RESUMO
BACKGROUND: Human milk from the infant's mother (own mother's milk; OMM) feedings reduces the risk of several morbidities in very low birthweight (VLBW) infants, but limited data exist regarding its impact on bronchopulmonary dysplasia (BPD). OBJECTIVE: To prospectively study the impact of OMM received in the neonatal intensive care unit (NICU) on the risk of BPD and associated costs. DESIGN/METHODS: A 5-year prospective cohort study of the impact of OMM dose on growth, morbidity and NICU costs in VLBW infants. OMM dose was the proportion of enteral intake that consisted of OMM from birth to 36â weeks postmenstrual age (PMA) or discharge, whichever occurred first. BPD was defined as the receipt of oxygen and/or positive pressure ventilation at 36â weeks PMA. NICU costs included hospital and physician costs. RESULTS: The cohort consisted of 254 VLBW infants with mean birth weight 1027±257â g and gestational age 27.8±2.5â weeks. Multivariable logistic regression demonstrated a 9.5% reduction in the odds of BPD for every 10% increase in OMM dose (OR 0.905 (0.824 to 0.995)). After controlling for demographic and clinical factors, BPD was associated with an increase of US$41â 929 in NICU costs. CONCLUSIONS: Increased dose of OMM feedings from birth to 36â weeks PMA was associated with a reduction in the odds of BPD in VLBW infants. Thus, high-dose OMM feeding may be an inexpensive, effective strategy to help reduce the risk of this costly multifactorial morbidity.
Assuntos
Displasia Broncopulmonar/prevenção & controle , Custos de Cuidados de Saúde/estatística & dados numéricos , Leite Humano , Peso ao Nascer , Extração de Leite , Displasia Broncopulmonar/economia , Displasia Broncopulmonar/etiologia , Feminino , Idade Gestacional , Humanos , Illinois , Cuidado do Lactente/economia , Cuidado do Lactente/métodos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal/economia , Masculino , Mães , Estudos Prospectivos , Fatores de RiscoRESUMO
Prompt diagnosis of malrotation and midgut volvulus in infants with bilious emesis is critical. However because of the limited frequency of pediatric upper gastrointestinal (UGI) fluoroscopic procedures in neonates, many diagnostic radiology residents complete their training never having seen or performed a UGI on a baby for evaluation of malrotation and midgut volvulus. A UGI simulation model for infants with bilious emesis was created to supplement the hands-on fluoroscopic experience of residents in training. We are now studying the addition of simulated UGI studies to our pediatric radiology curriculum.
