Short versus Extended Duration of Trophic Feeding to Reduce Time to Achieve Full Enteral Feeding in Extremely Preterm Infants: An Observational Study

Neonatology ◽  
2017 ◽  
Vol 112 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Ariel A. Salas ◽  
Nazia Kabani ◽  
Colm P. Travers ◽  
Vivien Phillips ◽  
Namasivayam Ambalavanan ◽  
...  
Keyword(s):  
Observational Study ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Extended Duration ◽  
Full Enteral Feeding ◽  
Trophic Feeding

scholarly journals Early progressive feeding in extremely preterm infants: a randomized trial

2018 ◽  
Vol 107 (3) ◽  
pp. 365-370 ◽  
Author(s):  
Ariel A Salas ◽  
Peng Li ◽  
Kelli Parks ◽  
Charitharth V Lal ◽  
Camilia R Martin ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Enteral Feeding ◽  
Primary Outcome ◽  
Central Venous Access ◽  
Venous Access ◽  
Feeding Group ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Postmenstrual Age ◽  
Full Enteral Feeding

ABSTRACT Background Due to insufficient evidence, extremely preterm infants (≤28 wk of gestation) rarely receive early progressive feeding (small increments of feeding volumes between 1 and 4 d after birth). We hypothesized that early progressive feeding increases the number of full enteral feeding days in the first month after birth. Objective The aim of this study was to determine the feasibility and efficacy of early progressive feeding in extremely preterm infants. Design In this single-center randomized trial, extremely preterm infants born between September 2016 and June 2017 were randomly assigned to receive either early progressive feeding without trophic feeding (early feeding group) or delayed progressive feeding after a 4-d course of trophic feeding (delayed feeding group). Treatment allocation occurred before or on feeding day 1. The primary outcome was the number of full enteral feeding days in the first month after birth. Secondary outcomes were death, necrotizing enterocolitis (NEC), culture-proven sepsis, growth percentiles at 36 wk postmenstrual age, use of parenteral nutrition, and need for central venous access. Results Sixty infants were included (median gestational age: 26 wk; mean ± SD birth weight: 832 ± 253 g). The primary outcome differed between groups (median difference favoring the early feeding group: +2 d; 95% CI: 0, 3 d; P = 0.02). Early progressive feeding reduced the use of parenteral nutrition (4 compared with 8 d; P ≤ 0.01) and the need for central venous access (9 compared with 13 d; P ≤ 0.01). The outcome of culture-proven sepsis (10% compared with 27%; P = 0.18), restricted growth (weight, length, and head circumference <10th percentile) at 36 wk postmenstrual age (25% compared with 50%; P = 0.07), and the composite outcome of NEC or death (27% compared with 20%; P = 0.74) did not differ between groups. Conclusion Early progressive feeding increases the number of full enteral feeding days in extremely preterm infants. This trial was registered at www.clinicaltrials.gov as NCT02915549.

scholarly journals The gut microbiome of extremely preterm infants randomized to the early progression of enteral feeding

2021 ◽  
Author(s):  
Ariel A. Salas ◽  
Kent A. Willis ◽  
Waldemar A. Carlo ◽  
Nengjun Yi ◽  
Li Zhang ◽  
...  
Keyword(s):  
Human Milk ◽  
Microbial Diversity ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Gut Microbiome ◽  
Mode Of Delivery ◽  
Early Feeding ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Early Progression

