Recommendations for Diagnosis and Prevention of Cytomegalovirus-Associated Necrotizing Enterocolitis in Breast-Fed Preterm Infants.

We present the case of a breast-fed preterm infant with postnatally acquired cytomegalovirus (CMV) and severe necrotizing enterocolitis (NEC) associated with CMV. The infant had persistent severe thrombocytopenia with clinical deterioration despite multiple platelet transfusions and maximal medical treatment. Surgical intervention was not feasible owing to the instability of the infant's condition. Upon identification of CMV in urine, intravenous ganciclovir was initiated with significant clinical improvement. We also present a literature review of cases of CMV-related NEC or other gastrointestinal complications in preterm and term infants.

Room air challenge predicts duration of supplemental respiratory support for infants with bronchopulmonary dysplasia.

OBJECTIVE: To determine whether a room air challenge (RAC) correlates with duration of respiratory support for infants with bronchopulmonary dysplasia (BPD). STUDY DESIGN: Prospective study of preterm infants with BPD from 2015 to 2018. Infants receiving ≤2 l flow at 36 weeks postmenstrual age (PMA) underwent RAC. Cox regression was used to adjust the duration of respiratory support after 36 weeks PMA for significant covariates. RESULTS: Of 161 infants with BPD, 91 were eligible for RAC; 51 passed and 40 failed. Infants who failed RAC had longer respiratory support after 36 weeks PMA than infants who passed (median 19 weeks (IQR 15-33) versus 2 weeks (IQR 1-8, p < 0.001)), which persisted after multivariable adjustment (hazard ratio -1.42, 95% CI -1.94 to -0.91, p < 0.001). Infants failing RAC also had more frequent and longer duration of home oxygen use. CONCLUSION: RAC may help provide anticipatory guidance regarding duration of respiratory support for infants with BPD.

Longitudinal changes in the gut microbiome of infants on total parenteral nutrition.

BACKGROUND: Animal studies suggest that total parenteral nutrition (TPN) may alter bacterial colonization of the intestinal tract and contribute to complications. Progressive changes in gut microbiome of infants receiving TPN are not well understood. METHODS: Infants with and without TPN/soy lipid were enrolled in a prospective, longitudinal study. Weekly fecal samples were obtained for the first 4 weeks of life. High throughput pyrosequencing of 16S rDNA was used for compositional analysis of the gut microbiome. RESULTS: 47 infants were eligible for analyses, 25 infants received TPN, and 22 infants did not (control). Although similar between TPN and control groups in the first week, fecal bacterial alpha diversity was significantly lower in the TPN group compared to controls at week 4 (Shannon index 1.0 vs 1.5, P-value = 0.03). The TPN group had significantly lower Bacteroidetes and higher Verrucomicrobia abundance compared to controls (P-values < 0.05), and these differences became more pronounced over time. At the genus level, TPN was associated with lower abundance of Bacteroides and Bifidobacterium in all weeks. CONCLUSIONS: TPN is associated with significant loss of biodiversity and alterations in the pattern of gut microbial colonization of infants over time. TPN-associated dysbiosis may predispose infants to adverse NICU outcomes.

Influence of gestational age and birth weight in neonatal cholesterol response to total parenteral nutrition.

BACKGROUND: Premature and critically ill infants receiving total parenteral nutrition (TPN) are at risk for dyslipidemia, and altered cholesterol levels in early life may contribute to later cardiovascular risk. Data regarding plasma cholesterol response to TPN in young infants are lacking. OBJECTIVE: To determine the changes in plasma cholesterol levels during the first week of life in infants receiving TPN and a comparison group of infants who did not receive TPN during routine care. METHODS: In a prospective, pilot cohort study, 38 neonates (30 TPN vs. 8 No-TPN) underwent serial blood sampling during the first week of life. Gas chromatography-mass spectrometry was used to measure cholesterol in plasma and TPN administered to study participants. RESULTS: Baseline cholesterol level was similar between groups. In contrast to infants who did not receive TPN, cholesterol levels during the first week of life were significantly higher than baseline in infants receiving TPN (maximum cholesterol response 34% vs. 103% change from baseline, No-TPN vs. TPN, respectively, P = .036). After adjusting for cumulative cholesterol received by infants receiving TPN, maximum cholesterol response remained inversely related to gestational age and birth weight (P < .05). CONCLUSION: Plasma cholesterol significantly increases during the first week of life in neonates receiving TPN. A higher cholesterol response was induced by TPN in infants of lower gestational age and birth weight.