Feeding the feeble

2021 ◽  
pp. 265-272
Author(s):  
Michael Obladen
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Tube Feeding ◽  
Theoretical Knowledge ◽  
Air Inlet ◽  
Nasogastric Tubes ◽  
Nutritional Needs ◽  
The 1960S

This chapter describes historic steps in feeding techniques and knowledge about the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920: tube feeding by gavage, medicine droppers and pipettes, feeding bottles with air inlet, and beaked spoons for nasal feeding. Indwelling nasogastric tubes were in use from 1951. For alleged safety concerns, postnatal feeding was postponed until a week of starvation was reached in the 1950s and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been known since 1919. However, nutritional practice lagged behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants fed formula than in those fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Compared to other aspects of neonatal medicine, there is little evidence on how to feed preterm infants.

Feeding the feeble: steps towards nourishing preterm infants

2015 ◽  
Vol 43 (5) ◽  
Author(s):  
Michael Obladen
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Tube Feeding ◽  
Theoretical Knowledge ◽  
Air Inlet ◽  
Nutritional Needs ◽  
The 1960S ◽  
Feeding Techniques

AbstractThis paper describes historic steps in feeding techniques and knowledge on the nutritional needs of premature infants. Devices to overcome weak sucking and swallowing were developed from 1851 to 1920, including tube feeding by gavage, medicine droppers and pipettes, feeding bottles with an air inlet, and beaked spoons for nasal feeding. Indwelling nastrogastric tubes were in use from 1951. For alleged safety concerns in the 1950s, postnatal feeding was postponed until a week of starvation was reached, and studies showed an association with neurological handicaps. The premature infant’s elevated need for energy, protein, and minerals has been established since 1919. However, these remained controversial, and nutritional practices continued to lag behind theoretical knowledge. Concentrated formula was developed in the 1940s, parenteral supplementation in the 1960s, and human milk fortifiers in the 1970s. In the 1990s, necrotizing enterocolitis was found to be more frequent in infants who were fed formula than in those who were fed human milk. Recently, probiotics were shown to reduce the risk of necrotizing enterocolitis. Nevertheless, compared with other aspects of neonatal medicine, there is still remarkably little evidence on how to feed preterm infants.

scholarly journals How Gut Microbiota Supports Immunity, Growth and Development of Preterm Infants: A Narrative Review

2021 ◽  
Vol 5 (1SP) ◽  
pp. 14
Author(s):  
Ariani Dewi Widodo
Keyword(s):  
Gut Microbiota ◽  
Human Milk ◽  
Preterm Infants ◽  
Premature Infants ◽  
Growth And Development ◽  
Gastrointestinal Microbiome ◽  
Gut Dysbiosis ◽  
Complex Ecosystem ◽  
Full Enteral Feeding ◽  
Lower Morbidity

ABSTRACTBackground: Gut microbiota, a complex ecosystem consisting of abundant microorganisms, plays a role in preterm infants’ immunity, growth, and development. Dysbiosis or disruption of the gut microbiota can precipitate various diseases, such as allergy or autoimmune disorders in premature infants. Purpose: This study aimed to review gut microbiota in preterm infants and its role in supporting the infants’ immunity, growth, and development. Discussion: Bifidobactericeae is the predominant microbiota in GI tract of preterm infants. However, various factors can influence this gut microbiota e.g., genetics, lifestyle of the mothers (smoking, diet, use of antibiotic, obesity), birth mode, type of feeding, and environmental factors. Gut dysbiosis can result in impaired immune system which predisposes the preterm infants to infections, even fatal adverse event. Furthermore, the growth and development might be affected as well as lead to various neurodevelopmental and psychiatric disorders. Human milk is a prebiotic source which can stimulate the growth of Baifidobactericeae and Bacteroidetes. If the human milk is inadequate or unavailable, the recommended interventions for gut dysbiosis in premature infants are probiotics, prebiotics, or both supplementations (synbiotics). The administration of prebiotics and probiotics associates with lower morbidity and death rates in preterm infants, as well as shorter duration of hospital stay and duration to achieve full enteral feeding. Conclusions: Immunity as well as growth and development of preterm infants are affected greatly by gut microbiota The less diverse microbiota in preterm infants’ gut predispose them to various health problems. Hence, this problem should be managed properly, one of which is prebiotic and probiotic supplementation Keywords: Gastrointestinal Microbiome, Premature, Immunity, Growth, Development

scholarly journals Influence of Family Integrated Care on the Intestinal Microbiome of Preterm Infants With Necrotizing Enterocolitis and Enterostomy: A Preliminary Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Mengyang Yang ◽  
Juan Du ◽  
Qin Yang ◽  
Wenyan Dou ◽  
Min Jiang ◽  
...  
Keyword(s):  
Integrated Care ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Intestinal Flora ◽  
Intestinal Microbiome ◽  
Rrna Gene ◽  
Α Diversity ◽  
Family Integrated Care ◽  
Family Integrated

