Benefits of early enteral nutrition in extremely low birth weight infants

<p><b>INTRODUCTION</b>Extremely low birth weight (ELBW) infants (i.e. preterm infants weighing < 1,000 g) often present with morphofunctional multiple organ immaturity. This study aimed to determine whether early enteral feeding improves digestive tolerance, and whether there is a difference in growth between ELBW infants who were fed with formula and those who were fed with breast milk.</p><p><b>METHODS</b>This study was conducted from 2012-2013 and involved 34 ELBW infants from the Preterm Neonatology Clinic of the 'Louis Turcanu' Clinical Children's Hospital Timisoara, Romania. Early enteral nutrition was introduced for all the infants - Group I was fed with formula, while Group II was fed with breast milk. Infants in each group were given their designated type of milk (formula/breast milk), using the same feeding method and the same volume rate advancement. They were monitored for any evidence of digestive intolerance (i.e. clinical signs of infection and necrotising enterocolitis [NEC]). Their growth curves and signs of infection were also monitored.</p><p><b>RESULTS</b>The average weight gained per week was greater among the infants in Group II than in Group I (120.83 g vs 97.27 g). The incidence of infection was 100% in Group I and 66.6% in Group II. Two of the infants in Group I developed NEC.</p><p><b>CONCLUSION</b>Early enteral feeding helped to improve the weight of ELBW infants. Breast milk was more effective than formula at improving the weight of these infants. Feeding with formula increased the incidence of NEC, invasive infection and morbidity among ELBW infants.</p>

Predictors of Mortality and Major Morbidities in Extremely Low Birth Weight Neonates.

Objectives: To determine predictors of mortality and morbidity in extremely low birth weight neonates (ELBW) from a developing country Study design: Prospective observational study. Setting: Level III neonatal unit in Northern India. Subjects: Neonates <1000g born and admitted to intensive care during study period were enrolled. They were analyzed based on survival and development of major morbidity. Multivariable logistic regression model was used to determine independent risk factors. Outcome: Mortality and major morbidity (one or more of the following: Bronchopulmonary dysplasia (BPD), Retinopathy of Prematurity (ROP) requiring laser, grade III or IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC) stage III) during hospital stay. Results: Of 255 ELBW neonates born, 149 received optimal care, of which 78 (52%) survived and 57 (39%) developed morbidities. Mean birth weight and gestational age were 29.1±2.6 weeks and 843±108g. Major causes of mortality were sepsis (46%), birth asphyxia (20%) and pulmonary hemorrhage (19%). Birth weight ≤800g [OR (95% CI)-3.51 (1.39-8.89), P=0.008], mechanical ventilation [4.10 (1.64-10.28), P=0.003] and hypotensive shock [10.75 (4.00-28.89), P<0.001] predicted mortality while birth weight ≤800g [3.75 (1.47-9.50), P=0.006], lack of antenatal steroids [2.62 (1.00-6.69), P=0.048), asphyxia [4.11 (1.45-11.69), P=0.008], ventilation [4.38 (1.29-14.79), P=0.017] and duration of oxygen therapy [0.004 (1.001-1.006), P=0.002] were the predictors of major morbidities. Conclusions: Low birth weight, mechanical ventilation and hypotensive shock predicted mortality in ELBW neonates while low birth weight, lack of antenatal steroids, birth asphyxia, ventilation and duration of oxygen therapy were predictors for major morbidity.

Survival and Morbidity Among Two Cohorts of Extremely Low Birth Weight Neonates from a Tertiary Hospital in Northern India.

This study was conducted to compare the survival and morbidity of extremely low birth weight neonates born during two different time periods (2009-10 and 2001-02) at a Level III referral neonatal unit in Northern India. All consecutive intramural extremely low birth weight neonates (<1000g), irrespective of gestation, and admitted to Intensive Care were enrolled. 149 and 123 neonates were enrolled during 2009-10 and 2001-02, respectively. The baseline characteristics were comparable except for mean birth weight, which was lower during 2009-10 (843±108g vs 885±126g, P=0.003). Surfactant therapy (54% vs 18%, P<0.001), non-invasive ventilation (28% vs 6%, P<0.001), high frequency ventilation (24% vs 4%, P=0.001), IVH (52% vs 25%, P<0.001) and PDA (34% vs 18%, P=0.004) were significantly more during 2009-10. Culture positive sepsis (33% vs 51%, P=0.003) and ROP rates (7% vs 23%, P=0.042) were significantly higher during 2001-02. Overall survival was similar; however, neonates between 28-30 weeks gestation had better survival (63%) during 2009-10 compared to 2001-02 (38%), P=0.009. Survival in neonates 28-30 weeks improved during this period while overall survival remained the same.

