Days with erythema ranged from 34-44% (p < 0.05). Days to first erythema were inversely correlated with gestational age. Risks for severe injury included short time to first erythema, 5 or more stools/day, infection, and Caucasian race/ethnicity. CONCLUSIONS The EHR-based scale can be readily implemented to mitigate diaper skin compromise in premature infants.
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Affiliation(s)
- Marty O Visscher
- James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA.
| | - Afshin Taleghani
- Neonatal Intensive Care Unit, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Melissa Nurre
- Neonatal Intensive Care Unit, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Karthikeyan Meganathan
- College of Medicine, Department of Environmental and Public Health, University of Cincinnati, Cincinnati, OH, USA
| | - Ruthann Strange
- Neonatal Intensive Care Unit, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Melissa Kinnett
- Neonatal Intensive Care Unit, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Vivek Narendran
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Huang J, Shen W, Wu F, Mao J, Liu L, Chang Y, Zhang R, Ye X, Qiu Y, Ma L, Cheng R, Wu H, Chen D, Chen L, Xu P, Mei H, Wang S, Xu F, Ju R, Zheng Z, Lin X, Tong X. Risk factors for severe bronchopulmonary dysplasia in a Chinese cohort of very preterm infants. Saudi Med J 2024; 45:369-378. [PMID: 38657990 PMCID: PMC11147577 DOI: 10.15537/smj.2024.45.4.20230741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To examine the risk factors for severe bronchopulmonary dysplasia (BPD) in a cohort of very preterm infants (VPIs) in China, as BPD is common among VPIs and associated with a high mortality rate. METHODS In this multicenter retrospective study, medical records from infants with BPD born at gestation age (GA) of <32 weeks with birth weight (BW) of <1,500 grams (g) in 7 regions of China were included. The cohort was stratified into different BPD severity groups based on their fraction of inspired oxygen requirement at a modified GA of 36 weeks or post discharge. Risk factors were identified using logistic regression analysis. RESULTS A significant inverse correlation was revealed between BPD severity and both GA and BW (p<0.001). Independent risk factors for severe BPD (sBPD) were identified as invasive mechanical ventilation (≥7d), multiple blood transfusion (≥3), nosocomial infection (NI), hemodynamically significant patent ductus arteriosus (hsPDA), delayed initiation of enteral nutrition, and longer time to achieve total caloric intake of 110 kcal/kg. Conversely, administration of antenatal steroids was associated with reduced risk of sBPD. CONCLUSION Our study not only reaffirmed the established risk factors of low GA and BW for sBPD in VPIs, but also identified additional, potentially modifiable risk factors. Further research is warranted to explore whether intervention in these modifiable factors might reduce the risk of sBPD.Clinical Trial Reg. No.: ChiCTR1900023418.
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Affiliation(s)
- Jing Huang
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Wei Shen
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Fan Wu
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Jian Mao
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Ling Liu
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yanmei Chang
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Rong Zhang
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Xiuzhen Ye
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yinping Qiu
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Li Ma
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Rui Cheng
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Hui Wu
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Dongmei Chen
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Ling Chen
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Ping Xu
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Hua Mei
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Sannan Wang
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Falin Xu
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Rong Ju
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Zhi Zheng
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Xinzhu Lin
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Xiaomei Tong
- From the Department of Neonatology (Huang, Shen, Zheng, Lin), Women and Children’s Hospital, School of Medicine, Xiamen University, from the Xiamen Key Laboratory of Perinatal-Neonatal Infection (Huang, Shen, Zheng, Lin), Xiamen Clinical Research Center for Perinatal Medicine, Xiamen, from the Department of Neonatology (F. Wu), The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, from the Department of Pediatrics (Mao), Shengjing Hospital of China Medical University, Shenyang, from the Department of Neonatology (Liu), Guiyang Maternal and Child Health Hospital, Guiyang Children’s Hospital, Guiyang, from the Department of Pediatrics (Chang, Tong), Peking University Third Hospital, Beijing, from the Department of Neonatology (Zhang), Children’s Hospital of Fudan University, Shanghai, from the Department of Neonatology (Ye), Guangdong Province Maternal and Children’s Hospital, Guangzhou, from the Department of Neonatology (Qiu), General Hospital of Ningxia Medical University, Yinchuan, from the Department of Neonatology (Ma), Children’s Hospital of Hebei Province, Shijiazhuang, from the Department of Neonatology (Cheng), Children’s Hospital of Nanjing Medical University, Nanjing, from the Department of Neonatology (H. Wu), The First Hospital of Jilin University, Changchun, from the Department of Neonatology (D. Chen), Quanzhou Maternity and Children’s Hospital, Quanzhou, from the Department of Pediatrics (L. Chen), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, from the Department of Neonatology (P. Xu), Liaocheng People’s Hospital, Liaocheng, from the Department of Neonatology (Mei), the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, from the Department of Neonatology (Wang), Suzhou Municipal Hospital, Suzhou, from the Department of Neonatology (F. Xu), The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, and from the Department of Neonatology (Ju), Chengdu Women’ and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
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Xu X, Ma H, Cheng S, Xue J. Effect of early preventive supplementation with calcium and phosphorus on metabolic bone disease in premature infants. BMC Pediatr 2024; 24:171. [PMID: 38459481 PMCID: PMC10921623 DOI: 10.1186/s12887-024-04654-w] [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] [Received: 04/20/2023] [Accepted: 02/17/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVE The objective was to study the effect of early preventive calcium and phosphorus supplementation on metabolic bone disease in preterm infants. METHODS A retrospective analysis of 234 preterm infants with a gestational age < 32 weeks or birth weight < 1500 g who were hospitalized in the Neonatology Department of the Second Hospital of Shandong University from 01.2018 to 12.2020 was conducted. One hundred thirty-two premature infants hospitalized from 01.2018 to 06.2019 did not receive prophylactic calcium and phosphorus supplementation in the early postnatal period. These infants received calcium or phosphorus supplementation at the time of hypocalcaemia or hypophosphatemia diagnosis. One hundred two premature infants hospitalized from 07.2019 to 12.2020 received early preventive calcium and phosphorus supplementation after birth. The levels of serum calcium and phosphorus, alkaline phosphatase, 25-hydroxyvitamin D, calcitonin, and parathyroid hormone at different time points and growth indicators at six months of age were compared between the two groups of infants. The number of cases of metabolic bone disease and fracture between the two groups was compared. RESULTS 1) A total of 12 infants (5.13%) among the 234 preterm infants were diagnosed with metabolic bone disease, including 2 (1.96%) in the prophylactic supplementation group and 10 (7.58%) in the nonprophylactic supplementation group. Fractures occurred in 3 premature infants (25.0%) with metabolic bone disease, all of whom were in the group that did not receive prophylactic supplementation. 2) There was no significant difference in serum calcium and calcitonin levels between the two groups. The levels of serum phosphorus and 25 hydroxyvitamin D in the prophylactic supplementation group were higher than those in the nonprophylactic supplementation group (P < 0.05). In comparison, alkaline phosphatase and parathyroid hormone levels were lower in the prophylactic supplementation group than in the nonprophylactic supplementation group (P < 0.05). Preterm infants in the prophylactic supplementation group had higher weight, length, head circumference, and bone density values than those in the nonprophylactic supplementation group (P < 0.05). CONCLUSION Preventive supplementation with calcium and phosphorus after birth can effectively improve calcium and phosphorus metabolism, and reduce the incidence of metabolic bone disease and fractures in premature infants. This can be further publicized and used clinically.
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Affiliation(s)
- Xuejing Xu
- Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Hongfang Ma
- Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Shuqi Cheng
- Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Jiang Xue
- Department of Neonatology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China.
- The Second Clinical Medical School of Shandong University, Jinan, 250033, China.
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10
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Feng W, Zhang H, Yan H, Yang ZB, Zhao JL, Zhang LB. Gastrointestinal perforation in extremely low birth weight infants: A single center retrospective study in China. Pediatr Neonatol 2024; 65:111-116. [PMID: 38114414 DOI: 10.1016/j.pedneo.2023.11.002] [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] [Received: 07/16/2023] [Revised: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Gastrointestinal perforation in extremely low birth weight infants, characterized by its rapid onset, multiple complications, and critical condition, poses a significant risk of infant mortality. The aim of this study was to investigate the clinical characteristics of pneumoperitoneum in extremely low birth weight infants (ELBWI) and explore the risk factors associated with gastrointestinal perforation in very low birth weight preterm infants. Additionally, we shared our surgical experiences in managing gastrointestinal perforation among extremely low birth weight infants. METHODS The Department of Neonatology at Chengdu Women and Children's Central Hospital conducted a retrospective study on gastrointestinal perforation in extremely low birth weight infants (birth weight <1000 g) who were admitted between 2014 and 2021. After baseline analysis and comparing it with the control group, we identified the risk factors associated with gastrointestinal perforation in ELBWI by multiple logistic regression analysis. The Kaplan-Meier analysis was performed to assess the adverse effect of gastrointestinal perforation for survival in ELBW infants. Cox multivariate regression analysis was used to evaluate hazard level of different variables for ELBW infants survival. RESULTS Hemodynamically significant patent ductus arteriosus (hsPDA)(p = 0.043, OR = 2.779) and sepsis (p = 0.014, OR = 2.265) were significant risk factors for gastrointestinal perforation in extremely low birth weight infants. The Cox proportional hazard model revealed that intraventricular hemorrhage (HR = 2.854, p<0.001) Sepsis (HR = 1.645, p = 0.015) and gastrointestinal perforation (HR = 1.876, p = 0.008) had detrimental effects on the survival of extremely low birth weight infants; conversely, ibuprofen (HR = 0.304, p<0.001) and blood transfusion (HR = 0.372, p<0.001) are beneficial factors for their survival. The preoperative indicators of infection in infants with spontaneous intestinal perforation (SIP) were significantly better than those in the necrotizing enterocolitis (NEC) group (p < 0.05). CONCLUSIONS Gastrointestinal perforation poses a significant threat the survival of extremely low birth weight (ELBW) infants, with hsPDA and sepsis serving as predisposing factors for gastrointestinal perforation. The gastrointestinal perforation caused by various diseases exhibits distinct clinical characteristics, necessitating tailored surgical approaches based on operative conditions.
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Affiliation(s)
- Wei Feng
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Hong Zhang
- Department of Pediatric Endocrinology, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Huan Yan
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Zheng-Bing Yang
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Jin-Liang Zhao
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Li-Bing Zhang
- The Department of Pediatric Surgery, Chengdu Women's and Children' Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
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11
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Elefson SK, Stoll B, Davis TA, Fiorotto ML, El-Kadi SW, Genovese K, Thymann T, Sangild PT, Burrin DG. Adverse Metabolic Phenotypes in Parenterally Fed Neonatal Pigs Do Not Persist into Adolescence. J Nutr 2024; 154:638-647. [PMID: 38181968 PMCID: PMC10900187 DOI: 10.1016/j.tjnut.2023.12.048] [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: 09/12/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Nutrition during fetal and neonatal life is an important determinant for the risk of adult-onset diseases, especially type 2 diabetes and obesity. OBJECTIVES We aimed to determine whether total parenteral nutrition (TPN) compared with enteral formula feeding [enteral nutrition (EN)] in term piglets during the first 2 wk after birth would increase the long-term (5-mo) development of metabolic syndrome phenotypes with adverse glucose homeostasis, fatty liver disease, and obesity. METHODS Neonatal female pigs were administered TPN (n = 12) or fed enterally with a liquid enteral milk-replacer formula (EN, n = 12) for 14 d. After transitioning TPN pigs to enteral feeding of liquid formula (days 15-26), both groups were adapted to a solid high-fat diet (30% of the total diet) and sucrose (20% of the total diet) diet (days 27-33), which was fed until the end of the study (140 d). Body composition was measured by dual-energy X-ray absorptiometry at 14, 45, and 140 d. Serum biochemistry and glucose-insulin values (after a fasting intravenous glucose tolerance test) were obtained at 140 d. Liver and muscle were analyzed for insulin receptor signaling and triglycerides. RESULTS Body weight was similar, but percent fat was higher, whereas percent lean and bone mineral density were lower in TPN than in EN pigs (P < 0.01) at 45 d of age but not at 140 d. At 140 d, there were no differences in serum markers of liver injury or lipidemia. Intravenous glucose tolerance test at 140 d showed a lower (P < 0.05) AUC for both glucose and insulin in TPN than in EN pigs, but the ratio of AUCs of insulin and glucose was not different between groups. CONCLUSIONS Administration of TPN during the neonatal period increased adipose deposition that transiently persisted in early adolescence when challenged with a high-fat diet but was not sustained or manifested as glucose intolerance.
