Electrical Cardiometry during transition and short-term outcome in very preterm infants: a prospective observational study.

The purpose of this study is to evaluate the association of Electrical Cardiometry (EC)-derived cardiac output indexed to weight (CO) and its changes during the first 48 h in relation to adverse short-term outcome in very preterm infants. In this prospective observational study of preterm infants < 32 weeks gestational age (GA), the combined adverse outcome was defined as mortality or abnormal cranial ultrasound (any grade intracranial hemorrhage (ICH) or periventricular leukomalacia) within the first 2 weeks postnatally. Logistic regression models were used to investigate the association between median CO and outcome and mixed-effects models for the time trajectory of CO. In the absence of device-specific thresholds for low or high CO, no thresholds were used in our analysis. Fifty-three infants (median (IQR) GA 29.0 (25.4-30.6) weeks, birthweight 1020 (745-1505) g) were included in the analysis. Median CO was 241 (197-275) mL/kg/min for the adverse outcome and 198 (175-227) mL/kg/min for normal outcome (odds ratio (OR) (95% confidence interval (95% CI)), 1.01 (1.00 to 1.03); p = 0.028). After adjustment for GA, the difference was not significant (adjusted OR (95% CI), 1.01 (0.99 to 1.02); p = 0.373). CO trajectory did not differ by outcome (p = 0.352). A post hoc analysis revealed an association between CO time trajectory and ICH ≥ grade 2.          Conclusions: EC-derived CO estimates within 48 h postnatally were not independently associated with brain injury (any grade) or mortality in the first 14 days of life. CO time trajectory was found to be associated with ICH ≥ grade 2. What is Known: • Bioreactance-derived cardiac output indexed to bodyweight (CO) in the transitional period has been associated with adverse short-term outcome in preterm infants. What is New: • Electrical Cardiometry (EC)-derived CO measurements in very preterm infants during the transitional period are not independently associated with adverse outcome (death or ultrasound detected brain damage) within 2 weeks postnatally. • In the first 48 h EC-derived CO increases over time and is higher in extremely preterm infants compared to very preterm and differs from previously reported bioreactance-derived CO values.

Factors Contributing to Non-Exclusive Breastfeeding in Primigravid Mothers

Aims We aimed to examine the factors contributing to non-exclusive breastfeeding in primigravid mothers in a large Irish tertiary maternity hospital. Methods This was a retrospective cohort study carried out at the Rotunda Hospital, Dublin, Ireland. Maternal demographics, antenatal, perinatal, delivery-related information and neonatal outcomes were collected and analysed. Results 569 eligible mothers were delivered during the study period. Out of the 416 mothers intending to breastfeed, 278 (67%) mothers were exclusively breastfeeding at discharge. On univariate analysis, a higher body mass index, unemployment, an Asian background, gestational diabetes, antenatal steroids, low birth weight and hypernatremia were all associated with non-exclusive breastfeeding (all p<0.05). On logistic regression, only gestational diabetes, a birthweight < 2500 grams and hypernatremia remained significantly associated with non-exclusive breastfeeding on discharge. Conclusion Addressing barriers to breast feeding through antenatal and early neonatal education, counselling and support, by qualified healthcare personnel may increase the number of infants exclusively breastfeeding on discharge.