The aim of this study was to investigate the influence of family integrated care (FICare) on the intestinal microbiome of preterm infants with necrotizing enterocolitis and enterostomy. This was a prospective pilot study at Beijing Children's Hospital. Premature infants with an enterostomy who met the enrollment criteria were divided into the 2-week FICare and non-FICare groups (non-randomly). We collected their fecal samples and subjected the intestinal microbiomes to 16S rRNA gene sequencing. Operational taxonomic units (OTU) were analyzed to assess the intestinal microbiome richness, and we then carried out α-diversity, β-diversity, and species clustering analyses and a linear discriminant analysis (LDA) effect size (LEfSe) analysis to identify the differences in the microbial communities between the two groups. There were 12 patients enrolled in the study (FICare, n = 7; non-FICare, n = 5). There were no significant between-group differences in demographic characteristics, or in the relative abundances of phyla and genera. The major bacterial phyla were Proteobacteria, Firmicutes, and Actinobacteria, and Serratia, Enterococcus, Cronobacter, and Bifidobacterium dominated at the genus level. The α-diversity analysis indicated that the intestinal flora was more diverse in the non-FICare group than the FICare group (p < 0.05). However, most of the other indicators did not suggest a difference between the two groups. There was a high proportion of shared OTUs between the two groups, and the PCoA and clustering analyses indicated that the two groups were difficult to distinguish, indicating that the intestinal microbiomes were relatively similar between the groups. In summary, short-term FICare had no significant positive effect on the establishment of intestinal flora diversity in premature infants with necrotizing enterocolitis and enterostomy. The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-OPN-17011801).

scholarly journals The Role of Human Milk Oligosaccharides and Probiotics on the Neonatal Microbiome and Risk of Necrotizing Enterocolitis: A Narrative Review

Nutrients ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 3052
Author(s):  
Lila S. Nolan ◽  
Jamie M. Rimer ◽  
Misty Good
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Mode Of Delivery ◽  
Intestinal Barrier ◽  
Vulnerable Population ◽  
Human Milk Oligosaccharides ◽  
Milk Oligosaccharides ◽  
Intestinal Homeostasis

Preterm infants are a vulnerable population at risk of intestinal dysbiosis. The newborn microbiome is dominated by Bifidobacterium species, though abnormal microbial colonization can occur by exogenous factors such as mode of delivery, formula feeding, and exposure to antibiotics. Therefore, preterm infants are predisposed to sepsis and necrotizing enterocolitis (NEC), a fatal gastrointestinal disorder, due to an impaired intestinal barrier, immature immunity, and a dysbiotic gut microbiome. Properties of human milk serve as protection in the prevention of NEC. Human milk oligosaccharides (HMOs) and the microbiome of breast milk are immunomodulatory components that provide intestinal homeostasis through regulation of the microbiome and protection of the intestinal barrier. Enteral probiotic supplements have been trialed to evaluate their impact on establishing intestinal homeostasis. Here, we review the protective role of HMOs, probiotics, and synbiotic combinations in protecting a vulnerable population from the pathogenic features associated with necrotizing enterocolitis.

scholarly journals Placental Vascular Obstructive Lesions: Risk Factor for Developing Necrotizing Enterocolitis

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Laure Dix ◽  
Matthias Roth-Kleiner ◽  
Maria-Chiara Osterheld
Keyword(s):  
Risk Factor ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Premature Infants ◽  
Strong Association ◽  
Age Groups ◽  
Control Group ◽  
Age Group ◽  
Significant Difference ◽  
And Control

Necrotizing enterocolitis (NEC) is a severe neonatal disease affecting particularly preterm infants. Its exact pathogenesis still remains unknown. In this study, we have compared the prevalence of vascular obstructive lesions in placentae of premature newborns which developed NEC and of a control group. We further compared separately the findings of placentae of infants of less than 30 weeks of gestation, the age group in which NEC occurs most frequently. We found signs of fetal vascular obstructive lesions in 65% of the placentae of preterm patients developing NEC, compared to only 17% of the placentae of preterm patients in the control group. In the age groups below 30 weeks of gestation, 58.5% of placentae of later NEC patients presented such lesions compared to 24.5% in the control group. The significant difference between NEC and control group suggests a strong association between fetal vascular obstructive lesions and NEC. Therefore, we propose that fetal vascular obstructive lesions might be considered as a risk factor for the development of NEC in premature infants.