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Affiliation(s)
- Sarah K Elefson
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Barbara Stoll
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Teresa A Davis
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Marta L Fiorotto
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Samer W El-Kadi
- School of Animal Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Kenneth Genovese
- USDA Southern Plains Agricultural Research Center, College Station, TX, United States
| | - Thomas Thymann
- Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark
| | - Per T Sangild
- Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark
| | - Douglas G Burrin
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.
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12
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Rangelova V, Kevorkyan A, Raycheva R, Krasteva M. Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit-Incidence and Strategies for Prevention. Diagnostics (Basel) 2024; 14:240. [PMID: 38337756 PMCID: PMC10854825 DOI: 10.3390/diagnostics14030240] [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: 12/10/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The second most prevalent healthcare-associated infection in neonatal intensive care units (NICUs) is ventilator-associated pneumonia (VAP). This review aims to update the knowledge regarding the incidence of neonatal VAP and to summarize possible strategies for prevention. The VAP incidence ranges from 1.4 to 7 episodes per 1000 ventilator days in developed countries and from 16.1 to 89 episodes per 1000 ventilator days in developing countries. This nosocomial infection is linked to higher rates of illness, death, and longer hospital stays, which imposes a substantial financial burden on both the healthcare system and families. Due to the complex nature of the pathophysiology of VAP, various approaches for its prevention in the neonatal intensive care unit have been suggested. There are two main categories of preventative measures: those that attempt to reduce infections in general (such as decontamination and hand hygiene) and those that target VAP in particular (such as VAP care bundles, head of bed elevation, and early extubation). Some of the interventions, including practicing good hand hygiene and feeding regimens, are easy to implement and have a significant impact. One of the measures that seems very promising and encompasses a lot of the preventive measures for VAP are the bundles. Some preventive measures still need to be studied.
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Affiliation(s)
- Vanya Rangelova
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Ani Kevorkyan
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Ralitsa Raycheva
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Maya Krasteva
- Department of Obstetrics and Gynecology, Neonatology Unit, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
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13
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Terefe A, Demtse A, Abebe F, Mislu E, Tachbele E. Predictors of time to full enteral feeding in low birth weight neonates admitted to neonatal intensive care unit: a prospective follow up study. BMC Pediatr 2024; 24:64. [PMID: 38245699 PMCID: PMC10799381 DOI: 10.1186/s12887-024-04545-0] [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] [Received: 04/10/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Survival of LBW infants has increased in recent years because of novel perinatal interventions, but the introduction and advancement of enteral feeds for low birth weight infants is challenging. In Ethiopia the proportion of low birth weight infants is thought to be 17.3%. The purpose of this study was to determine the time to full enteral feeding (FEF) and its predictors in LBW neonates admitted to neonatal intensive care unit in selected hospitals of Addis Ababa, Ethiopia. METHOD An institutional based prospective follow up study was conducted from March 15 to June 15, 2022 among 282 LBW neonates admitted to six randomly selected hospitals. Both primary and secondary data was used by interviewing mothers and prospective medical chart review of neonates. The Cox regression model was used and variables having a p-value less than 0.05 with 95% CIs in a multivariable analysis were declared as statistically significant association with time to full enteral feeding. RESULT Out of 282 neonates involved in this study, 211 (74.8%) of them reached at FEF. The overall median time to full enteral feeding was 5 days. Predictors significantly associated with time to full enteral feeding were educational level, birth weight, cesarean delivery, hospital acquired infection, being on antibiotics, age at initiation of trophic feeding, routine gastric residual evaluation and NICU location (hospital). CONCLUSIONS This study demonstrated the difficulty of understanding which low birth weight neonate will attain FEF in a timely manner and factors that affect time to FEF. There is a delay in full enteral feeding achievement among low birth weight neonates and there is a great deal of heterogeneity of practice among health care providers regarding feeding of infants as it was evidenced by a variation in feeding practice among hospitals. Nutrition should be considered as part of the management in neonatal intensive care units since low birth weight neonates are developing edematous malnutrition while they are in the NICU. There should be standard feeding protocol to avoid heterogeneity of practice and additional study should be conducted for each categories of GA and BW with long follow up time.
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Affiliation(s)
- Abraraw Terefe
- Midwifery Department, College of Health Science, Woldia University, Weldiya, Ethiopia.
| | - Asrat Demtse
- College of Medical Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikertemariam Abebe
- College of Health Science, School of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esuyawkal Mislu
- Midwifery Department, College of Health Science, Woldia University, Weldiya, Ethiopia
| | - Erdaw Tachbele
- Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Han J, Zhang L, Zhang R, Han S, Zhu J, Hu X, Sun J, Qiu G, Li Z, Yan W, Xie L, Ye X, Gong X, Li L, Bei F, Liu C, Cao Y. Using a new human milk fortifier to optimize human milk feeding among very preterm and/or very low birth weight infants: a multicenter study in China. BMC Pediatr 2024; 24:61. [PMID: 38243173 PMCID: PMC10797784 DOI: 10.1186/s12887-024-04527-2] [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] [Received: 08/10/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Human milk fortifier (HMF) composition has been optimized recently. But clinical evidence of its safety and efficacy is limited in Chinese population. The aim of this study was to evaluate effects of a new HMF in growth, nutritional status, feeding intolerance, and major morbidities among very preterm (VPT) or very low birth weight (VLBW) infants in China. METHODS VPT/VLBW infants admitted from March 2020 to April 2021 were prospectively included in the experimental (new HMF, nHMF) group, who received a new powdered HMF as a breast milk feeding supplement during hospitalization. Infants in the control group (cHMF) admitted from January 2018 to December 2019, were retrospective included, and matched with nHMF group infants for gestational age and birth weight. They received other kinds of commercially available HMFs. Weight gain velocity, concentrations of nutritional biomarkers, incidence of major morbidities, and measures of feeding intolerance were compared between the two groups. RESULTS Demographic and clinical characteristics of infants in nHMF and cHMF groups were comparable. Weight gain velocity had no significant difference between the nHMF (14.0 ± 3.5 g/kg/d) and the cHMF group (14.2 ± 3.8 g/kg/d; P = 0.46). Incidence of morbidities, including necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, culture-confirmed sepsis, and feeding intolerance during hospitalization between nHMF and cHMF, were similar (all P-values > 0.05). The time to achieve full enteral feeding [13.5 (10, 21) days] in the nHMF group was significantly shorter than that in the cHMF group [17 (12, 23) days, HR = 0.67, 95%CI: 0.49, 0.92; P = 0.01]. Compared with cHMF group, the decrease of blood urea nitrogen level over time in nHMF group was smaller (β = 0.6, 95%CI:0.1, 1.0; P = 0.01). CONCLUSIONS The new HMF can promote growth of preterm infants effectively without increasing the incidence of major morbidity and feeding intolerance. It can be used feasible in Chinese VPT/VLBW infants. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov (NCT04283799).
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Affiliation(s)
- Junyan Han
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Lan Zhang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Shuping Han
- Department of Pediatrics, Nanjing Maternity and Child Health Care Hospital, Women's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210004, China
| | - Jianxing Zhu
- Department of Neonatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Xuefeng Hu
- Department of Neonatology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jianhua Sun
- Department of Neonatology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Gang Qiu
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Zhenghong Li
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Weili Yan
- Department of Clinical Epidemiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, 201102, China
| | - Lijuan Xie
- Department of Neonatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Xiuxia Ye
- Department of Neonatology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200040, China
| | - Liling Li
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Fei Bei
- Department of Neonatology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Chan Liu
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
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15
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Sahu TK, Manerkar S, Mondkar J, Kalamdani P, Patra S, Kalathingal T, Kaur S. Effect of early total enteral feeding vs incremental feeding in small for gestational age very low birth weight infants: A randomized controlled trial. J Neonatal Perinatal Med 2024; 17:225-232. [PMID: 38640177 DOI: 10.3233/npm-230195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Affiliation(s)
- T K Sahu
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - S Manerkar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - J Mondkar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - P Kalamdani
- Department of Neonatology, Ex-faculty, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - S Patra
- Department of Neonatology, Ex-faculty, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - T Kalathingal
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
| | - S Kaur
- Department of Neonatology, Ex-faculty, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
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16
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Wilunda C, Israel‐Ballard K, Wanjohi M, Lang'at N, Mansen K, Waiyego M, Kibore M, Kamande E, Zerfu T, Kithua A, Muganda R, Muiruri J, Maina B, Njuguna E, Njeru F, Kiige LW, Codjia P, Samburu B, Mogusu E, Ngwiri T, Mirie W, Kimani‐Murage EW. Potential effectiveness of integrating human milk banking and lactation support on neonatal outcomes at Pumwani Maternity Hospital, Kenya. MATERNAL & CHILD NUTRITION 2024; 20:e13594. [PMID: 38051296 PMCID: PMC10750015 DOI: 10.1111/mcn.13594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre-post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score-matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting.
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Affiliation(s)
- Calistus Wilunda
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | | | - Milka Wanjohi
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Nelson Lang'at
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Kimberly Mansen
- Maternal, Newborn, Child Health and Nutrition ProgramPATHSeattleWashingtonUSA
| | | | | | - Eva Kamande
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | - Taddese Zerfu
- Nutrition and Food Systems UnitAfrican Population and Health Research CenterNairobiKenya
| | | | | | | | | | | | | | - Laura W. Kiige
- Nutrition SectionUNICEF ‐ Kenya Country OfficeNairobiKenya
| | - Patrick Codjia
- Nutrition SectionUNICEF ‐ Kenya Country OfficeNairobiKenya
| | - Betty Samburu
- Nutrition and Dietetics UnitMinistry of HealthNairobiKenya
| | - Esther Mogusu
- Nutrition and Dietetics UnitMinistry of HealthNairobiKenya
| | - Thomas Ngwiri
- Clinical ServicesGertrude's Children's HospitalNairobiKenya
| | - Waithera Mirie
- School of Nursing SciencesUniversity of NairobiNairobiKenya
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Tomlinson C, Haiek LN. Breastfeeding and human milk in the NICU: From birth to discharge. Paediatr Child Health 2023; 28:510-526. [PMID: 38638537 PMCID: PMC11022875 DOI: 10.1093/pch/pxad034] [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: 09/27/2021] [Accepted: 04/20/2022] [Indexed: 04/20/2024] Open
Abstract
It is well recognized that human milk is the optimal nutritive source for all infants, including those requiring intensive care. This statement reviews evidence supporting the importance of breastfeeding and human milk for infants, and why breastfeeding practices should be prioritized in the neonatal intensive care unit (NICU). It also reviews how to optimally feed infants based on their stability and maturity, and how to support mothers to establish and maintain milk production when their infants are unable to feed at the breast.
