Rapid Versus Slow Advancement of Feeds in Preterm Babies Less than 34 Weeks in Incidence of NEC and Feed Intolerance

Background: Preterm babies with abnormal doppler velocimetry during second and third trimesters of pregnancy pose various early neonatal morbidities like recurrent hypoglycaemia, feed intolerance and prolonged hospital stay. In our study we compared the incidence of hypoglycaemia, feed intolerance, risk of necrotising enterocolitis (NEC) and length of hospital stay among preterm babies with abnormal doppler flow to the gestational age matched preterm babies with normal umbilical artery doppler flow velocimetry.Methods: 30 preterm babies who had abnormal umbilical artery flow during their last antenatal doppler scan were included as study group and gestational age matched 30 preterm babies who had normal doppler study had been taken as controls. The incidence of hypoglycaemia, feed intolerance, NEC, length of hospital stay had been compared between two groups.Results: The case group with abnormal umbilical artery doppler had increased incidence of hypoglycaemia (15 of 30 babies in case versus 5 of 30 babies in control) which was statistically significant. Feed intolerance, necrotizing enterocolitis and length of hospital stay were all significantly increased in preterm babies with abnormal umbilical artery doppler when compared to preterm babies with normal umbilical artery doppler flow.Conclusions: Preterm babies with abnormal umbilical artery doppler were at increased risk of hypoglycaemia, feed intolerance, NEC and prolonged hospital stay. Knowledge on this is important to monitor closely for hypoglycaemia, gradually increase feeds and explain parents about expected morbidities which can increase the length of hospital stay in neonatal intensive care unit (NICU).

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Evaluation of A Concentrated Preterm Formula as a Liquid Human Milk Fortifier in Preterm Babies at Increased Risk of Feed Intolerance

Nutrients ◽

10.3390/nu10101433 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1433 ◽

Cited By ~ 3

Author(s):

Anish Pillai ◽

Susan Albersheim ◽

Julie Matheson ◽

Vikki Lalari ◽

Sylvia Wei ◽

...

Keyword(s):

Human Milk ◽

Preterm Infants ◽

Clinical Decision ◽

Feeding Intolerance ◽

Serious Adverse Events ◽

Increased Risk ◽

Preterm Formula ◽

Feed Intolerance ◽

Preterm Babies ◽

Human Milk Fortifier

There are concerns around safety and tolerance of powder human milk fortifiers to optimize nutrition in preterm infants. The purpose of this study was to evaluate the tolerance and safety of a concentrated preterm formula (CPF) as a liquid human milk fortifier (HMF) for premature infants at increased risk of feeding intolerance. We prospectively enrolled preterm infants over an 18-month period, for whom a clinical decision had been made to add CPF to human milk due to concerns regarding tolerance of powder HMF. Data on feed tolerance, anthropometry, and serum biochemistry values were recorded. Serious adverse events, such as mortality, necrotizing enterocolitis (NEC), and sepsis, were monitored. A total of 29 babies received CPF fortified milk during the study period. The most common indication for starting CPF was previous intolerance to powder HMF. Feeding intolerance was noted in 4 infants on CPF. The growth velocity of infants was satisfactory (15.9 g/kg/day) after addition of CPF to feeds. The use of CPF as a fortifier in preterm babies considered at increased risk for feed intolerance seems well tolerated and facilitates adequate growth. Under close nutrition monitoring, this provides an additional option for human milk fortification in this challenging subgroup of preterm babies, especially in settings with limited human milk fortifier options.

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Urine NMR Metabolomics Profile of Preterm Infants With Necrotizing Enterocolitis Over the First Two Months of Life: A Pilot Longitudinal Case-Control Study

Frontiers in Molecular Biosciences ◽

10.3389/fmolb.2021.680159 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jean-Charles Picaud ◽

Anna De Magistris ◽

Michele Mussap ◽

Sara Corbu ◽

Angelica Dessì ◽

...

Keyword(s):

Birth Weight ◽

Necrotizing Enterocolitis ◽

Very Low Birth Weight ◽

Late Onset ◽

Analysis Data ◽

Case Control ◽

Proton Nuclear Magnetic Resonance ◽

Feed Intolerance ◽

Preterm Babies ◽

Preterm Newborns

Objective: To investigate changes in the urine metabolome of very low birth weight preterm newborns with necrotizing enterocolitis (NEC) and feed intolerance, we conducted a longitudinal study over the first 2 months of life. The metabolome of NEC newborns was compared with two control groups that did not develop NEC: the first one included preterm babies with feed intolerance, while the second one preterm babies with good feed tolerance.Methods: Newborns developing NEC within the 3 weeks of life were identified as early onset NEC, while the remaining as late onset NEC. Case-control matching was done according to the gestational age (±1 week), birth weight (± 200 g), and postnatal age. A total of 96 urine samples were collected and analyzed. In newborns with NEC, samples were collected before, during and after the diagnosis over the first 2 months of life, while in controls samples were collected as close as possible to the postnatal age of newborns with NEC. Proton nuclear magnetic resonance (1H NMR) spectroscopy was used for metabolomic analysis. Data were analyzed by univariate and multivariate statistical analysis.Results: In all the preterm newborns, urine levels of betaine, glycine, succinate, and citrate positively correlated with postnatal age. Suberate and lactate correlated with postnatal age in preterms with NEC and in controls with food intolerance, while N,N-dimethylglycine (N,N-DMG) correlated only in controls with good digestive tolerance. Preterm controls with feed intolerance showed a progressive significant decrease of N-methylnicotinamide and carnitine. Lactate, betaine, myo-inositol, urea, creatinine, and N,N-dimethylglycine discriminated late-onset NEC from controls with good feed tolerance.Conclusion: Our findings are discussed in terms of contributions from nutritional and clinical managements of patients and gut microbiota.

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