Effective Strategies for the Prevention of Nosocomial Sepsis in Extremely Premature Infants / 한양의대학술지

Nosocomial sepsis or late onset sepsis is among the leading causes of mortality and morbidity in extremely low birth weight infants hospitalized to neonatal intensive care units (NICU). Prevention of nosocomial sepsis is based on strategies that aim to limit susceptibility to infections by enhancing functional maturities, and ameliorating extrinsic risk factors by limiting transmission of organisms and by promoting the judicious use of antimicrobials. Several clinical strategies which are available include; hand hygiene practices; prevention of central venous catheter-related septicemia; judicious use of therapeutic or prophylactic antimicrobials; proper skin care; and early trophic enteral feeding with human milk. The implementation of these proper clinical strategies and maintaining of surveillance system in individual NICU for prevention of nosocomial infection is quite effective and important to reduce the incidence of noscomial sepsis of extremely premature infants and ultimately to improve their survival and quality of life.

Therapeutic Strategies for PDA in Prematurity (How to treat PDA? When to treat PDA?)

Patent ductus arteriosus (PDA) occurs commonly in premature infants, especially extremely low birth weight infants (ELBWs) and in those with respiratory distress syndrome. About 80 percent of ELBWs have a murmur in earlier days after birth progress to large, persistent ductal shunts. Also, the ductus can reopen after closure that occurs either spontaneously or after indomethacin treatment among tiny and immature babies, more often ELBWs. Complications of prematurity that occur more commonly among infants with PDA than infants without PDA include pulmonary edema, BPD, NEC, congestive heart failure, and IVH. However there has been controversy as to whether or when the ductus arteriosus should be closed by either pharmacologic or surgical methods. Now there is still no definite standard guide-line to close PDA among prematurity especially ELBWs. Clinical decisions of the treatment of the ductus should be individualized and based on the gestation of the baby, respiratory condition and the facility of each neonatal intensive care unit.

Antenatal Steroid Treatment to Prevent Early Non-oliguric Hyperkalemia in Extremely Low Birth Weight (ELBW) Infants / 医学研究杂志

Objective To explore the effect of prenatal steroid (PNS) treatment on preventing early severe non-oliguric hyperkalemia in Extremely-Low-Birth-Weight (ELBW) infants.Methods Retrospective comparative analysis was performed on 31 ELBW infants who had been admitted to the hospital’s NICU between July 2001 and Jun 2005. Infants whose mothers received a full course of steroids before delivery (PNS group; n=18) were compared with those infants whose mothers did not receive steroids (NSG group; n=13). Infants were included in the PNS group if their mother was given one full course of dexamethasone ( 10 mg q12h4 doses) before delivery. The last dose must have been given at least 24 hours before delivery. The arterial blood gas , serum concentrations of potassium, sodium and creatinine were measured every 24 hours, and fluid intakes, urine outputs were monitored every day. Results Hyperkalemia was significantly lower in the PNS than in the NSG infants at the first 72 hours of age [5/18 cases ( 27.78%) vs 9/13 cases (69.23%)],P=0.023). However, the serum concentrations of sodium, creatinine, fluid intakes, urine outputs were not significantly difference in both groups. Conclusions Prenatal steroids treatment can reduce early severe non-oliguric hyperkalemia in EVBL infants.

A Survival Case of a 630 gram Extremely Low Birth Weight Neonate after Surgery for the Small Bowel Perforation

The surgical care of neonates, born weighing less then 1000 gram (Extremely Low Birth Weight; ELBW), is a very challenging problem to the pediatric surgeons. We report a survival case in which a successful operation for the spontaneous intestinal perforation was performed at the time when the baby weighed 630 g after 25.6 weeks' gestation. The child not only survived but also appears developmental normal at two years of age. The case is the smallest reported survivor in Korea after surgery. The cooperation between the pediatric surgeon and neonatologist is very important in the surgical management of ELBW neonate.

A Case of Mucocutaneous Candidiasis in a Baby with Extremely Very Low Birth Weight / 대한의진균학회지

Mucocutaneous infection with Candida spp. in infants ranges from such common conditions as thrush and diaper dermatitis to serious diseases with potential for systemic involvement. High-risk infants with mucosal or skin involvement with Candida spp. much more likely develop into systemic candidiasis. Consideration should be given to obtaining systemic cultures, skin biopsy and treating with systemic antifungal therapy in many such cases. We report a case of mucocutaneous candidiasis in a baby with extremely very low birth weight, who was treated with oral fluconazole.