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Affiliation(s)
- Christopher Tomlinson
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
| | - Laura N Haiek
- Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario, Canada
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18
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Bai Z, Lyu X, Tang Y, Wang M. Pediatric Tui Na for Feeding Intolerance in Premature Infants: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2023; 12:e46375. [PMID: 37843917 PMCID: PMC10616744 DOI: 10.2196/46375] [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: 02/09/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Feeding intolerance (FI), frequently resulting from gastrointestinal immaturity, is prevalent among premature infants. Current practices are gradually prioritizing nonpharmacological treatments, such as massage or "Tui na," considering the potential side effects of prolonged medication use. Pediatric Tui na, a specialized massage therapy based on traditional Chinese medicine, has been widely studied for treating FI in premature infants. However, to our knowledge, no systematic review specifically focusing on the effectiveness and safety of traditional Chinese medicine-based pediatric Tui na for FI in premature infants has been published yet. OBJECTIVE This study aims to develop a protocol for a systematic review and meta-analysis for evaluating the safety and efficacy of pediatric Tui na for premature infants with FI. METHODS We will perform a comprehensive search in the following databases: Springer, Cochrane Library, Embase, MEDLINE, Clarivate Analytics, Physiotherapy Evidence Database (PEDro), CINAHL, PubMed, Scopus, World Health Organization (WHO) International Clinical Trials Registry Platform, and Chinese biomedical databases (Wanfang database, the China National Knowledge Infrastructure, Chinese Scientific Journals Database, and Chinese Biomedical Literature Databases), limited to studies published in Chinese and English languages between January 2000 and January 2023. The search strategy will use MeSH (Medical Subject Headings) terms and database-specific keywords. A total of 2 independent reviewers will initially screen the studies based on titles and abstracts, followed by a full-text evaluation of the eligible studies. Studies will include any nonrandomized controlled trials, nonrandomized clinical studies, randomized controlled trials, and quasi-experimental studies wherein the treatment group involves premature infants with FI given pediatric Tui na. Primary outcomes will be necrotizing enterocolitis, gastric residual volume, emesis, and stool blood. Secondary outcomes will be abdominal distension weight gain, time to achieve full enteral feeding, any adverse effects associated with pediatric Tui na, and length of hospital stay. The Cochrane Collaboration Risk of Bias Tool will be used to assess the risk of bias and methodological quality. Funnel plots will be used for evaluating publication bias. Meta-analysis will be conducted using the Review Manager software (version 5.4; Cochrane Collaboration). Subgroup analyses will be considered according to treatment received, country or setting, sex, and birth weight of premature infants (if heterogeneity is high, I2≥50%). RESULTS This is a systematic review and meta-analysis protocol, so the results are not yet available. The protocol has been registered with PROSPERO (CRD42023390021). We are currently in the study selection phase. Results are expected to be completed by the end of 2023. CONCLUSIONS Following this protocol, a comprehensive and rigorous literature synthesis will be developed to assess the impact of pediatric Tui na treatment on premature infants with FI, enabling the determination of its efficacy and safety. TRIAL REGISTRATION PROSPERO CRD42023390021; https://tinyurl.com/bdf4kn23. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46375.
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Affiliation(s)
- Zirong Bai
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, China
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Xiaoxiao Lyu
- Department of Rehabilitation, Second People's Hospital of Tibet Autonomous Region, Tibet Autonomous Region, China
| | - Yichuan Tang
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, China
- Faculty of Medicine and Health, School of Health Sciences, University of Sydney, Sydney, Australia
| | - Meng Wang
- Department of Rehabilitation, College of Acupuncture and Moxibustion and Massage Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine, Nanjing, China
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19
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Immeli L, Mäkelä PM, Leskinen M, Sund R, Andersson S, Luukkainen P. Very low birthweight infants receive less enteral feeding than what is prescribed. Acta Paediatr 2023; 112:2084-2092. [PMID: 37341644 DOI: 10.1111/apa.16885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 06/22/2023]
Abstract
AIM Feeding a very low birthweight (VLBW, <1500 g) infant is challenging. Our aims were to study how prescribed enteral feeding is implemented in VLBW infants and to identify factors associating with slow enteral feeding progression. METHODS Our retrospective cohort included 516 VLBW infants born before 32 weeks of gestation during 2005-2013 and admitted to Children's Hospital, Helsinki, Finland, for at least the two first weeks of life. Nutritional data were collected from birth until the age of 14-28 days, depending on the length of stay. RESULTS We found that enteral feeding progressed slower than recommended and implementation differed from the prescriptions, especially during the parenteral nutrition phase (milk intake 10-20 mL/kg/day): 71% [40-100], median [IQR], of the prescribed enteral milk was administered. The full prescribed amount was less likely administered if a higher volume of gastric residual was aspirated or if the infant did not pass stool during the same day. Longer opiate use, patent ductus arteriosus, respiratory distress syndrome and slower passage of the first meconium associated with slower enteral feeding progression. CONCLUSION Enteral feeding of a VLBW infant is often not administered as prescribed, which possibly plays a significant role in the slow progression of enteral feeding.
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Affiliation(s)
- Lotta Immeli
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Pauliina M Mäkelä
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Markus Leskinen
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Reijo Sund
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sture Andersson
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Luukkainen
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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20
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Assad M, Jerome M, Olyaei A, Nizich S, Hedges M, Gosselin K, Scottoline B. Dilemmas in establishing preterm enteral feeding: where do we start and how fast do we go? J Perinatol 2023; 43:1194-1199. [PMID: 37169912 DOI: 10.1038/s41372-023-01665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 05/13/2023]
Abstract
Beginning and achieving full enteral nutrition is a key step in the care of preterm infants, particularly very low birth weight (VLBW) infants. As is true for many organ system-specific complications of prematurity, the gastrointestinal tract must complete in utero development ex utero while concurrently serving a physiologic role reserved for after completion of full term development. The preterm gut must assume the placental function of the interface between a source of energy, precursors for anabolism, and micronutrients, and the developing infant-through digestion and absorption of milk, instead of directly from the mother via the uteroplacental interface. The benefits of enteral nourishment in preterm infants are counterbalanced by gastrointestinal complications of prematurity: dysmotility leading to difficulty establishing and advancing feeds, and the risk of necrotizing enterocolitis (NEC). Concern for these complications can prolong the need for parenteral nutrition with an associated increase in risk for central line-associated bloodstream infection (CLABSI) and parenteral nutrition (PN)-associated cholestasis or liver disease (PNALD). Thus, a daily issue facing neonatologists caring for preterm infants is how to optimally begin, advance, and reach full enteral nutrition sufficient to satisfy the nutrient, energy, and fluid requirements of VLBW infants while minimizing risk. In this perspective, we provide an overview of the approaches and supporting data for starting and advancing enteral feeds in preterm infants, particularly very low birth weight infants, and we discuss the significant gaps in knowledge that accompany current approaches. This framework recognizes the dilemmas of preterm feeding initiation and advancement and identifies areas of opportunity for further investigation.
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Affiliation(s)
- Maushumi Assad
- Division of Neonatology, Department of Pediatrics, University of Massachusetts T.H.Chan School of Medicine, Worcester, MA, 01655, USA
| | - Maggie Jerome
- Graduate Programs in Human Nutrition, Oregon Health & Sciences University, Portland, OR, 97239, USA
| | - Amy Olyaei
- Division of Neonatology, Department of Pediatrics, Oregon Health & Sciences University, Portland, OR, 97239, USA
| | - Samantha Nizich
- Division of Neonatology, Department of Pediatrics, Oregon Health & Sciences University, Portland, OR, 97239, USA
| | - Madeline Hedges
- Division of Neonatology, Department of Pediatrics, Oregon Health & Sciences University, Portland, OR, 97239, USA
| | - Kerri Gosselin
- Division of Neonatology, Department of Pediatrics, University of Massachusetts T.H.Chan School of Medicine, Worcester, MA, 01655, USA
| | - Brian Scottoline
- Division of Neonatology, Department of Pediatrics, Oregon Health & Sciences University, Portland, OR, 97239, USA.
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Abiramalatha T, Thanigainathan S, Ramaswamy VV, Rajaiah B, Ramakrishnan S. Re-feeding versus discarding gastric residuals to improve growth in preterm infants. Cochrane Database Syst Rev 2023; 6:CD012940. [PMID: 37387544 PMCID: PMC10312053 DOI: 10.1002/14651858.cd012940.pub3] [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: 07/01/2023]
Abstract
BACKGROUND Routine monitoring of gastric residuals in preterm infants on tube feeds is a common practice in neonatal intensive care units used to guide initiation and advancement of enteral feeding. There is a paucity of consensus on whether to re-feed or discard the aspirated gastric residuals. While re-feeding gastric residuals may aid in digestion and promote gastrointestinal motility and maturation by replacing partially digested milk, gastrointestinal enzymes, hormones, and trophic substances, abnormal residuals may result in vomiting, necrotising enterocolitis, or sepsis. OBJECTIVES To assess the efficacy and safety of re-feeding when compared to discarding gastric residuals in preterm infants. SEARCH METHODS: Searches were conducted in February 2022 in Cochrane CENTRAL via CRS, Ovid MEDLINE and Embase, and CINAHL. We also searched clinical trial databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA We selected RCTs that compared re-feeding versus discarding gastric residuals in preterm infants. DATA COLLECTION AND ANALYSIS Review authors assessed trial eligibility and risk of bias and extracted data, in duplicate. We analysed treatment effects in individual trials and reported the risk ratio (RR) for dichotomous data and the mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We found one eligible trial that included 72 preterm infants. The trial was unmasked but was otherwise of good methodological quality. Re-feeding gastric residual may have little or no effect on time to regain birth weight (MD 0.40 days, 95% CI -2.89 to 3.69; 59 infants; low-certainty evidence), risk of necrotising enterocolitis stage ≥ 2 or spontaneous intestinal perforation (RR 0.71, 95% CI 0.25 to 2.04; 72 infants; low-certainty evidence), all-cause mortality before hospital discharge (RR 0.50, 95% CI 0.14 to 1.85; 72 infants; low-certainty evidence), time to establish enteral feeds ≥ 120 mL/kg/d (MD -1.30 days, 95% CI -2.93 to 0.33; 59 infants; low-certainty evidence), number of total parenteral nutrition days (MD -0.30 days, 95% CI -2.07 to 1.47; 59 infants; low-certainty evidence), and risk of extrauterine growth restriction at discharge (RR 1.29, 95% CI 0.38 to 4.34; 59 infants; low-certainty evidence). We are uncertain as to the effect of re-feeding gastric residual on number of episodes of feed interruption lasting for ≥ 12 hours (RR 0.80, 95% CI 0.42 to 1.52; 59 infants; very low-certainty evidence). AUTHORS' CONCLUSIONS We found only limited data from one small unmasked trial on the efficacy and safety of re-feeding gastric residuals in preterm infants. Low-certainty evidence suggests re-feeding gastric residual may have little or no effect on important clinical outcomes such as necrotising enterocolitis, all-cause mortality before hospital discharge, time to establish enteral feeds, number of total parenteral nutrition days, and in-hospital weight gain. A large RCT is needed to assess the efficacy and safety of re-feeding of gastric residuals in preterm infants with adequate certainty of evidence to inform policy and practice.