Abstract Background Early progression of feeding could influence the development of the gut microbiome. Methods We collected fecal samples from extremely preterm infants randomized to receive either early (feeding day 2) or delayed (feeding day 5) feeding progression. After study completion, we compared samples obtained at three different time points (week 1, week 2, and week 3) to determine longitudinal differences in specific taxa between the study groups using unadjusted and adjusted negative binomial and zero-inflated mixed models. Analyses were adjusted for a mode of delivery, breastmilk intake, and exposure to antibiotics. Results We analyzed 137 fecal samples from 51 infants. In unadjusted and adjusted analyses, we did not observe an early transition to higher microbial diversity within samples (i.e., alpha diversity) or significant differences in microbial diversity between samples (i.e., beta diversity) in the early feeding group. Our longitudinal, single-taxon analysis found consistent differences in the genera Lactococcus, Veillonella, and Bilophila between groups. Conclusions Differences in single-taxon analyses independent of the mode of delivery, exposure to antibiotics, and breastmilk feeding suggest potential benefits of early progression of enteral feeding volumes. However, this dietary intervention does not appear to increase the diversity of the gut microbiome in the first 28 days after birth. Trial Registration ClinicalTrials.gov identifier: NCT02915549. Impact Early progression of enteral feeding volumes with human milk reduces the duration of parenteral nutrition and the need for central venous access among extremely preterm infants. Early progression of enteral feeding leads to single-taxon differences in longitudinal analyses of the gut microbiome, but it does not appear to increase the diversity of the gut microbiome in the first 28 days after birth. Randomization in enteral feeding trials creates appealing opportunities to evaluate the effects of human milk diets on the gut microbiome.

scholarly journals Improved nutrition for extremely preterm infants – A population based observational study

2018 ◽  
Vol 23 ◽  
pp. 245-251 ◽  
Author(s):  
Vera Westin ◽  
Susanna Klevebro ◽  
Magnus Domellöf ◽  
Mireille Vanpée ◽  
Boubou Hallberg ◽  
...  
Keyword(s):  
Observational Study ◽  
Preterm Infants ◽  
Population Based ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Effect of Enteral Vitamin A on Fecal Calprotectin in Extremely Preterm Infants: A Nested Prospective Observational Study

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Abhijeet A. Rakshasbhuvankar ◽  
J. Jane Pillow ◽  
Sanjay Keshav Patole ◽  
Elizabeth A. Nathan ◽  
Karen Simmer
Keyword(s):  
Placebo Group ◽  
Vitamin A ◽  
Observational Study ◽  
Preterm Infants ◽  
Prospective Observational Study ◽  
Fecal Calprotectin ◽  
Water Soluble ◽  
Water Soluble Vitamin ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

<b><i>Background:</i></b> Vitamin A has anti-inflammatory and immune-modulating properties. We aimed to assess whether enteral water-soluble vitamin A supplementation in extremely preterm infants decreases fecal calprotectin, a marker of intestinal inflammation. <b><i>Methods:</i></b> This was a prospective observational study nested in a randomized, double-blind, placebo-controlled clinical trial investigating enteral vitamin A (5,000 IU/day) for reducing the severity of bronchopulmonary dysplasia (BPD) in extremely preterm infants. Fecal calprotectin levels were measured using enzyme-linked immunosorbent assay after 28 days of Vitamin A or placebo supplementation. <b><i>Results:</i></b> Fecal calprotectin was measured in 66 infants (Vitamin A: 33, Placebo: 33). The mean (standard deviation) gestational age (25.5 [1.55] vs. 25.8 [1.48]; <i>p</i> = 0.341) (week), birth weight (810 [200] vs. 877 [251]; <i>p</i> = 0.240) (gram), and factors influencing fecal calprotectin levels were comparable between the vitamin A versus placebo group infants. All infants were exclusively fed with mother’s or donor’s human breast milk if mother’s milk was unavailable using a standardized feeding regimen and received prophylactic probiotic supplementation. Fecal calprotectin levels (median; 25th–75th centiles) (micrograms/gram of feces) were not significantly different between vitamin A (152; 97–212) and placebo groups (179; 91–313) (<i>p</i> = 0.195). Two infants in the vitamin A group developed definite necrotizing enterocolitis compared to none in the placebo group. Incidence of BPD at 36 weeks postmenstrual age was similar between the groups (vitamin A: 18/33, placebo: 13/33, <i>p</i> = 0.218). <b><i>Conclusion:</i></b> Enteral supplementation with water-soluble vitamin A did not affect fecal calprotectin levels in extremely preterm infants. Studies with a larger sample size are required to confirm the findings.

