Prebiotics for feeding of preterm infants

The intestinal flora of breast-fed infants is generally dominated by bifidobacteria which have beneficial properties. Their presence is due to various components of breast milk, including prebiotic substances. These prebiotics were added to artificial milk formulae to mimic breast milk in its action on intestinal flora. The aim of the study was to compare a prebiotic enriched formula versus a standard formula in feeding premature neonates as regards: Daily weight gain, feeding intolerance, stool frequency, electrolyte disturbance, duration of hospital stay and outcome. A prospective double-blinded study including hundred preterm neonates admitted to Neonatal Intensive Care Unit Cairo University over the period from October 2008 to May 2009. Fifty preterms were randomly assigned to receive milk formula enriched with prebiotics in the form of Galactooligosaccharides and Fructooligosaccharides [0.8g/100mI dilution] by naso gastric tube [group 1]. Fifty other preterms of matched gestational age and birth weight were randomly assigned to receive milk formula not enriched with prebiotics by naso gastric feeding [group2]. Both milk formulae were equal in caloric content. Neonates received the formula until they were discharged. None of the studied neonates received total parentral nutrition. Preterms in both groups were compared regarding their daily weight gain, number of stool motions, consistency of stools, development of feeding intolerance in the form of vomiting, constipation, crying, abdominal distension following feeds, gastric residual>25% of the feed, and outcome. Patients were classified into two groups. Group 1, including 50 preterms receiving prebiotics enriched formula and group 2, including 50 preterms receiving non enriched formula. Mean gesfational age was 32.52 +/- 1.502 weeks in group 1 versus 32.58 +/- 1.63 weeks in group 2, Pvalue 0.31 [NS] .Mean birth weight was 1693 +/- 0.7 gm in group 1 versus 1704 +/- 1 gm in group 2, P value 0.407 [NS]. Caesarean section was performed in 68% of deliveries in both groups. Males were 58% in both groups. Mean daily weight gain was 26.934 +/- 4.6914 gm in group 1 compared to 24.048 +/- 7.5215 gm in group 2, P value 0.001 [HS]. Number of stool motions was 2.450 +/- 0.4473 motions/day in group 1 versus 1.548 +/- 0.269 motions/day in group 2 P value 0.001 [HS]. Stool consistency was softer in group I than in group 2. Feeding intolerance was detected in 8% of cases in group 1 [4% had gastric residue>25% of the feed, 2% had abdominal distension following the feed, and 2% had constipation] versus 30% in group 2 [12%had gastric residue>25%, 10% had abdominal distension following the feeds and 8%had constipation P value 0.001 [HS]. Laboratory investigations performed at day 7 revealed the following: Mean HB 11.7 +/- 2 gm/dl in group I versus 11.4 +/- 2.6 in group 2, P value 0.591 [NS]. Mean total leukocytic count was 8.8 +/- 5.3 in group I versus 11.6 +/- 6 in group2, P value 0.102 [NS]. Mean platelet count was 228.5 +/- 98.7 in group 1 versus 190.5 +/- 96.6 in group 2, P value 0.137 [NS]. In group 1, six percent of patients developed positive C-Reactive Protein, 2% had I :T Ratio>0.2 in complete blood while 16% developed positive C-Reactive Protein, 6% had I :T Ratio>0.2 in complete blood count in group 2. Mean duration of hospital stay was 13 +/- 5days in group I versus 19 +/- 8 days in group 2, P value 0.001[HS]. According to outcome: 2% died in group I versus 6% in group 2. Breast-feeding remains the gold standard for infant nutrition. Prebiotic supplementation to infant formula is a trial to mimic the composition of breast milk. Prebiotic supplementation appears safe and improves daily weight gain, entral tolerance, increases stool frequency, softens its consistency to mimic that observed in breast fed infants and reduces the duration of hospital stay

study of microbiological pattern of neonatal sepsis

The main of this [prospective] analytic study was to determine the microbiological pattern of bacterial infection in the neonatal intensive care unit of Kasr El Eini hospital, to investigate microbial colonization of neonates at birth before any interference and to examine whether surface cultures yielded information helpful in management. The study population comprised 70 high risk neonates whether full terms or preterm infants admitted to Kasr El Eini neonatal intensive care unit for a 6 months period from 1/3/2002 to 30/9/2002 babies with congenital anomalies were excluded from the study. The included neonates were subjected to laboratory studies as CBC, CRP, IT ratio, superficial cultures in the form of ear and throat swabs and deep culture in the from of blood culture. We defined neonatal sepsis by positive blood culture. The results showed that 70 out of 101 neonates included in the study developed sepsis [69.3%]. The incidence of early onset sepsis [49.5%] was higher than late onset sepsis [19.8%]. The highest incidence of sepsis was in the gestational age group 30 - <32 weeks and the weight group 1500 - <2500 grams. Clinical signs and laboratory investigation revealed no significance in relation to sepsis. The most prevalent organism recovered from blood culture was klebsiella [40%], followed by coagulase negative staph aureus, CONS [20%], staph aureus [15.7%] and enterobacter [15.7%]. Colonization detected by ear swabs was 68.5% in septic neonates and 64.5% in non septic neonates. The predominant organisms recovered from ear swabs in the septic group were CONS [38.6%] followed by staph aureus [18.6%] then klebsiella [5.7%]. Colonization detected by throat swabs was 55.7% in septic neonates and 42% in the non septic neonates. The most common organism recovered from throat swab in the septic group were klebsiella [15.7%] and E. coli [14.3%] followed by CONS and staph aureus [10%] each. Superficial swabs were of limited value in diagnosis of neonatal sepsis. Results of throat swabs were more significant than ear swabs with higher matching with blood culture [21.4% in contrast to 8.5% for ear swabs]. Mortality among septic neonates was 44.2% and among non septic neonates was 25.8%. Incidence of sepsis was still high in our unit [69.3%]. Early onset sepsis was much-higher than late onset sepsis. Klebsiella was the predominant organism causing sepsis followed by CONS and staph aureus. Superficial swabs were of limited value in diagnosis of neonatal sepsis. Throat swabs showed more matching with blood culture than ear swabs. Blood culture is still the gold standard for the diagnosis of neonatal sepsis