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Affiliation(s)
- Thangaraj Abiramalatha
- Neonatology, Kovai Medical Center and Hospital (KMCH), Coimbatore, Tamil Nadu, India
- KMCH Research Foundation, Coimbatore, Tamil Nadu, India
| | | | | | - Balakrishnan Rajaiah
- Neonatology, Kovai Medical Center and Hospital (KMCH), Coimbatore, Tamil Nadu, India
| | - Srinivas Ramakrishnan
- Neonatology, Kovai Medical Center and Hospital (KMCH), Coimbatore, Tamil Nadu, India
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22
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Abiramalatha T, Thanigainathan S, Ramaswamy VV, Rajaiah B, Ramakrishnan S. Routine monitoring of gastric residual for prevention of necrotising enterocolitis in preterm infants. Cochrane Database Syst Rev 2023; 6:CD012937. [PMID: 37327390 PMCID: PMC10275261 DOI: 10.1002/14651858.cd012937.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Routine monitoring of gastric residual in preterm infants on gavage feeds is a common practice used to guide initiation and advancement of feeds. It is believed that an increase in or an altered gastric residual may be predictive of necrotising enterocolitis (NEC). Withholding monitoring of gastric residual may take away the early indicator and thus may increase the risk of NEC. However, routine monitoring of gastric residual as a guide, in the absence of uniform standards, may lead to unnecessary delay in initiation and advancement of feeds and hence might result in a delay in establishing full enteral feeds. This in turn may increase the duration of total parenteral nutrition (TPN) and central venous line usage, increasing the risk of associated complications. Furthermore, delays in establishing full enteral feeds increase the risk of extrauterine growth restriction and neurodevelopmental impairment. OBJECTIVES • To assess the efficacy and safety of routine monitoring versus no monitoring of gastric residual in preterm infants • To assess the efficacy and safety of routine monitoring of gastric residual based on two different criteria for interrupting feeds or decreasing feed volume in preterm infants SEARCH METHODS: We conducted searches in Cochrane CENTRAL via CRS, Ovid MEDLINE, Embase and CINAHL in February 2022. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs), quasi- and cluster-RCTs. SELECTION CRITERIA We selected RCTs that compared routine monitoring versus no monitoring of gastric residual and trials that used two different criteria for gastric residual to interrupt feeds in preterm infants. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility, risk of bias and extracted data. We analysed treatment effects in individual trials and reported risk ratio (RR) for dichotomous data, and mean difference (MD) for continuous data, with respective 95% confidence intervals (CI). We calculated the number needed to treat for an additional beneficial/harmful outcome (NNTB/NNTH) for dichotomous outcomes with significant results. We used GRADE to assess the certainty of evidence. MAIN RESULTS We included five studies (423 infants) in this updated review. Routine monitoring versus no routine monitoring of gastric residual in preterm infants Four RCTs with 336 preterm infants met the inclusion criteria for this comparison. Three studies were performed in infants with birth weight of < 1500 g, while one study included infants with birth weight between 750 g and 2000 g. The trials were unmasked but were otherwise of good methodological quality. Routine monitoring of gastric residual: - probably has little or no effect on the risk of NEC (RR 1.08, 95% CI 0.46 to 2.57; 334 participants, 4 studies; moderate-certainty evidence); - probably increases the time to establish full enteral feeds (MD 3.14 days, 95% CI 1.93 to 4.36; 334 participants, 4 studies; moderate-certainty evidence); - may increase the time to regain birth weight (MD 1.70 days, 95% CI 0.01 to 3.39; 80 participants, 1 study; low-certainty evidence); - may increase the number of infants with feed interruption episodes (RR 2.21, 95% CI 1.53 to 3.20; NNTH 3, 95% CI 2 to 5; 191 participants, 3 studies; low-certainty evidence); - probably increases the number of TPN days (MD 2.57 days, 95% CI 1.20 to 3.95; 334 participants, 4 studies; moderate-certainty evidence); - probably increases the risk of invasive infection (RR 1.50, 95% CI 1.02 to 2.19; NNTH 10, 95% CI 5 to 100; 334 participants, 4 studies; moderate-certainty evidence); - may result in little or no difference in all-cause mortality before hospital discharge (RR 2.14, 95% CI 0.77 to 5.97; 273 participants, 3 studies; low-certainty evidence). Quality and volume of gastric residual compared to quality of gastric residual alone for feed interruption in preterm infants One trial with 87 preterm infants met the inclusion criteria for this comparison. The trial included infants with 1500 g to 2000 g birth weight. Using two different criteria of gastric residual for feed interruption: - may result in little or no difference in the incidence of NEC (RR 5.35, 95% CI 0.26 to 108.27; 87 participants; low-certainty evidence); - may result in little or no difference in time to establish full enteral feeds (MD -0.10 days, 95% CI -0.91 to 0.71; 87 participants; low-certainty evidence); - may result in little or no difference in time to regain birth weight (MD 1.00 days, 95% CI -0.37 to 2.37; 87 participants; low-certainty evidence); - may result in little or no difference in number of TPN days (MD 0.80 days, 95% CI -0.78 to 2.38; 87 participants; low-certainty evidence); - may result in little or no difference in the risk of invasive infection (RR 5.35, 95% CI 0.26 to 108.27; 87 participants; low-certainty evidence); - may result in little or no difference in all-cause mortality before hospital discharge (RR 3.21, 95% CI 0.13 to 76.67; 87 participants; low-certainty evidence). - we are uncertain about the effect of using two different criteria of gastric residual on the risk of feed interruption episodes (RR 3.21, 95% CI 0.13 to 76.67; 87 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Moderate-certainty evidence suggests routine monitoring of gastric residual has little or no effect on the incidence of NEC. Moderate-certainty evidence suggests monitoring gastric residual probably increases the time to establish full enteral feeds, the number of TPN days and the risk of invasive infection. Low-certainty evidence suggests monitoring gastric residual may increase the time to regain birth weight and the number of feed interruption episodes, and may have little or no effect on all-cause mortality before hospital discharge. Further RCTs are warranted to assess the effect on long-term growth and neurodevelopmental outcomes.
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Affiliation(s)
- Thangaraj Abiramalatha
- Neonatology, Kovai Medical Center and Hospital (KMCH), Coimbatore, Tamil Nadu, India
- KMCH Research Foundation, Coimbatore, Tamil Nadu, India
| | | | | | - Balakrishnan Rajaiah
- Neonatology, Kovai Medical Center and Hospital (KMCH), Coimbatore, Tamil Nadu, India
| | - Srinivas Ramakrishnan
- Neonatology, Kovai Medical Center and Hospital (KMCH), Coimbatore, Tamil Nadu, India
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23
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Kosmeri C, Giapros V, Rallis D, Balomenou F, Serbis A, Baltogianni M. Classification and Special Nutritional Needs of SGA Infants and Neonates of Multiple Pregnancies. Nutrients 2023; 15:2736. [PMID: 37375640 DOI: 10.3390/nu15122736] [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: 05/15/2023] [Revised: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Data regarding the nutritional management of preterm small for gestational age (SGA) infants are scarce. In the recent report of ESPGHAN, the recommended energy for very preterm infants during hospitalization has been increased, yet this may not fit the needs of all preterm infants. It is important to distinguish fetal growth-restricted (FGR) infants from constitutional SGA infants, as well as preterm SGA from preterm AGA infants, since they may have different nutritional needs. Preterm FGR infants, and specifically infants < 29 weeks' gestation, accumulate nutrient deficits due to intrauterine malnutrition, prematurity, morbidities, delayed initiation of feeding, and feeding intolerance. Therefore, these infants may need more aggressive nutrition for optimal catch-up growth and neurologic development. However, a balance should be kept between optimal and excessive catch-up growth, since the combination of intrauterine malnutrition and excessive postnatal growth has been linked with later adverse metabolic consequences. Furthermore, multiple gestation is often complicated by FGR and prematurity. There is controversy in the definition of FGR in multiple gestations, and it should be noted that FGR in multiple gestation usually differs etiologically from FGR in singletons. The aim of this review is to summarize existing knowledge regarding the nutritional needs of preterm FGR and FGR infants of multiple gestation.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, 455 00 Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Foteini Balomenou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, 455 00 Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 455 00 Ioannina, Greece
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24
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Gunes NEO, Cetinkaya S. Assessment the knowledge, care, and experiences of neonatal nurses about enteral nutrition. Medicine (Baltimore) 2023; 102:e31081. [PMID: 37233433 PMCID: PMC10219700 DOI: 10.1097/md.0000000000031081] [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] [Received: 04/23/2022] [Accepted: 09/07/2022] [Indexed: 05/27/2023] Open
Abstract
Enteral-feeding refers to any nutritional method throughout the gastrointestinal tract, including oral feeding. This qualitative study examined the information, experiences, and records of neonatal nurses of enterally fed patients. The study was conducted between 05.04.2018 and 05.05.2018 with 22 nurses (73.3%) working in the neonatal intensive care clinic of Çukurova University Balcali Hospital, Adana, Turkey. The data were collected by "Observation and Interview Form" developed based on the literature. Nurses were observed, and interviews were conducted depending on their appointments. Data were collected by observing each nurse on 2 different days. In all observations; it was determined that the nurses changed the feeding set daily, regularly checked the location of the feeding tube and amount of residue, and administered medication through the feeding tube. In 22.7% of the observations, nurses did not securely fix the feeding tube, 27.2% did not write a daily date on the injector with the residual volume measured, and 31.8% did not wash the injector. All the nurses recorded the amount of feed, residual amounts, and content. At the end of the interviews, 9% of the nurses stated that they had experienced aspiration among the complications encountered during enteral feeding. During the interview, they stated that all nurses were educated about enteral nutrition, had control of whether the probe was in place before feeding, performed residual control, washed their hands before the procedure, fixed the food injector to 1 place, and allowed the food injector to flow spontaneously with negative pressure. According to the results of the interviews and observations, nurses could not reflect on their nursing practices correctly. Nurses working in neonatal intensive care units should be regularly trained to share the results of evidence-based studies on enteral nutrition.
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Affiliation(s)
| | - Senay Cetinkaya
- Cukurova University, Faculty of Health Sciences, Department of Nursing, Child Health and Diseases Nursing (Associate Professor), Adana, Turkey
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25
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Liang L, Zhuo R, Zhu H, Xie Q, Yang M, Liu Y, Lin J. Establishment of a nomogram model for predicting metabolic bone disease in preterm infants: A case‒control study. Eur J Pediatr 2023:10.1007/s00431-023-04985-3. [PMID: 37184649 DOI: 10.1007/s00431-023-04985-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To investigate risk factors for metabolic bone disease (MBD) in preterm infants and establish a nomogram model for predicting MBD risk. METHODS A total of 1104 preterm infants were enrolled, among whom 809 were included in the modelling set and 295 were included in the validation set. The modelling set was divided into MBD (n = 185) and non-MBD (n = 624) groups. A multivariate logistic regression analysis was used to investigate the independent risk factors for MBD. R software was used to plot the nomogram model, which was then validated by the data of the validation set. Receiver operating characteristic (ROC) and calibration curves were used to evaluate the nomogram model's performance, and the clinical decision curve was used to assess the clinical practicability of the model. RESULTS Gestational age, time of trophic feeding initiation, parenteral nutrition duration, necrotizing enterocolitis, bronchopulmonary dysplasia, cholestasis and sepsis were independent risk factors for MBD in preterm infants (P < 0.05). The ROC curve of the modelling set had an area under the curve (AUC) of 0.801; the risk prediction value of 0.196 corresponding to the maximum Youden index was the best value, and the prediction critical value was 125 points. The ROC curve of the validation set had an AUC of 0.854. The calibration curve analysis showed good accuracy and consistency between the model's predicted and actual values. CONCLUSIONS The nomogram model provides an efficient tool for the early assessment of MBD risk. Preterm infants with scores ≥ 125 should receive close attention and interventions in the early stage. WHAT IS KNOWN • The incidence and severity of MBD are inversely proportional to gestational age and birth weight. Bone loss can lead to prolonged hospital stay, ventilator dependence, pathological fractures and short stature. WHAT IS NEW • Gestational age, time of trophic feeding initiation, parenteral nutrition duration, necrotizing enterocolitis, bronchopulmonary dysplasia, cholestasis and sepsis were independent risk factors for MBD in preterm infants. The nomogram model provides an efficient tool for the early assessment of MBD risk.
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Affiliation(s)
- Liyu Liang
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Ruiyan Zhuo
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Hui Zhu
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China.
| | - Qinmei Xie
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Meijun Yang
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Yongle Liu
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Jinwen Lin
- Neonatal Intensive Care Unit of Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China
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26
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Dekker DM, van Brakel M, van den Akker CH, Plötz FB. Enteral Feeding for Moderately Premature and Low Birth Weight Infants: A Single-Center Retrospective Observational Cohort Study. JPGN REPORTS 2023; 4:e288. [PMID: 37200721 PMCID: PMC10187862 DOI: 10.1097/pg9.0000000000000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/13/2023] [Indexed: 05/20/2023]
Abstract
Controversy exists in clinical practice regarding optimal initial enteral feeding (EF) for moderately premature and low birth weight (BW) infants. We included 96 infants stratified into 3 groups (I: 1600-1799 g [n = 22]; II: 1800-1999 g [n = 42]; III: 2000-2200 g [n = 32]). The protocol recommended starting with minimal EF (MEF) in infants weighing <1800 g. On the first day of life, 5% of the infants in group I did not follow the protocol mandating MEF, but started with exclusive EF instead, compared to 36% and 44% of the infants in groups II and III, respectively. The median number of days until exclusive EF was achieved was 5 days longer for infants receiving MEF than for infants who had received normal portions of EF from birth onward. We observed no significant differences in feeding-related complications. We advocate omitting MEF in moderately premature infants with a BW of 1600 g or higher.
