Influence of Routine Probiotic Supplementation on the Incidence of Necrotizing Enterocolitis and Late Onset Sepsis

PURPOSE: This study aimed to investigate the influence of routine probiotic supplementation on causes of neonatal morbidity and mortality, such as necrotizing enterocolitis (NEC) and late onset sepsis. METHODS: All neonates born at <32 weeks of gestation and weighing <1,500 g admitted to the neonatal intensive care unit during the study period were included. The study period was divided into the pre-probiotic period, between January 2009 and February 2011, and the probiotic period, between November 2012 and December 2014. The probiotic given was a mixture of Lactobacillus plantarum, L. rhamnosus, Bifidobacterium lactis and B. longum, administered at the time of the first feeding over 2 mL once daily. RESULTS: A total of 358 infants were screened for enrollment, with 149 infants included in the pre-probiotic group (mean birth weight 937 g, mean gestational age 27.9 wk), and 158 in the probiotic group (1,040 g, 28.6 wk). Probiotics had no statistically significant impact on NEC and late onset sepsis. However, three cases of probiotic related sepsis occurred after the infants were routinely administered probiotics in our unit. CONCLUSION: Routine probiotic supplementation did not reduce the incidence of NEC in very low birth weight (VLBW) infants. However, severe sepsis was caused by strains in the probiotic administered to patients. Therefore, routine prophylactic use of probiotic in VLBW infants should be performed cautiously.

The Usefulness of Birth Weight Z-Score as a Predictor of Catch Up Growth in Preterm Infants

PURPOSE: The aim of the study was to examine whether the degree of fetal smallness in small for gestational age (SGA) infants would increase the risk of catch-up-growth failure at 12 and 24 months corrected age (CA), and whether the high-calorie nutritional support would improve catch-up growth between 12 and 24 months CA. METHODS: We conducted a retrospective cohort study on 103 preterm infants born between January 2010 and December 2011. Logistic regression analysis was performed to investigate whether the birth weight z-score would be an independent risk factor for catch-up growth failure at 12 or 24 months CA. Among the 46 infants with failed catch-up growth at 12 months CA, 16 infants were provided high-calorie nutritional support, including nutritional supplements and medium chain triglyceride (MCT) oil at the pediatric gastroenterology clinic. RESULTS: Of 103 preterm infants, 34 infants (33%) were SGA and 69 infants (67%) were appropriate for gestational age (AGA). One birth weight z-score decrement increased the odds for catch-up growth failure 2.9 times at 12 months CA and 3.0 times at 24 months CA after adjustment for major neonatal morbidities. The increase in z-score between 12 and 24 months CA was significantly greater in the infants provided nutritional support than in the infants who were not provided nutritional support. CONCLUSION: The birth weight z-score can be used as a predictor of catch-up growth failure. High-calorie nutritional support may improve weight gain during the second year in preterm infants with failed catch-up growth at 12 months CA.

A Case of a Preterm Infant with Prenatally Diagnosed Intrauterine Midgut Volvulus / 대한주산의학회잡지

Intrauterine midgut volvulus is a rare and potentially life-threatening congenital disease that can lead to intestinal ischemia, sepsis and peritonitis caused by bowel perforation and meconium obstruction. Early detection and immediate treatment is crucial to improve the outcome. Herein, we report a preterm infant of 30 weeks of gestation with intrauterine midgut volvulus associated with meconium peritonitis who survived after cesarean delivery and immediate postnatal surgical intervention. The outcome of in-utero intestinal volvulus depends on optimal delivery timing and adequate postnatal treatment. Therefore, prompt multidisciplinary consultation and planning with obstetricians, neonatologists and pediatric surgeons is necessary to reduce the morbidity and mortality associated with fetal midgut volvulus, especially in the preterm period.