Human milk-derived versus bovine milk-derived fortifier use in very low birth weight infants: growth and vitamin D status.

Background: Human milk-derived fortifier (HMDF) coupled with human milk feeding in extremely premature infants reduces the adverse outcome risks of early exposure to bovine milk ingredients but may not provide enough nutrients for adequate catch-up growth compared with bovine milk-derived fortifier (BMDF). Objective: This study aims to compare HMDF and BMDF effects on growth parameters and serum 25-hydroxy vitamin D (25OHD) levels in preterm very low birth weight (VLBW) infants during the first 8 weeks of life. Methods: We present a retrospective chart review of inpatient VLBW infants with birth weight <1,500 g and gestational age <32 completed weeks who received either their mother's milk or donor breast human milk fortified with HMDF or BMDF for the first 8 weeks. Weight, head circumference, length gain, and 25OHD level were calculated at 4 and 8 weeks of age. Results: A total of 139 VLBW infants (91 HMDF + 48 BMDF) received fortified human milk without any supplemental premature formula from birth to 4 weeks of age, of whom 44 (37 HMDF + 7 BMDF) continued until 8 weeks of age. There was no statistically significant difference in the growth parameters between the two groups at 4 and 8 weeks of age. Serum 25OHD level in the HMDF group was significantly higher compared with that in the BMDF group at 4 weeks of age despite receiving lower vitamin D supplementation. Conclusion: Similar gain in growth parameters in HMDF and BMDF groups at 4 and 8 weeks of age was observed, suggesting that HMDF provides adequate nutrients for growth in VLBW infants. A higher 25OHD level in HMDF may suggest better absorption.

A Multifunctional, Low Cost and Sustainable Neonatal Database System.

Continuous improvement in the clinical performance of neonatal intensive care units (NICU) depends on the use of locally relevant, reliable data. However, neonatal databases with these characteristics are typically unavailable in NICUs using paper-based records, while in those using electronic records, the inaccuracy of data and the inability to customize commercial data systems limit their usability for quality improvement or research purposes. We describe the characteristics and uses of a simple, neonatologist-centered data system that has been successfully maintained for 30 years, with minimal resources and serving multiple purposes, including quality improvement, administrative, research support and educational functions. Structurally, our system comprises customized paper and electronic components, while key functional aspects include the attending-based recording of diagnoses, integration into clinical workflows, multilevel data accuracy and validation checks, and periodic reporting on both data quality and NICU performance results. We provide examples of data validation methods and trends observed over three decades, and discuss essential elements for the successful implementation of this system. This database is reliable and easily maintained; it can be developed from simple paper-based forms or used to supplement the functionality and end-user customizability of existing electronic medical records. This system should be readily adaptable to NICUs in either high- or limited-resource environments.

Tracheal Length Measurement in Intubated Neonates to Guide the Design and Use of Endotracheal Tube Glottic Depth Markings.

BACKGROUND: Data on neonatal tracheal length are needed to inform the standardization of safety features for endotracheal tubes (ETTs) such as glottic depth markings. Laryngotracheal airway measurements are available from digital imaging in infants and children but not in neonates. We aimed to determine the tracheal length (TL) of intubated preterm and term neonates. METHODS: An observational study was performed on 57 neonates of 22-42 weeks' gestation and <1 week of age. Two clinicians independently reviewed 153 digital chest radiographs to determine the carina position and TL. TL was measured from carina to mid-C4 (cricoid level). We analyzed interrater agreement (within 0.5 vertebral levels) on the position of the carina and TL. TL was plotted as a function of gestational age and weight, using graphical and regression analyses. RESULTS: Carina position ranged from T3 to T5.5, with an interrater agreement of 95%. On image pairs concordant for carina position, TL determinations were virtually identical between readers (mean difference 0.1 mm, 95% CI -0.5-0.6 mm). Average mid-tracheal length overlies the body of T1. In infants aged less than 32 weeks' gestation, the mid-trachea lies <20 mm from the carina or the larynx. TL linearly correlates with gestational age, but correlation with birthweight best fits a segmented regression with a node at 1 kg. CONCLUSIONS: The functional length of the laryngotracheal airway can be reliably measured in sick neonates. It correlates well with gestational age and birthweight, and this information can inform the redesign of ETT markings to promote the safer use of these devices.