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Affiliation(s)
- Dorita M.Z. Dekker
- From the Tergooi MC, Department of Pediatrics, Blaricum, The Netherlands
| | - Monique van Brakel
- From the Tergooi MC, Department of Pediatrics, Blaricum, The Netherlands
| | - Chris H.P. van den Akker
- Amsterdam UMC, location University of Amsterdam, Emma Children’s Hospital, Department of Pediatrics—Neonatology, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
| | - Frans B. Plötz
- From the Tergooi MC, Department of Pediatrics, Blaricum, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC, location University of Amsterdam, Emma Children’s Hospital, Department of Pediatrics, Amsterdam, The Netherlands
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27
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Pimenta HP, Rocha AD, Guimarães ACLD, da Costa ACC, Moreira MEL. Oropharyngeal colostrum administration in neonates with gastroschisis: a randomized clinical trial. CRITICAL CARE SCIENCE 2023; 35:209-216. [PMID: 37712811 PMCID: PMC10406415 DOI: 10.5935/2965-2774.20230010-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/29/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To evaluate the effect of colostrum therapy on days to start a suckling diet in newborns diagnosed with simple gastroschisis. METHODS Randomized clinical trial with newborns diagnosed with simple gastroschisis at a federal hospital in Rio de Janeiro who were randomized to receive oropharyngeal administration of 0.2mL of colostrum or a "sham procedure" during the first 3 days of life. The analysis included clinical outcomes such as days without food, days with parenteral feeding, days until the start of enteral feeding, days to reach complete enteral feeding, sepsis and length of hospital stay. RESULTS The onset of oral feeding (suction) in patients with simple gastroschisis in both groups occurred at a median of 15 days. CONCLUSION The present study showed that there were no significant differences in the use of colostrum therapy and the number of days to the start of enteral feeding and suction diet between groups of newborns with simple gastroschisis.
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28
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Cardoso M, Virella D, Papoila AL, Alves M, Macedo I, E Silva D, Pereira-da-Silva L. Individualized Fortification Based on Measured Macronutrient Content of Human Milk Improves Growth and Body Composition in Infants Born Less than 33 Weeks: A Mixed-Cohort Study. Nutrients 2023; 15:nu15061533. [PMID: 36986263 PMCID: PMC10052754 DOI: 10.3390/nu15061533] [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: 01/19/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
The optimal method for human milk (HM) fortification has not yet been determined. This study assessed whether fortification relying on measured HM macronutrient content (Miris AB analyzer, Upsala, Sweden) composition is superior to fortification based on assumed HM macronutrient content, to optimize the nutrition support, growth, and body composition in infants born at <33 weeks' gestation. In a mixed-cohort study, 57 infants fed fortified HM based on its measured content were compared with 58 infants fed fortified HM based on its assumed content, for a median of 28 and 23 exposure days, respectively. The ESPGHAN 2010 guidelines for preterm enteral nutrition were followed. Growth assessment was based on body weight, length, and head circumference Δ z-scores, and the respective growth velocities until discharge. Body composition was assessed using air displacement plethysmography. Fortification based on measured HM content provided significantly higher energy, fat, and carbohydrate intakes, although with a lower protein intake in infants weighing ≥ 1 kg and lower protein-to-energy ratio in infants weighing < 1 kg. Infants fed fortified HM based on its measured content were discharged with significantly better weight gain, length, and head growth. These infants had significantly lower adiposity and greater lean mass near term-equivalent age, despite receiving higher in-hospital energy and fat intakes, with a mean fat intake higher than the maximum recommended and a median protein-to-energy ratio intake (in infants weighing < 1 kg) lower than the minimum recommended.
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Affiliation(s)
- Manuela Cardoso
- Nutrition Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 2890-495 Lisbon, Portugal
| | - Daniel Virella
- Research Unit, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 1169-045 Lisbon, Portugal
- Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 1169-045 Lisbon, Portugal
| | - Ana Luísa Papoila
- Research Unit, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 1169-045 Lisbon, Portugal
- Centre of Statistics and Its Applications, University of Lisbon, 1749-016 Lisbon, Portugal
| | - Marta Alves
- Research Unit, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 1169-045 Lisbon, Portugal
- Centre of Statistics and Its Applications, University of Lisbon, 1749-016 Lisbon, Portugal
| | - Israel Macedo
- Neonatal Intensive Care Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 2890-495 Lisbon, Portugal
| | - Diana E Silva
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
- CINTESIS-Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Luís Pereira-da-Silva
- Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 1169-045 Lisbon, Portugal
- Nutrition Lab, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Centro Clínico Académico de Lisboa, 1169-045 Lisbon, Portugal
- Medicine of Woman, Childhood and Adolescence Academic Area, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
- CHRC-Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal
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29
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Gao L, Shen W, Wu F, Mao J, Liu L, Chang YM, Zhang R, Ye XZ, Qiu YP, Ma L, Cheng R, Wu H, Chen DM, Chen L, Xu P, Mei H, Wang SN, Xu FL, Ju R, Zheng Z, Lin XZ, Tong XM. Effect of early initiation of enteral nutrition on short-term clinical outcomes of very premature infants: A national multicenter cohort study in China. Nutrition 2023; 107:111912. [PMID: 36577163 DOI: 10.1016/j.nut.2022.111912] [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: 08/08/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The management of enteral nutrition in very preterm infants (VPIs) is still controversial, and there is no consensus on the optimal time point after birth at which enteral nutrition can be started. The aim of this study was to investigate the effect of early initiation of enteral nutrition on the short-term clinical outcomes of VPIs. METHODS Data of infants (n = 2514) born before 32 wk of gestation were collected from 28 hospitals located in seven different regions of China. Based on whether enteral feeding was initiated within or after 24 h since birth, the infants were divided into an early initiation of enteral feeding (EIEF) group and a delayed initiation of enteral feeding (DIEF) group. RESULTS Compared with the DIEF group, the EIEF group was more likely to tolerate enteral nutrition and had less need for parenteral nutrition (all P < 0.05). The EIEF group was associated with lower incidence rates of feeding intolerance, extrauterine growth restriction (EUGR), and late-onset sepsis (LOS) (all P < 0.05). There was no significant difference in the incidence of necrotizing enterocolitis (NEC) (Bell stage ≥2) between the two groups (P = 0.118). The multivariate logistic regression analysis revealed that EIEF was a protective factor against EUGR (odds ratio [OR], 0.621; 95% confidence interval [CI], 0.544-0.735; P < 0.001), feeding intolerance (OR, 0.658; 95% CI, 0.554-0.782; P < 0.001), and LOS (OR, 0.706; 95% CI, 0.550-0.906; P = 0.006). CONCLUSIONS Early initiation of enteral feeding was associated with less frequency of feeding intolerance, EUGR, and LOS, and it may shorten the time to reach total enteral feeding without increasing the risk of NEC.
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Affiliation(s)
- Liang Gao
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Fan Wu
- Department of Neonatology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Liu
- Department of Neonatology, Guiyang Maternal and Child Health Hospital and Guiyang Children's Hospital, Guiyang, China
| | - Yan-Mei Chang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Rong Zhang
- Department of Neonatology, Pediatric Hospital of Fudan University, Shanghai, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, China
| | - Yin-Ping Qiu
- Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Li Ma
- Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Rui Cheng
- Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Ling Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Hua Mei
- Department of Neonatology, the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Fa-Lin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China.
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China.
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30
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Miller AN, Curtiss J, Taylor SN, Backes CH, Kielt MJ. A review and guide to nutritional care of the infant with established bronchopulmonary dysplasia. J Perinatol 2023; 43:402-410. [PMID: 36494567 DOI: 10.1038/s41372-022-01578-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/20/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
Bronchopulmonary dysplasia (BPD) remains the most common long-term morbidity of premature birth, and the incidence of BPD is not declining despite medical advancements. Infants with BPD are at high risk for postnatal growth failure and are often treated with therapies that suppress growth. Additionally, these infants may display excess weight gain relative to linear growth. Optimal growth and nutrition are needed to promote lung growth and repair, improve long-term pulmonary function, and improve neurodevelopmental outcomes. Linear growth in particular has been associated with favorable outcomes yet can be difficult to achieve in these patients. While there has been a significant clinical and research focus regarding BPD prevention and early preterm nutrition, there is a lack of literature regarding nutritional care of the infant with established BPD. There is even less information regarding how nutritional needs change as BPD evolves from an acute to chronic disease. This article reviews the current literature regarding nutritional challenges, enteral nutrition management, and monitoring for patients with established BPD. Additionally, this article provides a practical framework for interdisciplinary nutritional care based on our clinical experience at the Comprehensive Center for Bronchopulmonary Dysplasia.
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Affiliation(s)
- Audrey N Miller
- Division of Neonatology, Department of Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, OH, USA. .,Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Jennifer Curtiss
- Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Clinical Nutrition and Lactation, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah N Taylor
- Division of Neonatology, Yale School of Medicine, New Haven, CT, USA
| | - Carl H Backes
- Division of Neonatology, Department of Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, OH, USA.,Division of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Matthew J Kielt
- Division of Neonatology, Department of Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, OH, USA.,Comprehensive Center for Bronchopulmonary Dysplasia, Nationwide Children's Hospital, Columbus, OH, USA
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31
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The dilemma of feeding during the treatment of patent ductus arteriosus with oral ibuprofen in preterm infants ≤30 weeks of gestation-a randomized controlled trial. J Perinatol 2023; 43:203-208. [PMID: 36604581 DOI: 10.1038/s41372-022-01597-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To evaluate the effect of minimal enteral feeding (MEN) versus withholding feeding on time to reach full feeds during treatment of hs-PDA with oral ibuprofen in infants ≤30 weeks. STUDY DESIGN We performed a single-center, randomized control trial of 126 premature infants born ≤30 weeks gestation, <7 days of age with hs-PDA comparing continuation of MEN (n = 64) vs no feeding (n = 62) during treatment. The primary outcome was time to reach a feed volume of 150 ml/kg/day. Secondary outcomes included were episodes of feed intolerance, GI bleed, NEC and other comorbidities. RESULTS There was no difference in the time to reach full feeds - median age of 16 days in both groups (p = 0.573). Incidence of feed intolerance, NEC and other secondary outcomes were also similar in both groups. CONCLUSIONS Continuing MEN during treatment of hs-PDA with oral ibuprofen does not decrease time to reach full enteral feeds in very preterm infants.
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Embleton ND, Jennifer Moltu S, Lapillonne A, van den Akker CHP, Carnielli V, Fusch C, Gerasimidis K, van Goudoever JB, Haiden N, Iacobelli S, Johnson MJ, Meyer S, Mihatsch W, de Pipaon MS, Rigo J, Zachariassen G, Bronsky J, Indrio F, Köglmeier J, de Koning B, Norsa L, Verduci E, Domellöf M. Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. J Pediatr Gastroenterol Nutr 2023; 76:248-268. [PMID: 36705703 DOI: 10.1097/mpg.0000000000003642] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight <1800 g. METHODS The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee of Nutrition (CoN) led a process that included CoN members and invited experts. Invited experts with specific expertise were chosen to represent as broad a geographical spread as possible. A list of topics was developed, and individual leads were assigned to topics along with other members, who reviewed the current literature. A single face-to-face meeting was held in February 2020. Provisional conclusions and recommendations were developed between 2020 and 2021, and these were voted on electronically by all members of the working group between 2021 and 2022. Where >90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached. RESULTS In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier. CONCLUSIONS We provide updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants.