Recent Outcome of Extremely Low Birth Weight Infants at Asan Medical Center

PURPOSE: Survival rate of infants weighing less than 1, 000 g has been increased due to advanced neonatal care. We evaluated the outcome of extremely low birth weight (ELBW) infants who were born at Asan Medical Center. METHODS: We retrospectively reviewed survival, morbidities, and catch-up growth of the 105 ELBW infants from 1999 to 2002. RESULTS: Overall survival rate of ELBW infants was 65.7%. In respect to birth weight, the survival rates for or = grade III, periventricular leukomalacia, severe retinopathy of prematurity > or = stage III and clinical or proven sepsis were 8.7%, 4.3%, 47.8%(n=33), 69.6%, respectively. 29 infants required laser photocoagulation due to retinopathy of prematurity. Duration of total parenteral nutrition (TPN) was 44.0 +/- 22.3 days. The incidences of TPN-associated cholestasis and necrotizing enterocolitis were 34.8%, 7.2%, repectively. At 18 months, 78.3% of ELBW infants showed catch-up growth. CONCLUSION: Survival rate of ELBW infants was 65.7%, which was much improved but lower than that of western and Japanese outcome. Further efforts must be made to increase their survival rates and to reduce morbidities.

Non-oliguric Hyperkalemia in Extremely Low Birth Weight Infants

PURPOSE: The aim of this study was to investigate the incidence and contributing factors of nonoliguric hyperkalemia in extremely low birth weight infants (ELBW) within 96 hours after birth in very low birth weight infants. METHODS: The incidence of non-oliguric hyperkalemia and difference of clinical feature between hyperkalemic (>or=7.0 mEq/L) and normokalemic (<7.0 mEq/L) groups were determined by reviewing medical records of 35 extremely low birth weight infants admitted in Samsung Medical Center between Jan. 2001 to Dec. 2001. We analyzed the serum levels of sodium, potassium, fluid intake, urine output, blood gas analysis values, and other factors that influenced serum electrolytes. RESULTS: Among 35 ELBW infants, 11 (31%) was hyperkalemia developed and 4 infants (36%) was associated with cardiac arrythmia. The incidence and onset time of hyperkalemia showed inverse correlation with birth weight and gestational age. Perinatal complications and serum levels of sodium, fluid intake, hourly urine output, and other blood gas analysis were no different in both groups. Dopamine administrations, UAC insertion rate, ICH incidence and base deficit were significantly increased in hyperkalemic group. CONCLUSION: Non-oliguric hyperkalemia is a frequent complication of ELBW infant. Serum potassium should be monitored closely to avoid life threatening cardiac arrhythmia in these infants.

Efficacy of empirical pharmacological therapy in clinically suspected Gastroesophageal Reflux (GER) in Extremely Low Birth Weight (ELBW) infants.

Prokinetic drugs and H2-receptor blocking agents are being used for suspected GER in ELBW (<1,000 grams) infants with apnea and bradycardia (unresponsive to methylxanthines) or feeding intolerance. Purpose: To evaluate whether anti-reflux therapy is effective in ELBW infants in improving the clinical signs for which the therapy was instituted. Methods: Clinical data of all ELBW infants admitted to NICU at Georgetown University Hospital in 1996, who received prokinetic drugs (cisapride or metoclopramide) and/or an H2 receptor blocking agent (ranitidine) were reviewed. The number of episodes and the frequency of intervention for apnea/bradycardia (As&Bs), and the number of trancutaneous oxygen desaturation episodes (O2 desats) were recorded for 72 hours before and after the institution of anti-GER therapy. Feeding intolerance was assessed by the ability to tolerate enteral feeding without significant gastric residue. The data (mean ฑ SD) were analyzed by paired t-test. Results: Twenty out of 68 infants received prokinetic drugs and/or ranitidine. Eighteen infants received anti-reflux therapy for apnea and/or bradycardia unresponsive to methylxanthines, and two infants for slow gastric emptying noted during a milk scan. The mean postnatal age and body weight at the time of therapy were 63 ฑ 37 days and 1,365 ฑ 486 grams respectively. Feeding tolerance did not change after anti-reflux therapy. There was no significant improvement in the number of apnea/bradycardia, desaturation episodes or the need for intervention after the medications was given. Conclusion: Pharmacological therapy for clinically suspected GER is prescribed frequently and appears to be of questionable efficacy in ELBW infants. As anti-reflux therapy may have serious side effects, its routine use in ELBW infants needs to be reassessed.