How does continuous nasogastric milk feeding compare with intermittent bolus milk feeding for preterm infants?

Optimization of nutritional management of preterm infants is crucial for achievement of their long-term health. Enteral nutrition is preferred to total parenteral nutrition (TPN) because the former avoids complications related to vascular catheterization, sepsis, adverse effects of TPN, and fasting. Due to the lack of ability of preterm infants to coordinate suckling, swallowing, and breathing, tube feeding is necessary for most infants less than 1500 g to ensure sufficient feeding tolerance, to support optimal growth and to reduce the risk of aspiration. Therefore, feeding by orogastric or nasogastric tube using either continuous or intermittent bolus delivery of formula or human milk is common practice for these infants. Theoretical risks and benefits of both continuous nasogastric milk feeding and intermittent bolus milk feeding have been proposed. According to the literature, continuous nutrition could be preferred in smaller infants (as those with a birthweight below 1250 g) or hemodynamically impaired infants; in stable growing infants nutrition can be administered intermittently as in healthy term infants.

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Continuous Versus Intermittent Bolus Feeding in Very Preterm Infants - Effect on Respiratory Morbidity

Case Medical Research ◽

10.31525/ct1-nct03961139 ◽

2019 ◽

Author(s):

Keyword(s):

Preterm Infants ◽

Respiratory Morbidity ◽

Very Preterm Infants ◽

Very Preterm ◽

Intermittent Bolus

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Intermittent Kangaroo Mother Care and the Practice of Breastfeeding Late Preterm Infants: Results from Four Hospitals in Different Provinces of China

10.21203/rs.2.18645/v2 ◽

2020 ◽

Author(s):

Bo Zhang ◽

Zhiying Duan ◽

Yingxi Zhao ◽

Sarah Williams ◽

Stephen Wall ◽

...

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Exclusive Breastfeeding ◽

Kangaroo Mother Care ◽

Late Preterm ◽

Feeding Practice ◽

Late Preterm Infants ◽

Breastfeeding Rate ◽

Milk Feeding

Abstract Background China has an extremely low exclusive breastfeeding rate. Kangaroo mother care (KMC) has been shown to increase the exclusive breastfeeding rate among infants born extremely or very preterm. However, there is limited evidence surrounding intermittent KMC and exclusive breastfeeding in late preterm infants. In our study we investigated the association between the provision of intermittent KMC and breastfeeding practice for late preterm infants in four hospitals in different provinces of China. Methods Intermittent KMC was recommended to the mothers of all preterm infants admitted to the postnatal wards of participating hospitals between March 2018 and March 2019. Those who agreed to practice KMC were enrolled in the “KMC group”, those who did not were enrolled in the “No KMC group”. Basic maternal socio-demographic information was collected, feeding practice; outcome and method, were recorded daily whilst in hospital. A follow-up survey of feeding practice was conducted 42 days after discharge. Calculations for feeding practice were performed separately for both groups. Logistics regression was used to analyze the association between KMC and feeding outcome and method, adjusting for socio-demographic covariates. Results Among the 844 mothers participating in the study, 627 (74.3%) chose to perform KMC. More of the mothers who provided KMC were exclusively breast milk feeding their infants in the 24 hours before hospital discharge (54.6%) and at follow-up (57.3%), compared to mothers who did not provide KMC (34.6% at discharge and 33.2% at follow-up,). Mothers in the KMC group were more likely to be breastfeeding (method) than mothers in the No KMC group (65.3% vs. 52.1% at discharge, and 83.1% vs. 67.3% at follow up). Logistic regression indicated that compared with the No KMC group, mothers who provided KMC were twice as likely to be exclusively breast milk feeding their infants at discharge (OR=2.15 (1.53-3.02)), use breastfeeding method at discharge as opposed to other means such as bottle or cup feeding (OR=1.61 (1.15-2.25)), be exclusive breast milk feeding at follow-up (OR=2.55 (1.81-3.61)), and use breastfeeding method at follow-up (OR=2.09 (1.44-3.02)). Conclusions Intermittent KMC was associated with a nearly doubled increase in exclusive breast milk feeding (outcome) and breastfeeding (method) at both discharge and 42 days after discharge for late preterm infants. This is especially important in China where exclusive breastfeeding rates are low, intermittent KMC provides a feasible means to increase the likelihood of these vulnerable infants receiving the benefits of exclusive breastmilk.