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Affiliation(s)
| | | | | | - Chris H P van den Akker
- the Department of Pediatrics - Neonatology, Amsterdam UMC - Emma Children's Hospital, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Virgilio Carnielli
- Polytechnic University of Marche and Division of Neonatology, Ospedali Riuniti, Ancona, Ancona, Italy
| | - Christoph Fusch
- the Department of Pediatrics, Nuremberg General Hospital, Paracelsus Medical School, Nuremberg, Germany
- the Division of Neonatology, Department of Pediatrics, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Konstantinos Gerasimidis
- the Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Johannes B van Goudoever
- Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Nadja Haiden
- the Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Silvia Iacobelli
- the Réanimation Néonatale et Pédiatrique, Néonatologie - CHU La Réunion, Saint-Pierre, France
| | - Mark J Johnson
- the Department of Neonatal Medicine, University Hospital Southampton NHS Trust, Southampton, UK
- the National Institute for Health Research Biomedical Research Centre Southampton, University Hospital Southampton NHS Trust and University of Southampton, Southampton, UK
| | - Sascha Meyer
- the Department of General Paediatrics and Neonatology, University Hospital of Saarland, Homburg, Germany
| | - Walter Mihatsch
- the Department of Pediatrics, Ulm University, Ulm, Germany
- the Department of Health Management, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Miguel Saenz de Pipaon
- the Department of Pediatrics-Neonatology, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain
| | - Jacques Rigo
- the Neonatal Unit, University of Liège, CHR Citadelle, Liège, Belgium
| | - Gitte Zachariassen
- H.C. Andersen Children's Hospital, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Jiri Bronsky
- the Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
| | - Flavia Indrio
- the Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Jutta Köglmeier
- the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Barbara de Koning
- the Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lorenzo Norsa
- the Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - Elvira Verduci
- the Department of Health Sciences, University of Milan, Milan, Italy
- the Department of Paediatrics, Ospedale dei Bambini Vittore Buzzi, Milan, Italy
| | - Magnus Domellöf
- the Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
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Borràs-Novell C, Herranz Barbero A, Balcells Esponera C, López-Abad M, Aldecoa Bilbao V, Izquierdo Renau M, Iglesias Platas I. Influence of maternal and perinatal factors on macronutrient content of very preterm human milk during the first weeks after birth. J Perinatol 2023; 43:52-59. [PMID: 35931800 PMCID: PMC9839448 DOI: 10.1038/s41372-022-01475-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify changes in macronutrient content of very preterm human milk associated with perinatal factors. STUDY DESIGN Milk macronutrients were measured on weeks 1, 2, 4 and 8 with mid-infrared transmission spectrometers. RESULT We assessed 625 samples (from 117 mothers and 130 very preterm infants). Average concentrations were: protein 1.3 ± 0.3 g/dl, carbohydrates 7.3 ± 0.6 g/dl, fat 3.7 ± 1.0 g/dl and energy 296.0 ± 41.0 kJ/dl (70.7 kcal/dl). Gestational age negatively correlated with protein (rho: -0.307, p < 0.001) and energy (r: -0.193, p = 0.003). Advanced maternal age, gestational age and intrauterine growth restriction were independently associated with milk protein content over the first 4 weeks (adjusted R2: 0.113, p = 0.002). CONCLUSION These findings may help neonatologists identify patients fed Mother´s Own Milk who are at increased risk of poor postnatal growth.
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Affiliation(s)
- Cristina Borràs-Novell
- Neonatology Department. BCNatal - Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | - Ana Herranz Barbero
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Carla Balcells Esponera
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Miriam López-Abad
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Victoria Aldecoa Bilbao
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Izquierdo Renau
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Isabel Iglesias Platas
- grid.5841.80000 0004 1937 0247Neonatology Department. BCNatal – Centre de Medicina Maternofetal i Neonatologia de Barcelona. Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain ,grid.416391.80000 0004 0400 0120Neonatal Intensive Care Unit, Norfolk and Norwich University Hospital, Norwich, UK
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Hashmi A, Darakamon MC, Aung KK, Mu M, Misa P, Jittamala P, Chu C, Phyo AP, Turner C, Nosten F, McGready R, Carrara VI. Born too soon in a resource-limited setting: A 10-year mixed methods review of a special care baby unit for refugees and migrants on the Myanmar-Thailand border. Front Public Health 2023; 11:1144642. [PMID: 37124770 PMCID: PMC10130587 DOI: 10.3389/fpubh.2023.1144642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Preterm birth is a major public health concern with the largest burden of morbidity and mortality falling within low- and middle-income countries (LMIC). Materials and methods This sequential explanatory mixed methods study was conducted in special care baby units (SCBUs) serving migrants and refugees along the Myanmar-Thailand border. It included a retrospective medical records review, qualitative interviews with mothers receiving care within SCBUs, and focus group discussions with health workers. Changes in neonatal mortality and four clinical outcomes were described. A mix of ethnographic phenomenology and implementation frameworks focused on cultural aspects, the lived experience of participants, and implementation outcomes related to SCBU care. Results From 2008-2017, mortality was reduced by 68% and 53% in very (EGA 28-32 weeks) and moderate (EGA 33-36 weeks) preterm neonates, respectively. Median SCBU stay was longer in very compared to moderate preterm neonates: 35 (IQR 22, 48 days) vs. 10 days (IQR 5, 16). Duration of treatments was also longer in very preterm neonates: nasogastric feeding lasted 82% (IQR 74, 89) vs. 61% (IQR 40, 76) of the stay, and oxygen therapy was used a median of 14 (IQR 7, 27) vs. 2 (IQR 1, 6) days respectively. Nine interviews were conducted with mothers currently receiving care in the SCBU and four focus group discussions with a total of 27 local SCBU staff. Analysis corroborated quantitative analysis of newborn care services in this setting and incorporated pertinent implementation constructs including coverage, acceptability, appropriateness, feasibility, and fidelity. Coverage, acceptability, and appropriateness were often overlapping outcomes of interest highlighting financial issues prior to or while admitted to the SCBU and social issues and support systems adversely impacting SCBU stays. Interview and FGD findings highlight the barriers in this resource-limited setting as they impact the feasibility and fidelity of providing evidence-based SCBU care that often required adaptation to fit the financial and environmental constraints imposed by this setting. Discussion This study provides an in-depth look at the nature of providing preterm neonatal interventions in a SCBU for a vulnerable population in a resource-limited setting. These findings support implementation of basic evidence-based interventions for preterm and newborn care globally, particularly in LMICs.
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Affiliation(s)
- Ahmar Hashmi
- Institute for Implementation Science, University of Texas Health Sciences Center (UTHealth), Houston, TX, United States
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center (UTHealth), Houston, TX, United States
| | - Mu Chae Darakamon
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Ko Ko Aung
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Mu Mu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Prapatsorn Misa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Cindy Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Aung Pyae Phyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Claudia Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Verena I. Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Verena I. Carrara
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[Influencing factors for the development and severity of bronchopulmonary dysplasia in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1326-1333. [PMID: 36544414 PMCID: PMC9785086 DOI: 10.7499/j.issn.1008-8830.2207013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To study the influencing factors for the development and severity of bronchopulmonary dysplasia (BPD) in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g. METHODS A retrospective analysis was performed on the medical data of preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g who were admitted to Women and Children's Hospital Affiliated to Xiamen University from January 1, 2017 to December 31, 2021. According to oxygen dependence on day 28 after birth, they were divided into two groups: BPD (n=218) and non-BPD (n=142). According to disease severity based on oxygen concentration required at the corrected age of 36 weeks or at discharge, the infants with BPD were divided into two groups: mild BPD (n=154) and moderate/severe BPD (n=64). Indices such as perinatal data and nutritional status were compared between groups. The multivariate logistic regression analysis was used to determine the influencing factors for BPD and its severity. RESULTS The incidence rate and severity of BPD increased with the reduction in gestational age and birth weight (P<0.05). The multivariate logistic regression analysis showed that a long duration of invasive mechanical ventilation (OR=1.320, P<0.05), hemodynamically significant patent ductus arteriosus (OR=2.032, P<0.05), and a prolonged time to reach oral calorie goal of 110 kcal/(kg·d) (OR=1.041, P<0.05) were risk factors for BPD, while an older gestational age was a protective factor against BPD (OR=0.535, P<0.05). Early-onset sepsis (OR=2.524, P<0.05) and a prolonged time to reach oral calorie goal of 110 kcal/(kg·d) (OR=1.029, P<0.05) were risk factors for moderate/severe BPD, while a high mean weight growth velocity was a protective factor against moderate/severe BPD (OR=0.906, P<0.05). CONCLUSIONS The incidence rate and severity of BPD in preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g can be reduced by shortening the duration of invasive mechanical ventilation, giving early treatment of early-onset sepsis and hemodynamically significant patent ductus arteriosus, adopting active enteral nutritional strategies, and increasing mean weight growth velocity.
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Schill EM, Floyd AN, Newberry RD. Neonatal development of intestinal neuroimmune interactions. Trends Neurosci 2022; 45:928-941. [PMID: 36404456 PMCID: PMC9683521 DOI: 10.1016/j.tins.2022.10.002] [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: 07/01/2022] [Revised: 09/19/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
Interactions between the enteric nervous system (ENS), immune system, and gut microbiota regulate intestinal homeostasis in adults, but their development and role(s) in early life are relatively underexplored. In early life, these interactions are dynamic, because the mucosal immune system, microbiota, and the ENS are developing and influencing each other. Moreover, disrupting gut microbiota and gut immune system development, and potentially ENS development, by early-life antibiotic exposure increases the risk of diseases affecting the gut. Here, we review the development of the ENS and immune/epithelial cells, and identify potential critical periods for their interactions and development. We also highlight knowledge gaps that, when addressed, may help promote intestinal homeostasis, including in the settings of early-life antibiotic exposure.
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Affiliation(s)
- Ellen Merrick Schill
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA; Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA.
| | - Alexandria N Floyd
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Rodney D Newberry
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA.
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Impact of a Standardized Nutrition Bundle Including Donor Human Milk on Hospital Outcomes in Very Low Birth-Weight (VLBW) Infants in a Safety-Net Hospital. Adv Neonatal Care 2022; 22:503-512. [PMID: 36413779 DOI: 10.1097/anc.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Standardized protocols have been shown to reduce clinical practice variation and improve patient outcomes. PURPOSE To measure the impact of a standardized nutrition bundle inclusive of donor human milk (DHM) on hospital outcomes of very low birth-weight (VLBW) infants in a safety-net hospital. METHODS The study used the Model for Improvement methodology to drive improvement in practice. Outcome measures consisted of necrotizing enterocolitis (NEC), mortality, growth at 36 weeks' postmenstrual age and discharge, as well as volume and type of milk consumption during hospitalization. FINDINGS NEC rate decreased from 16.67% in the control group to 6.78% in the standardized nutrition bundle group (P = .07). Similarly, there was significant reduction in mortality with the bundled intervention (15.6% in the control group vs 1.6% in the nutrition bundle group; P = .006). Time to first (15 vs 27.5 hours of life; P < .001) and full-volume enteral feeding (8.5 vs 10 days; P = .086) were reduced in the standardized nutrition bundle group compared with the control group. The human milk volume almost doubled with the intervention. IMPLICATIONS FOR PRACTICE Our standardized nutrition bundle protocol inclusive of DHM resulted in lower NEC rates and reduced mortality. The implementation of the DHM program proved to be cost-effective and saved lives. Our findings may help guide development of a structured approach to nutrition protocols inclusive of DHM that can be adapted by other units located in safety-net hospitals. IMPLICATIONS FOR RESEARCH Future research on ethnic and racial barriers to access and affordability of DHM is warranted and much needed.
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Yang Y, Wang J, Tong M, Cheng R, Pan J. The localization and improvement of the Functional Status Scale and the reliability and validity in very low birth weight infants. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:603-612. [PMID: 36581578 PMCID: PMC10494238 DOI: 10.3724/zdxbyxb-2022-0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To develop a Chinese version of Functional Status Scale (FSS) and to test its reliability and validity in very low birth weight infants (VLBWIs). METHODS The FSS was translated into Chinese and the content was modified in accordance with relevant guidelines and specifications. The Chinese version of FSS was applied to evaluate VLBWIs admitted from January 2018 to June 2020 at 7th day after birth and 34 weeks of postmenstrual age, respectively. The scores were analyzed by descriptive statistics (coefficient of variation method, critical ratio method and answer distribution analysis method), and the reliability and the validity were analyzed. The internal consistency reliability was analyzed using Cronbach's α coefficient, the inter rater reliability was analyzed using Spearman correlation coefficient. The content validity was analyzed using correlation coefficient method and expert scoring method; the structural validity was analyzed using exploratory and confirmatory factor analysis method; the known group validity was analyzed using area under the curve (AUC) value and Pearson correlation coefficient. The preliminary response of the initial and re-evaluation scales was calculated. RESULTS After screening by inclusion and exclusion criteria, 548 and 523 VLBWIs were included for initial evaluation and re-evaluation, respectively. Descriptive statistics showed that the mean was close to the median, the maximum and minimum values were close to or equal to the values at both ends, and the coefficient of variation was >0.15. The critical ratio method showed that the | t| value of all items in the initial evaluation and re-evaluation was >3 ( P<0.01). The answer distribution analysis method showed that the answer selection rate of different levels of each item was <80%. Internal consistency test showed that the general Cronbach's α was 0.803 and the re-evaluation Cronbach's α was 0.708, with a good internal consistency. According to the inter-rater reliability, the Spearman correlation coefficient was 0.968 in the initial evaluation and 0.989 in the re-evaluation ( P<0.01). The correlation coefficient of the items in the scale by the correlation coefficient method was more than 0.4. The item-level content validity index (I-CVI) was greater than 0.78, universal agreement of scale of content validity index was 0.83, the average of scale of content validity index was 0.97 and the Kappa was greater than 0.74. Exploratory factor analysis showed that the initial Kaiser-Meyer-Olkin (KMO) value was 0.846, the re-evaluated KMO value was 0.843 ( P<0.01). There was one factor with extracted eigenvalue>1, which could explain 54.221% and 53.403% of the total variation respectively, suggesting that there was a common factor in the initial evaluation and re-evaluation scales, which was consistent with the original scale design. Confirmatory factor analysis showed that the items in the initial and re-evaluation were significant ( P<0.01), and the value of standard load coefficient was greater than 0.5. The known group validity showed that FSS had a good predictive and discriminative ability for short-term outcomes. The items of mental status, motor function, sensory and communication in the re-evaluation scale had a good correlation with gross motor and fine motor energy areas in Gesell developmental schedule. The Pearson correlation coefficient between initial evaluation and re-evaluation was 0.609 ( P<0.01). CONCLUSION The Chinese version FSS scale has good reliability and validity, the included items are simple and easy to be applied in clinical practice.