scholarly journals Tolerance in Preterm Infants Fed Exclusively with Human Milk. Prospective Analytic Study

2020 ◽  
pp. 01-06
Author(s):  
Pasqua Anna Quitadamo ◽  
Chiara Cisternino ◽  
Carmela Parente ◽  
Paola Lurdo ◽  
Massimiliano Copetti ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Premature Infants ◽  
Statistical Correlation ◽  
Analytic Study ◽  
Prospective Analysis ◽  
Food Tolerance ◽  
Donor Milk ◽  
Total Percentage ◽  
The Relationship

Human milk is the best feeding for premature infants. When Own Mother’s Milk (OMM) is insufficient or unavailable, the alternative is represented by the Donor Milk (DM). OMM and DM must be fortified to support the adequate growth. Objectives: Evaluation of the food tolerance on preterm fed exclusively with fortified Human Milk (HM). Materials and Methods: This prospective analysis has been performed on a sample of 48 preterm with GA ≤ 32 weeks. Gastric Residual (GR), Vomiting (V) and Feeding Suspension (FS) are the parameters performed. We identified two categories (OMM/DM) and 4 groups: newborns fed exclusively with OMM (EOMM), with prevalent OMM (POMM), with exclusively DM (EDM) and with prevalent DM (PDM). Results: The overall incidence of GRs was 18%, the incidence of bilious residuals was 4%, the incidence of Vs was 4.5%, there was no indication of blood in the stool, the total percentage of days of FS was 12.7%. There was no statistical correlation between the incidence of GR, V, FS in the two categories (OMM/DM). The relationship between the kind of feeding and the GA or the BW was not statistically significant. Conclusions: The study highlights the irreplaceability of the OMM in feeding the preterm and that the DM is a valid substitute of OMM.

Effectiveness of Human Milk-Based Fortifiers for Preventing Necrotizing Enterocolitis in Preterm Infants: Case Not Proven

2013 ◽  
Vol 8 (4) ◽  
pp. 421-421 ◽  
Author(s):  
Nicholas D. Embleton ◽  
Caroline King ◽  
Chris Jarvis ◽  
Helen Mactier ◽  
Freya Pearson ◽  
...  
Keyword(s):  
Human Milk ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis

Macronutrient analysis of preterm human milk using mid-infrared spectrophotometry

2019 ◽  
Vol 47 (7) ◽  
pp. 785-791 ◽  
Author(s):  
Özgül Bulut ◽  
Asuman Çoban ◽  
Zeynep İnce
Keyword(s):  
Breast Milk ◽  
Human Milk ◽  
Preterm Infants ◽  
High Body Mass Index ◽  
Income Level ◽  
Human Breast Milk ◽  
Human Breast ◽  
Mid Infrared ◽  
Macronutrient Content ◽  
Nutritional Needs

Abstract Background Human milk is the optimal source of nutrition for preterm infants. However, breast milk alone is often not sufficient to satisfy the high nutritional needs for growth and development in preterm infants. Fortified human breast milk is the best way to meet the nutritional needs of preterm infants. Human breast milk is fortified according to the estimated nutrient content of mature breast milk; however, because the content of breast milk is highly variable, the macronutrient support may be more or less than needed. The goal of this study was to analyze the macronutrient content of preterm human milk during the first 6 weeks of lactation. Methods The study included 32 mothers of preterm infants with a gestational age of ≤32 weeks. Breast milk was collected in 24-h cycles and analyzed daily using mid-infrared (MIR) spectroscopy. We measured protein, fat and lactose concentrations in the breast milk, and the energy content was calculated. Results The protein content was high during the first weeks of lactation, but decreased as lactation progressed. The fat, energy and lactose contents of the breast milk were low during the first 2 weeks of lactation, increased as lactation progressed and remained constant thereafter. In women with high body mass index (BMI), higher protein levels were found in transitional milk. In women who had high income level, higher fat and energy levels were found in transitional milk. Conclusion Our findings indicate that the macronutrient content of preterm breast milk changes throughout the course of lactation, with BMI and income level. Knowledge of the macronutrient composition of breast milk is necessary to ensure that preterm infants receive the appropriate types and quantities of nutrients to promote optimal growth, and to ensure that breast milk is fortified according to individual needs. Our findings may be useful for the provision of optimal nutritional support for preterm infants.

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