RESUMO
OBJECTIVE: To evaluate the effects of guideline-driven prophylactic supplementation of a multi-strain neonatal intensive care unit-specific probiotic product on infants born very preterm (VP) or very low birth weight (VLBW). STUDY DESIGN: A prospective cohort of 125 infants born in one year after implementation who received probiotics were compared to a retrospective cohort of eligible 126 VP or VLBW infants who did not receive probiotics. The primary outcome of interest was necrotizing enterocolitis (NEC). RESULT: The incidence of NEC decreased from 6.3 to 1.6%. After adjusting for multiple variables, there were no significant differences in primary or other outcomes of interest; odds ratio (95% confidence interval) NEC 0.27 (0.05-1.33), death 0.76 (0.26-2.21) and late-onset sepsis 0.54 (0.18-1.63). No adverse effects related to probiotics supplementation were observed. CONCLUSION: Although nonsignificant, prophylactic probiotics supplementation in infants born VP or VLBW was associated with reduction of NEC.
Assuntos
Enterocolite Necrosante , Probióticos , Sepse , Recém-Nascido , Lactente , Humanos , Estudos Retrospectivos , Estudos Prospectivos , Lactente Extremamente Prematuro , Recém-Nascido de muito Baixo Peso , Probióticos/uso terapêutico , Enterocolite Necrosante/prevenção & controle , Enterocolite Necrosante/epidemiologia , Sepse/prevenção & controleRESUMO
Insufficient nutrient supply in preterm infants and protein deprivation in particular can represent a nutritional emergency. It can cause many of the features of the starvation response, including insulin resistance and hyperglycemia, as well as growth failure and neurological injury. At Baylor University Medical Center, we began providing intravenous protein on the first day of life to extremely low birth weight infants in 2000. This has led to significant improvements in the time to regain birth weight and the rate of daily weight gain during the first month of life. While neonatologists traditionally focus first on newborns' warmth, respiratory support, and cardiovascular support, early aggressive nutrition support, in the form of intravenous amino acids at time of admission as well as glucose, is of great benefit and should be a standard element in the initial care of the extremely low birth weight infant.