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Affiliation(s)
- Yang Yang
- 1. Department of Child Health Care, Maternity Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China
- 2. Department of Neonatology, Children's Hospital Affiliated to Nanjing Medical University, Nanjing 210008, China
| | - Jing Wang
- 1. Department of Child Health Care, Maternity Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China
| | - Meiling Tong
- 1. Department of Child Health Care, Maternity Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China
| | - Rui Cheng
- 2. Department of Neonatology, Children's Hospital Affiliated to Nanjing Medical University, Nanjing 210008, China
| | - Jingjing Pan
- 3. Department of Neonatology, Maternal and Child Branch, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
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Zhang T, Luo H, Wang H, Mu D. Association of Human Milk Fortifier and Feeding Intolerance in Preterm Infants: A Cohort Study about Fortification Strategies in Southwest China. Nutrients 2022; 14:nu14214610. [PMID: 36364872 PMCID: PMC9655617 DOI: 10.3390/nu14214610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The present strategy of administering human milk fortifier (HMF) in southwest China (swC) is mainly based on European and American populations’ guidelines. Additionally, some southwest Chinese preterm infants have been observed to develop feeding intolerance (FI) after administration of HMF. In order to develop adapted southwest Chinese guidelines for the administration of HMF to preterm infants and improve fortification strategies, a retrospective cohort study was performed to explore the association of the use of HMF and FI. Objective: To explore the association between HMF and FI in preterm infants and provide recommendations for its use in swC. Methods: This cohort study included 298 preterm infants from West China Second University Hospital. Maternal and infant clinical data were collected from electronic patient records. The infant cohort was divided into two groups based on the use/nonuse of HMF. The association between HMF and FI was evaluated using multivariate analysis. Nonlinear relationships and threshold effects were evaluated using generalized additive models and two-piecewise linear regression models. Results: The multivariate analysis confirmed that there is no significant association between HMF use and FI, but significant risk factors for FI include early HMF initiation (p = 0.02), full-strength HMF initiation (p = 0.04), and fast HMF supplementation rates (p = 0.004). Through smooth curve fitting and threshold effect analysis, we found that two inflection points, an initial concentration of HMF > 24 mg/mL and a HMF supplementation rate > 12.5 mg/mL/d, significantly increased FI risk. Conclusions: Routine HMF fortification can be safely used in preterm infants with gestational age < 32 wk or birth weight < 1500 g in swC, and we advise initiating fortification when enteral milk intake reaches 100 mL/kg/day, with an HMF concentration of 1:50 and if tolerated, increase to 1:25 more than 38 h. The recommended HMF supplementation rate differs from current guidelines and provides evidence for developing southwest Chinese guidelines. A prospective trial is needed in order to validate this proposal.
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Affiliation(s)
- Ting Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu 610041, China
| | - Huan Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu 610041, China
| | - Hua Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu 610041, China
- Correspondence:
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu 610041, China
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40
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Incidence of Metabolic Bone Disease After Implementation of Bone Protective Nutritional Strategies: A Prospective Cohort Study. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2640-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lyu Y, Zhu D, Wang Y, Jiang S, Lee SK, Sun J, Li L, Cao Y. Current epidemiology and factors contributing to postnatal growth restriction in very preterm infants in China. Early Hum Dev 2022; 173:105663. [PMID: 36087460 DOI: 10.1016/j.earlhumdev.2022.105663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postnatal growth restriction (PGR) is common in very preterm infants (VPIs) and is associated with adverse short and long-term developmental outcomes. Postnatal growth status for VPIs in middle- or low-income countries remains unclear. AIMS To evaluate PGR in VPIs and identify maternal and neonatal factors, clinical practice, and major neonatal morbidities associated with PGR in China. STUDY DESIGN Prospective cohort study. SUBJECTS We included 6085 infants born at <32 weeks gestation who were admitted at 57 hospitals in the Chinese Neonatal Network in 2019. OUTCOME MEASURES Birth and discharge weights were converted to age-specific Z-scores. PGR was defined as a decrease in weight z-score from birth to discharge >2. RESULTS The overall incidence of PGR was 19.9 %. The mean (standard deviation [SD]) weight Z-score was 0.12 (0.78) at birth and decreased to -1.36 (0.98) at discharge. About 4.0 % of VPIs were small for gestational age (SGA) at birth and 25.5 % of SGA infants had PGR. The incidence of PGR increased with decreasing gestational age except in the SGA subgroup. Each 1-unit increase in birthweight Z-score was associated with a 1.49-fold increased risk for PGR. Late initiation of enteral feeds and late achievement of full enteral feeds were positively associated with PGR. The common morbidities that influenced PGR were necrotizing enterocolitis ≥ stage II, patent ductus arteriosus requiring medical or surgical treatment, sepsis, bronchopulmonary dysplasia, and respiratory distress syndrome requiring surfactants. CONCLUSION Nearly one fifth of VPIs were PGR, and one fourth of SGA had PGR, which warranted further study to investigate underlying causes by which to improve postnatal growth in very preterm infants in future.
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Affiliation(s)
- Yanyu Lyu
- Department of Neonatology, Children's Hospital of Capital Institute of Pediatrics, Beijing, China; Experiment Center, Capital Institute of Pediatrics, Beijing, China
| | - Dongzhe Zhu
- Department of Neonatology, Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Yanchen Wang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China
| | - Siyuan Jiang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China; Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Jianhua Sun
- Division of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Li
- Department of Neonatology, Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Yun Cao
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China; Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
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Li M, Fang Y, Lian Y, Lu X, Qiu M, He Y. Effect of hydrolyzed formulas on gastrointestinal tolerance in preterm infants: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2022; 35:10173-10180. [DOI: 10.1080/14767058.2022.2122794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Mengyuan Li
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Yuehui Fang
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Yiyao Lian
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Xiaodi Lu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Meijuan Qiu
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
| | - Yuna He
- Chinese Center for Disease Control and Prevention, National Institute for Nutrition and Health, Beijing, China
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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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Seliga-Siwecka J, Płotko A, Wójcik-Sep A, Bokiniec R, Latka-Grot J, Żuk M, Furmańczyk K, Zieliński W, Chrzanowska M. Effect of standardized vs. local preoperative enteral feeding practice on the incidence of NEC in infants with duct dependent lesions: Protocol for a randomized control trial. Front Cardiovasc Med 2022; 9:893764. [PMID: 36158805 PMCID: PMC9492877 DOI: 10.3389/fcvm.2022.893764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Infants with duct dependent heart lesions often require invasive procedures during the neonatal or early infancy period. These patients remain a challenge for pediatric cardiologists, neonatologists, and intensive care unit personnel. A relevant portion of these infant suffer from respiratory, cardiac failure and may develop NEC, which leads to inadequate growth and nutrition, causing delayed or complicated cardiac surgery. Methods This randomized control trial will recruit term infants diagnosed with a duct dependant lesion within the first 72 h of life. After obtaining written parental consent patients will be randomized to either the physician led enteral feeding or protocol-based feeding group. The intervention will continue up to 28 days of life or day of cardiosurgical treatment, whichever comes first. The primary outcomes include NEC and death related to NEC. Secondary outcomes include among others, number of interrupted feedings, growth velocity, daily protein and caloric intake, days to reach full enteral feeding and on mechanical ventilation. Discussion Our study will be the first randomized control trial to evaluate if standard (as in healthy newborns) initiation and advancement of enteral feeding is safe, improves short term outcomes and does not increase the risk of NEC. If the studied feeding regime proves to be intact, swift implementation and advancement of enteral nutrition may become a recommendation. Trial registration The study protocol has been approved by the local ethical board. It is registered at ClinicalTrials.gov NCT05117164.
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Affiliation(s)
- Joanna Seliga-Siwecka
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
- *Correspondence: Joanna Seliga-Siwecka
| | - Ariel Płotko
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Agata Wójcik-Sep
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Renata Bokiniec
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Julita Latka-Grot
- Department of Neonatology, Children's Health Memorial Institute, Warsaw, Poland
| | - Małgorzata Żuk
- Cardiology Clinic, Children's Health Memorial Institute, Warsaw, Poland
| | - Konrad Furmańczyk
- Department of Applied Mathematics, Institute of Information Technology, Warsaw University of Life Sciences, Warsaw, Poland
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Zieliński
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
- Department of Statistics and Econometrics, Institute of Economics and Finance, Warsaw University of Life Sciences, Warsaw, Poland
| | - Mariola Chrzanowska
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
- Department of Statistics and Econometrics, Institute of Economics and Finance, Warsaw University of Life Sciences, Warsaw, Poland
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Wurst U, Ackermann B, Kiess W, Thome U, Gebauer C. "Alcohol intoxication by proxy on a NICU" - a case report. BMC Pediatr 2022; 22:521. [PMID: 36056306 PMCID: PMC9438338 DOI: 10.1186/s12887-022-03567-w] [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: 12/29/2020] [Accepted: 08/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ethanol intoxications in newborns are generally due to false preparation of formula with alcoholics or alcohol consumption by the breastfeeding mothers. Rarely, intoxications occur in hospitalized newborns, e.g., from excessive use of alcoholic hand sanitizers. We herein report a strange case of acute ethanol intoxications in our NICU. Case presentation An extremely premature infant (23 0/7 weeks gestational age, birthweight 580 g) suffered from repeated life-threatening events with hemodynamic compromise, apnea, and lactic acidosis while being treated in our neonatal intensive care unit (NICU). Symptomatic treatment with intravenous fluids and, if necessary, intubation and catecholamine therapy led to recovery after several hours each time. The episodes eventually turned out to be severe ethanol intoxications brought about by breast milk contaminated with ethanol. The breast milk was supplied by the infant’s mother, who consumed non-trivial amounts of alcohol to build up her strength and make herself produce more milk, which was recommended to her by a family member. Additionally, she supplemented her own mother’s milk with cow’s milk because she was worried her baby was underserved with her milk. The mother admitted to this in intensive conversations with our team and a professional translator. Conclusions This unique case underlines how different cultural dynamics can attribute to life-threatening events in the care of premature infants. It is important for us to emphasize that intensive communication and building a confident relationship with the parents of patients is essential to the work on NICUs. Child safeguarding issues and possibilities of intoxications have to stay in mind even in a supposedly safe space like the NICU.
