Maternal Milk and Relationships to Early Neurobehavioral Outcome in Preterm Infants

Background: A premature infant is deprived of in-utero sensory experiences which are essential for normal brain development and rather is exposed to unusual sensory stimuli in the Neonatal Intensive Care Units (NICU) that pose risk to the developing brain in terms of adverse neurodevelopmental outcomes. The objective of this study was to study and compare the effect of specific physiotherapy intervention with multisensory stimulation on neurobehavioral outcome and weight gain in preterm infants. Inclusion criteria was preterm infants appropriate for gestational age more than 32 weeks, babies who were hemodynamically stable and babies receiving full enteral feeds. Exclusion criteria were major congenital anomalies, inability to undergo intervention (any fracture) or perinatal asphyxia. Methods: Eligible infants were randomly allocated into one of the two groups. Group A was offered multisensory stimulation: Auditory, Tactile, Visual and Vestibular (ATVV). Group B received Specific Physiotherapy Intervention (SPI) in form of kinesthetic exercises, oil massage and oral stimulation. The outcome was studied before and after intervention. Appropriate statistical tests were applied. Results: Both the groups had better suck co-ordination and improvement on neurobehavioral scale following intervention when compared to pre-intervention status (P<0.0001). When both groups were compared, SPI group had better sucking coordination than ATVV group, improvement in neurobehavioral scale was similar in either group.Conclusions: In preterm infants, Specific Physiotherapy Interventions are more effective in improving suck co-ordination, has better weight gain and are equally effective in improving neurobehavioral outcome compared to multisensory stimulation.

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Perinatal Risk and Protective Factors in the Development of Diffuse White Matter Abnormality on Term-Equivalent Age MRI in Infants Born Very Preterm

10.1101/2020.08.01.20166488 ◽

2020 ◽

Author(s):

Nehal A Parikh ◽

Puneet Sharma ◽

Lili He ◽

Hailong Li ◽

Mekibib Altaye ◽

...

Keyword(s):

White Matter ◽

Protective Factors ◽

Preterm Infants ◽

Brain Mri ◽

White Matter Abnormality ◽

Maternal Milk ◽

Very Preterm Infants ◽

Equivalent Age ◽

Very Preterm ◽

Diffuse White Matter

Importance: Diffuse white matter abnormality (DWMA) is the most common brain MRI finding in very preterm infants and is predictive of neurodevelopmental impairments. However, its etiology remains elusive and identifying perinatal risk and protective factors may allow clinicians to reduce the burden of DWMA. Objective: To identify perinatal clinical factors that are associated with the development of objectively diagnosed DWMA in very preterm infants. Design: A prospective cohort was enrolled between September 2016 and November 2019. Brain MRIs were collected at 39 to 45 weeks postmenstrual age (PMA) to evaluate DWMA volume. A pre-defined list of pertinent maternal characteristics, pregnancy/delivery data, and neonatal ICU data was collected for enrolled patients to identify antecedents of objectively diagnosed DWMA. Setting: Five level III/IV NICUs in the greater Cincinnati, Ohio area. Participants: A population-based sample of 392 very preterm infants born before 33 weeks gestational age. Exposure: Very preterm birth with associated diseases and treatments. Main Outcome and Measure: Objectively diagnosed DWMA volume on brain MRI at term-equivalent age. Results: 377 of the 392 very preterm infants (96%) had high quality MRI data. Mean (SD) gestational age was 29.3 (2.5) weeks. In multivariable linear regression analyses, pneumothorax (p=.027), severe bronchopulmonary dysplasia (BPD) (p=.009), severe retinopathy of prematurity (ROP) (p<0.001), and male sex (p=.041) were associated with increasing volume of DWMA. The following factors were associated with decreased risk of DWMA: dexamethasone for severe BPD (p=.004), duration of caffeine for severe BPD (p = 0.009), and exclusive maternal milk at NICU discharge (p=.049). Conclusions and Relevance: Severe ROP and BPD exhibited the strongest adverse association with the development of DWMA. Caffeine and dexamethasone treatments for infants with severe BPD exhibited a protective effect against development of DWMA. The beneficial association with maternal milk is also a modifiable factor that has clinical implications.

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