scholarly journals Clinical effects of breast milk enema on meconium evacuation in premature infants: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Liqiang Zheng ◽  
Li Gai ◽  
Jinyue Gao ◽  
Chaonan Kong ◽  
Yali Wang ◽  
...  
Keyword(s):  
Breast Milk ◽  
Preterm Infants ◽  
Premature Infants ◽  
Enteral Feeding ◽  
Controlled Trial ◽  
Block Design ◽  
Clinical Effects ◽  
Study Results ◽  
Extremely Preterm ◽  
Full Enteral Feeding

Abstract Background Delayed meconium evacuation is an important cause of intestinal dysfunction in preterm infants. There are many methods to induce defecation in preterm infants: however, the effects are controversial. Finding a new intervention method to promote meconium evacuation in premature infants is necessary. Therefore, in the proposed study, the effectiveness of breast milk enema on complete meconium evacuation and time to achieve full enteral feeding will be investigated in preterm infants. Methods/design The study is a randomized, open-label, parallel-group, and single-center clinical trial. A total of 294 preterm infants will be recruited and stratified based on gestational age. Then, the infants will be assigned in a randomized block design to the intervention and control groups with a 1:1 ratio. Preterm infants in the control and intervention groups will receive saline enema and breast milk enema, respectively. The primary outcomes will be the time to achieve complete meconium evacuation from birth and time to achieve full enteral feeding from birth in preterm infants. The secondary outcomes will include hospitalization days, body weight at discharge, duration of total parenteral nutrition, cholestasis, and adverse events. Discussion The results of this trial will determine whether breast milk enema shortens the time to complete meconium evacuation and the time to achieve full enteral feeding in extremely preterm and preterm infants. Furthermore, the study results may provide a new, safe, inexpensive, and easy-to-use intervention to effectively evacuate meconium in preterm infants. Trial registration ISRCTN Registry ISRCTN17847514. Registered on September 14, 2019

Life expectancy of extremely preterm infants

2007 ◽  
Vol 148 (48) ◽  
pp. 2279-2284 ◽  
Author(s):  
Gabriella Vida ◽  
Ilona Sárkány ◽  
Simone Funke ◽  
Judit Gyarmati ◽  
Judit Storcz ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Preterm Infants ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Optimális esetben a 24–28. gesztációs hét közötti, igen éretlen újszülöttek olyan szülészeti intézményben születnek, ahol neonatalis intenzív centrum működik, így mind az akut, mind a hosszú távú ellátásukat magas színvonalon biztosítják. A PTE OEKK ÁOK Szülészeti és Nőgyógyászati Klinikán 2000. január 1. és 2004. december 31. között 7499 újszülött született. A koraszülési frekvencia 20% (1499/7499), ezen belül az extrém alacsony gesztációs korúak aránya (≦28. gesztációs hét) 18% (272/1499), míg a 25. gesztációs hét alattiaké 3,2% (48/1499) volt. A túlélés a gesztációs hetek emelkedésével fokozatosan javul. Az életben maradt koraszülöttek későbbi életkilátásai és társadalmi beilleszkedése függ az olyan maradandó károsodásoktól, mint a látáscsökkenés, halláskárosodás, somatomentalis fejlődés zavarai, krónikus tüdőbetegség. A klinikán vizsgált alacsony gesztációs korú csoportban az összes fogyatékkal élő betegek aránya 15,3%. Döntő többségük a 25. gesztációs hétnél korábban született koraszülöttek közül kerül ki. A 26. gesztációs héttől a koraszülöttek több mint fele tartós károsodás nélkül éli túl az extrém éretlenség társuló problémáit. Megállapították, hogy a korai koponya-ultrahangvizsgálattal, szemészeti szűréssel, otoacusticus emissio mérésével jól prognosztizálhatók a maradandó károsodások, így lehetővé válik a korai kezelés.

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