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Alkaline phosphatase isoenzymes in the plasma of preterm and term infants: serial measurements and clinical correlations.

Clinical Chemistry ◽

10.1093/clinchem/33.10.1783 ◽

1987 ◽

Vol 33 (10) ◽

pp. 1783-1787 ◽

Cited By ~ 21

Author(s):

P M Crofton ◽

R Hume

Keyword(s):

Alkaline Phosphatase ◽

Preterm Infants ◽

Intestinal Alkaline Phosphatase ◽

Group Status ◽

Term Infants ◽

Alkaline Phosphatase Isoenzymes ◽

Preterm Babies ◽

Clinical Correlations ◽

Serial Measurements ◽

Milk Feeding

Abstract Serial measurements of the bone and fetal intestinal isoenzymes of alkaline phosphatase (EC 3.1.3.1) in the plasma of 43 term and 43 preterm infants, from birth to six weeks later, indicate that the bone isoenzyme gradually increases over this period in both preterm and term infants fed with unsupplemented commercial formulas. Preterm babies given formula supplemented with calcium (with or without additional phosphate) had significantly lower bone isoenzyme activities for most of the study period. The concentrations of fetal intestinal isoenzyme increased, under the stimulation of milk feeding, from generally undetectable at birth to a peak during the first two weeks postpartum, and then declined. This increase was highly significantly negatively correlated with gestational age, the preterm infants having a much higher and more prolonged increase in this isoenzyme than did term infants. Unlike the adult isoenzyme, fetal intestinal alkaline phosphatase in plasma showed no relationship with blood group status.

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Concentrating human milk: an innovative point-of-care device designed to increase human milk feeding options for preterm infants

Journal of Perinatology ◽

10.1038/s41372-020-00820-x ◽

2020 ◽

Author(s):

Elizabeth R. Schinkel ◽

Elizabeth R. Nelson ◽

Bridget E. Young ◽

Robin M. Bernstein ◽

Sarah N. Taylor ◽

...

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Point Of Care ◽

Milk Feeding

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Human milk as a protective factor for bronchopulmonary dysplasia: a systematic review and meta-analysis

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-314205 ◽

2018 ◽

Vol 104 (2) ◽

pp. F128-F136 ◽

Cited By ~ 12

Author(s):

Jinglan Huang ◽

Li Zhang ◽

Jun Tang ◽

Jing Shi ◽

Yi Qu ◽

...

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Protective Factor ◽

Meta Analysis ◽

Statistical Significance ◽

Current Evidence ◽

Inclusion Criteria ◽

Formula Group ◽

Milk Feeding

ObjectiveTo summarise current evidence evaluating the effects of human milk on the risk of bronchopulmonary dysplasia (BPD) in preterm infants.DesignWe searched for studies on human milk and BPD in English and Chinese databases on 26 July 2017. Furthermore, the references of included studies were also screened. The inclusion criteria in this meta-analysis were the following: (1) preterm infants (<37 weeks); (2) human milk; (3) comparing with formula feeding; (4) the outcome included BPD; and (5) the type of study was randomised controlled trial (RCT) or cohort study.ResultA total of 17 cohort studies and 5 RCTs involving 8661 preterm infants met our inclusion criteria. The ORs and 95% CIs of six groups were as follows: 0.78 (0.68 to 0.88) for exclusive human milk versus exclusive formula group, 0.77 (0.68 to 0.87) for exclusive human milk versus mainly formula group, 0.76 (0.68 to 0.87) for exclusive human milk versus any formula group, 0.78 (0.68 to 0.88) for mainly human milk versus exclusive formula group, 0.83 (0.69 to 0.99) for mainly human milk versus mainly formula group and 0.82 (0.73 to 0.93) for any human milk versus exclusive formula group. Notably, subgroup of RCT alone showed a trend towards protective effect of human milk on BPD but no statistical significance.ConclusionBoth exclusive human milk feeding and partial human milk feeding appear to be associated with lower risk of BPD in preterm infants. The quality of evidence is low. Therefore, more RCTs of this topic are needed.

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