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Affiliation(s)
- Ulrike Wurst
- Department for Neonatology, Hospital for Children and Adolescents, University Hospital Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany. .,Hospital for Children and Adolescents, Department of Women and Child Health, University Hospital Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany.
| | - Benjamin Ackermann
- Department for Neonatology, Hospital for Children and Adolescents, University Hospital Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, Department of Women and Child Health, University Hospital Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Ulrich Thome
- Department for Neonatology, Hospital for Children and Adolescents, University Hospital Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Corinna Gebauer
- Department for Neonatology, Hospital for Children and Adolescents, University Hospital Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
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Kumbhare SV, Jones WD, Fast S, Bonner C, Jong G‘, Van Domselaar G, Graham M, Narvey M, Azad MB. Source of human milk (mother or donor) is more important than fortifier type (human or bovine) in shaping the preterm infant microbiome. Cell Rep Med 2022; 3:100712. [PMID: 36029771 PMCID: PMC9512671 DOI: 10.1016/j.xcrm.2022.100712] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/13/2022] [Accepted: 07/14/2022] [Indexed: 12/20/2022]
Abstract
Milk fortifiers help meet the nutritional needs of preterm infants receiving their mother’s own milk (MOM) or donor human milk. We conducted a randomized clinical trial (NCT03214822) in 30 very low birth weight premature neonates comparing bovine-derived human milk fortifier (BHMF) versus human-derived fortifier (H2MF). We found that fortifier type does not affect the overall microbiome, although H2MF infants were less often colonized by an unclassified member of Clostridiales Family XI. Secondary analyses show that MOM intake is strongly associated with weight gain and microbiota composition, including Bifidobacterium, Veillonella, and Propionibacterium enrichment. Finally, we show that while oxidative stress (urinary F2-isoprostanes) is not affected by fortifier type or MOM intake, fecal calprotectin is higher in H2MF infants and lower in those consuming more MOM. Overall, the source of human milk (mother versus donor) appears more important than the type of milk fortifier (human versus bovine) in shaping preterm infant gut microbiota. Milk fortifier type (human versus bovine) has little impact on the preterm microbiome Milk source (mother versus donor) is strongly associated with microbiome composition Feeding mother’s own milk is linked to better weight gain and less gut inflammation
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Kebede DA, Tafere Y, Eshete T, Abebaw E, Adimasu M, Endalew B. The time to initiate trophic feeding and its predictors among preterm neonate admitted to neonatal intensive care unit, Multicenter study, Northwest Ethiopia. PLoS One 2022; 17:e0272571. [PMID: 35951594 PMCID: PMC9371352 DOI: 10.1371/journal.pone.0272571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Trophic feeding is a small volume, hypo-caloric feeding, gut priming or minimal enteral feeding acclimate the immature gut of enteral fasting preterm neonates. Delayed starting of trophic feeding had resulted in short and long-term physical and neurological sequels. The current study aimed to estimate the time to initiate trophic feeding and its predictors among preterm neonates admitted in the neonatal intensive care unit of Debre Markos, Felege Hiwot, and Tibebe Ghion comprehensive specialized hospitals. Methods An institutional-based prospective follow-up study was conducted among 210 neonates. The data were collected with interview and chart review, entered into Epi data 3.1 and exported to Stata 14.1 for analysis. Multivariable Cox regression models were fitted to identify predictors of time to initiate trophic feeding. Result A total of 210 neonates were followed for 10136 person-hours of risk time and 191 (90.95%) of neonates were started trophic feeding. The overall incidence of starting trophic feeding was 2 per 100 (95% CI: 2, 2.2) person-hours observations. The median survival time was 42 hours (95% CI: 36, 48). APGAR- score at first minute <7 (AHR: 0.6, 95% CI: 0.44, 0.82), gestational age of <34 weeks (AHR: 0.69, 95% CI: 0.5, 0.94), presence of respiratory distress syndrome (AHR: 0.5, 95% CI: 0.36, 0.68), presence of hemodynamic instability (AHR: 0.37, 95% CI: 0.24, 0.57), presence of perinatal asphyxia (AHR: 0.63, 95% CI: 0.44, 0.89), cesarean section delivery (AHR: 0.63, 95% CI: 0.44, 89) and being delivered within the study hospitals (AHR: 0.54, 95% CI: 0.39, 0.74) were found to be statistically significant predictors of time to initiate trophic feeding. Conclusion There was a significant delay to initiate trophic feeding in the studied hospitals. Gestational age of below 34 weeks, APGAR-score of less than seven, out-born delivery, cesarean delivery, presence of respiratory distress syndrome; perinatal asphyxia, and hemodynamic instability were predictors of delay in starting of trophic feeding. Standardized feeding guideline has to be implemented to overcome delays in enteral feeding initiation.
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Affiliation(s)
| | - Yilikal Tafere
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tewodros Eshete
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Ermias Abebaw
- School of Medicine, Debre Markos University, Debre Markos, Ethiopia
- * E-mail:
| | - Mekonen Adimasu
- Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekalu Endalew
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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48
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Wang L, Lin XZ, Shen W, Wu F, Mao J, Liu L, Chang YM, Zhang R, Ye XZ, Qiu YP, Ma L, Cheng R, Wu H, Chen DM, Chen L, Xu P, Mei H, Wang SN, Xu FL, Ju R, Zheng Z, Tong XM. Risk factors of extrauterine growth restriction in very preterm infants with bronchopulmonary dysplasia: a multi-center study in China. BMC Pediatr 2022; 22:363. [PMID: 35751057 PMCID: PMC9229749 DOI: 10.1186/s12887-022-03405-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Nutritional deficiency soon after birth is a risk factor of chronic lung disease (bronchopulmonary dysplasia, BPD). Afflicted infants are further prone to inadequate growth during hospitalization (extrauterine growth restriction, EUGR). This multi-center retrospective study investigated risk factors of EUGR, specifically in very preterm infants with BPD. METHOD Data of infants with BPD who were born less than 32 weeks gestation (n = 1010) were collected from 7 regions of China. All infants were non-small for gestational age at birth. Infants were characterized as EUGR or non-EUGR at 36 weeks gestation or discharge, or stratified by gestational age or birthweight. Logistic regression analysis was applied. RESULTS In 65.5% of the population, the BPD was mild. Infants with severe BPD (8.3%) had the highest rate of EUGR (72.6%, P < 0.001). Groups stratified by gestational age did not differ in rates of EUGR, but the birthweight of the EUGR group was significantly lower than that of the non-EUGR (P < 0.001). Birthweights of < 1000, 1000-1499, and ≥ 1500 g showed EUGR rates of 65.9%, 43.4%, and 23.8%, respectively (P < 0.001). Overall, the independent risk factors of EUGR were: moderate-to-severe BPD, gestational hypertension, cesarean section, cumulative fasting time, time required to achieve 110 kcal/kg/d, and hemodynamically significant patent ductus arteriosus (hsPDA). CONCLUSION In very preterm infants with BPD, the lower the birthweight or the more severe the BPD, the greater the risk of EUGR. In those with hsPDA, or moderate-to-severe BPD, it is especially important to prevent EUGR through perinatal management, enteral nutrition, and nutritional strategies.
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Affiliation(s)
- Lian Wang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Fan Wu
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jian Mao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Liu
- Department of Neonatology, Guiyang Maternal and Child Health Hospital·Guiyang Children's Hospital, Guiyang, China
| | - Yan-Mei Chang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiu-Zhen Ye
- Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, China
| | - Yin-Ping Qiu
- Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Li Ma
- Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Rui Cheng
- Department of Neonatology, Children' Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Ling Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, China
| | - Hua Mei
- Department of Neonatology, the Affiliate Hospital of Inner Mongolia Medical University, Hohhot, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, China
| | - Fa-Lin Xu
- Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rong Ju
- Department of Neonatology, Chengdu Women' and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, China
| | - Xiao-Mei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China.
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Zhong Q, Lu Q, Peng N, Liang XH. Amino Acid-Based Formula vs. Extensively Hydrolyzed Formula in the Treatment of Feeding Intolerance in Preterm Infants: Study Protocol for a Randomized Controlled Trial. Front Nutr 2022; 9:854121. [PMID: 35711561 PMCID: PMC9196310 DOI: 10.3389/fnut.2022.854121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
Background Feeding intolerance is a common problem in preterm infants, which is associated with an increased risk of infections, prolonged hospitalization, and increased economic costs. When human milk is not available, formula feeding is required. Amino acid-based formula and extensively hydrolyzed formula could be considered for use for severe feeding intolerance. A recent Cochrane meta-analysis found that preterm infants fed extensively hydrolyzed formula compared with standard formula could not reduce the risk of feeding intolerance and necrotizing enterocolitis, and weight gain was slower. Some studies reported that preterm infants fed amino acid-based formula could reduce the gastric residual volume. We hypothesize that amino acid-based formula can improve feeding intolerance and establish full enteral feeding more rapidly in preterm infants compared with extensively hydrolyzed formula. Method The randomized, prospective, controlled trial was conducted at the Children's Hospital of Chongqing Medical University (Chongqing, China). A total of 190 preterm infants with gestational age <32 weeks or birth weight <1,500 g and with a diagnosis of feeding intolerance were included. Patients were randomized to an amino acid-based formula-fed group and an extensively hydrolyzed formula-fed group. The primary outcome is the time (days) to reach full enteral feedings. Secondary outcomes include duration of vomiting and abdominal distension, gastric residual volume, body weight, length and head circumference during hospitalization, length of hospital stay (days), cost of hospitalization, time (days) of parenteral nutrition, change of abdomen circumference, main serum parameters, and incidence of adverse events. Discussion The successful implementation of our study will provide robust evidence for formula alternatives in preterm infants with feeding intolerance. Clinical Trial Registration www.ClinicalTrials.gov, identifier: NCT05347706.
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Affiliation(s)
- Qin Zhong
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi Lu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Nan Peng
- Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiao-Hua Liang
- Department of Clinical Epidemiology and Bioinformatics, Children's Hospital of Chongqing Medical University, Chongqing, China
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50
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Bajwa RU, Raju MNP, Govande VP, Hemingway M, Hammonds K, Vora N. Infant nutrition (donor human milk vs. maternal milk) and long-term neurodevelopmental and growth outcomes in very low birth weight infants. J Matern Fetal Neonatal Med 2022; 35:10025-10029. [PMID: 35703947 DOI: 10.1080/14767058.2022.2086794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Human milk, the ultimate source of nutrition for premature infants, enhances host defense mechanism, gastrointestinal maturation, lowers infection rate, improves neurodevelopmental outcomes, and reduces long-term cardiovascular and metabolic disease. Recently, there has been an increase in donor breast milk (DBM) use for premature infants; however, data are limited on the long-term effects of DBM on the infant's growth and neurodevelopmental outcomes. OBJECTIVE To determine if there is an association between type of infant nutrition (maternal breast milk (MBM) or DBM) and neurodevelopmental and growth outcomes in very low birth weight (VLBW) infants. DESIGN/METHODS Retrospective cohort study of VLBW (<1500 g) infants admitted to the Baylor Scott & White Memorial Hospital Neonatal Intensive Care Unit from January 2014 to December 2016. Infants with major congenital anomalies, born at an outside hospital, who were nil per os (NPO) for >15 days, or who died before NICU discharge were excluded. Infants were stratified into two groups (MBM or DBM) based on predominant nutrition (>50%) received in the first month of life. Primary outcomes of neurodevelopmental delay(s) between 2 and 4 years of age identified via ICD 9/10 codes. Growth data (weight, length, and head circumference) were obtained from well-check visits at 12-, 18-, 24-, 36-, and 48-months. Severity of illness was determined using the Clinical Risk Index in Babies-II (CRIB-II) score. Generalized linear models were used to assess the relationship between nutrition and neurodevelopmental delay and trends in growth over time. RESULTS Two hundred and nine infants were included: 146 MBM; 63 DBM. Median gestational age was 28 weeks (range, 23-35) and median birthweight was 1050 g (range, 410-1470). There were no significant differences in birthweight, gestational age, CRIB-II score, or length of stay between the groups. Infants fed DBM had a significantly larger weight z-score (p=.005), length z-score (p=.01), and head circumference z-score (p=.04), on average from birth to 48 months compared to MBM infants, while controlling for NICU length of stay and number of follow-up months; however, this only equated to DBM infants being 0.5 in taller and 0.9 lbs heavier at 48 months. There were no statistically significant differences among type of infant nutrition and long-term neurodevelopmental outcomes, while controlling for CRIB-II score. CONCLUSIONS Infants fed DBM have a slightly greater propensity for growth over time compared to infants fed MBM. Longer follow-up is needed to further determine the effect, infant nutrition has on neurodevelopmental outcomes.
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Affiliation(s)
- Raza U Bajwa
- Department of Neonatology, Baylor Scott and White Health, Temple, TX, USA
| | - Muppala N P Raju
- Department of Neonatology, Baylor Scott and White Health, Temple, TX, USA
| | - Vinayak P Govande
- Department of Neonatology, Baylor Scott and White Health, Temple, TX, USA
| | - Martha Hemingway
- Department of Neonatology, Baylor Scott and White Health, Temple, TX, USA
| | | | - Niraj Vora
- Department of Neonatology, Baylor Scott and White Health, Temple, TX, USA
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