PIH18 ANALYSIS OF NECROTIZING ENTEROCOLITIS COSTS AMONG EXTREMELY PRETERM INFANTS FED EXCLUSIVELY HUMAN-MILK BASED DIET VS. HUMAN-MILK FORTIFIED WITH BOVINE-MILK BASED SUPPLEMENTS

Introduction: Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. Methods: A retrospective cohort study in extremely preterm infants (gestational age <28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. Results: A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. Conclusion: The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

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Neurodevelopmental and growth outcomes of extremely preterm infants with necrotizing enterocolitis or spontaneous intestinal perforation

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2020.05.013 ◽

2020 ◽

Cited By ~ 2

Author(s):

Carlos Zozaya ◽

Jyotsna Shah ◽

Agostino Pierro ◽

Augusto Zani ◽

Anne Synnes ◽

...

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Intestinal Perforation ◽

Growth Outcomes ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Spontaneous Intestinal Perforation

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Conservative Non-intervention Approach for Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants

Frontiers in Pediatrics ◽

10.3389/fped.2020.605134 ◽

2020 ◽

Vol 8 ◽

Author(s):

Se In Sung ◽

Yun Sil Chang ◽

So Yoon Ahn ◽

Heui Seung Jo ◽

Misun Yang ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Ductus Arteriosus ◽

Intervention Approach ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Surgical Treatments ◽

Minimal Evidence ◽

Patent Ductus

While persistent patent ductus arteriosus (PDA) in preterm infants has been known to be associated with increased mortality and morbidities including bronchopulmonary dysplasia, and necrotizing enterocolitis, there is minimal evidence supporting their causal relationships, and most traditional medical and/or surgical treatments have failed to show improvements in these outcomes. As such, the pendulum has swung toward the conservative non-intervention approach for the management of persistent PDA during the last decade; however, the benefits and risks of this approach are unclear. In this mini review, we focused on whom, when, and how to apply the conservative non-intervention approach for persistent PDA, especially in extremely preterm infants.

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Antenatal Exposure to Magnesium Sulfate and Spontaneous Intestinal Perforation and Necrotizing Enterocolitis in Extremely Preterm Neonates

American Journal of Perinatology ◽

10.1055/s-0037-1603344 ◽

2017 ◽

Vol 34 (12) ◽

pp. 1227-1233 ◽

Cited By ~ 5

Author(s):

Mohamed Shalabi ◽

Adel Mohamed ◽

Brigitte Lemyre ◽

Khalid Aziz ◽

Daniel Faucher ◽

...

Keyword(s):

Magnesium Sulfate ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Intestinal Perforation ◽

Preterm Neonates ◽

Network Database ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Using Data ◽

Spontaneous Intestinal Perforation

Background There have been recent concerns regarding the higher rates of spontaneous intestinal perforation (SIP) in preterm infants that have been exposed to intrapartum magnesium sulfate (MgSO4). Objective To assess the association between intrapartum MgSO4 exposure and necrotizing enterocolitis (NEC) and/or SIP in extremely preterm neonates. Design A retrospective cohort study was conducted using data from the Canadian Neonatal Network database. Infants born at < 28 weeks' gestation admitted to neonatal units in Canada between 2011 and 2014 were divided into two groups: those exposed antenatally to MgSO4 and those unexposed. Stratified analyses for infants born between 22 and 25 weeks' gestation and those born between 26 and 27 weeks' gestation were conducted. The primary outcome was intestinal injury, identified as either NEC or SIP. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression. Results We compared 2,300 unexposed infants with 2,055 exposed infants. There was no difference in the odds of NEC (9.88% exposed vs. 9.59% unexposed; aOR: 0.92; 95% CI: 0.75–1.14) or SIP (3.4% exposed vs. 3.39% unexposed; aOR: 1.05; 95% CI: 0.75–1.48) between the two groups. Conclusion Antenatal exposure to MgSO4 was not associated with NEC or SIP in extremely preterm infants.

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

Pediatric Research ◽

10.1038/s41390-021-01831-w ◽

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.

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Probiotic intervention to prevent necrotizing enterocolitis in extremely preterm infants born before 32 weeks of gestation or with a birth weight of less than 1500 g

Archivos Argentinos de Pediatria ◽

10.5546/aap.2021.eng.185 ◽

2021 ◽

Vol 119 (3) ◽

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Probiotic Intervention

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Nordic study on human milk fortification in extremely preterm infants: a randomised controlled trial—the N-forte trial

BMJ Open ◽

10.1136/bmjopen-2021-053400 ◽

2021 ◽

Vol 11 (11) ◽

pp. e053400

Author(s):

Georg Bach Jensen ◽

Fredrik Ahlsson ◽

Magnus Domellöf ◽

Anders Elfvin ◽

Lars Naver ◽

...

Keyword(s):

Breast Milk ◽

Human Milk ◽

Preterm Infants ◽

Ethical Review ◽

Human Breast Milk ◽

Human Breast ◽

Preterm Formula ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Randomised Controlled

IntroductionThe mortality rate of extremely low gestational age (ELGA) (born <gestational week 28+0) infants remains high, and severe infections and necrotising enterocolitis (NEC) are common causes of death. Preterm infants receiving human milk have lower incidence of sepsis and NEC than those fed a bovine milk-based preterm formula. Despite this, fully human milk fed ELGA infants most often have a significant intake of cow’s milk protein from bovine-based protein fortifier. The aim of this study is to evaluate whether the supplementation of human milk-based, as compared with bovine-based, nutrient fortifier reduces the prevalence of NEC, sepsis and mortality in ELGA infants exclusively fed with human milk.Methods and analysisA randomised-controlled multicentre trial comparing the effect of a human breast milk-based fortifier with a standard bovine protein-based fortifier in 222–322 ELGA infants fed human breast milk (mother’s own milk and/or donor milk). The infants will be randomised to either fortifier before reaching 100 mL/kg/day in oral feeds. The intervention, stratified by centre, will continue until the target postmenstrual week 34+0. The primary outcome is a composite of NEC, sepsis or death. Infants are characterised with comprehensive clinical and nutritional data collected prospectively from birth until hospital discharge. Stool, urine, blood and breast milk samples are collected for analyses in order to study underlying mechanisms. A follow-up focusing on neurological development and growth will be performed at 2 and 5.5 years of age. Health economic analyses will be made.Ethics and disseminationThe study is conducted according to ICH/GCP guidelines and is approved by the regional ethical review board in Linköping Sweden (Dnr 2018/193-31, Dnr 2018/384-32). Results will be presented at scientific meetings and published in peer-reviewed publications.Trial registration numberThe study was registered with ClinicalTrials.gov NCT03797157, 9 January 2019.

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