Management strategies of functional intestinal obstruction of prematurity

Functional intestinal obstruction of prematurity (FIOP) is characterised by a partial or complete failure of meconium evacuation due to hypomotility of the immature bowel and this presents with features of intestinal obstruction typically within the first 2 weeks of life. It contributes significantly to the morbidity and mortality of extremely and very low birth weight preterm infants. This disorder has been described using many terminologies and there is controversy amidst clinicians as to the optimal approach to its management. This review summarises the characteristic clinical and radiologic findings to aid timely diagnosis and initiation of prompt treatment. Available evidence on different treatment options and their limitations is reviewed and practical stepwise management is described. In most cases, FIOP can be successfully managed conservatively with proactive management and monitoring. Overall outcomes are favourable and normal long-term gastrointestinal function is commonly experienced. Evidence for investigations to exclude cystic fibrosis and Hirschsprung’s disease in preterm infants with FIOP is evaluated and a link with focal intestinal perforation is highlighted.

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Proactive Management Promotes Outcome in Extremely Preterm Infants: A Population-Based Comparison of Two Perinatal Management Strategies

Yearbook of Obstetrics Gynecology and Women s Health ◽

10.1016/s1090-798x(08)70406-5 ◽

2006 ◽

Vol 2006 ◽

pp. 158-159

Author(s):

P.P. van den Berg

Keyword(s):

Preterm Infants ◽

Management Strategies ◽

Population Based ◽

Proactive Management ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Perinatal Management

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Proactive Management Promotes Outcome in Extremely Preterm Infants: A Population-Based Comparison of Two Perinatal Management Strategies

PEDIATRICS ◽

10.1542/peds.114.1.58 ◽

2004 ◽

Vol 114 (1) ◽

pp. 58-64 ◽

Cited By ~ 101

Author(s):

S. Hakansson

Keyword(s):

Preterm Infants ◽

Management Strategies ◽

Population Based ◽

Proactive Management ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Perinatal Management

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Neurodevelopmental assessment of very low birth weight preterm infants at corrected age of 18-24 months by Bayley III scales

Jornal de Pediatria ◽

10.2223/jped.2230 ◽

2012 ◽

Cited By ~ 3

Author(s):

Luciana Volpiano Fernandes ◽

Ana Lucia Goulart ◽

Amélia Miyashiro Nunes dos Santos ◽

Marina Carvalho de Moraes Barros ◽

Camila Campos Guerra ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Very Low Birth Weight

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Early hyperglycaemia was linked to a risk of late‐onset sepsis in very low birth weight preterm infants in a neonatal intensive care unit

Acta Paediatrica ◽

10.1111/apa.16007 ◽

2021 ◽

Author(s):

Paolo Manzoni ◽

Alessandro Messina ◽

Simone Ceratto ◽

Eleonora Tognato ◽

Mauro Stronati ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Low Birth Weight ◽

Neonatal Intensive Care Unit ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Late Onset ◽

Late Onset Sepsis

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Bone Mineral Density, Body Composition, and Metabolic Health of Very Low Birth Weight Infants Fed in Hospital Following Current Macronutrient Recommendations during the First 3 Years of Life

Nutrients ◽

10.3390/nu13031005 ◽

2021 ◽

Vol 13 (3) ◽

pp. 1005

Author(s):

Walter Mihatsch ◽

Izaskun Dorronsoro Martín ◽

Vicente Barrios-Sabador ◽

María L. Couce ◽

Gabriel Á. Martos-Moreno ◽

...

Keyword(s):

Bone Mineral Density ◽

Health Outcome ◽

Body Composition ◽

Preterm Infants ◽

Bone Mineral ◽

Very Low Birth Weight ◽

Metabolic Health ◽

Mineral Density ◽

Term Infants ◽

Vlbw Infants

The present study longitudinally evaluated growth, bone mineral density, body composition, and metabolic health outcome in very low birth weight (VLBW) infants whose in-hospital target nutrient intake was within recent recommendations. From six months to three years, bone mineral density (dual-energy X-ray absorptiometry, DXA), body composition, and metabolic health outcome were compared with a reference group of term infants. The aim was to test whether in-hospital achieved weight gain until 36 weeks of gestation (light or appropriate for term equivalent age; LTEA or ATEA) predicts later growth, bone mineral density (BMD), abdominal obesity, or metabolic health outcomes such as insulin resistance, relative to term infants, during the first three years of life. Target in-hospital energy and protein intake was not achieved. Growth in weight, length and head circumference, mid arm circumference, adiposity, fat free mass (FFM), and bone mineralization in VLBW infants was less than those in term infants and influenced by nutritional status at discharge. Preterm infants had poorer motor and cognitive outcomes. Post-discharge body composition patterns indicate FFM proportional to height but lower fat mass index in LTEA preterm infants than term infants, with no evidence of increased truncal fat in preterm infants. The hypothesis of early BMD catch-up in VLBW infants after discharge was not supported by the present data. The clinical significance of these findings is unclear. The data may suggest a reduced obesity risk but an increased osteoporosis risk. Since postnatal growth restriction may have permanent negative health effects, LTEA VLBW infants would especially appear to benefit from targeted preventive interventions. Further follow-up of the infants is required.

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Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03510-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiajia Jing ◽

Yiheng Dai ◽

Yanqi Li ◽

Ping Zhou ◽

Xiaodong Li ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Very Low Birth Weight ◽

Postnatal Growth ◽

Weight Increase ◽

Antenatal Corticosteroids ◽

Lung Maturation ◽

Growth Outcomes

Abstract Background Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants. Methods A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23–37 weeks’ gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes. Results A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54–25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed. Conclusions Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.

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The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

BioMed Research International ◽

10.1155/2018/6832685 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Jin-Jiao Li ◽

Jacqueline P. W. Chung ◽

Sha Wang ◽

Tin-Chiu Li ◽

Hua Duan

Keyword(s):

Surgical Treatment ◽

Minimally Invasive ◽

Treatment Options ◽

Management Strategies ◽

Definitive Treatment ◽

Surgical Approaches ◽

Child Bearing ◽

Fertility Sparing

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.

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A Systematic Review and Meta-Analysis of Human Milk Feeding and Short-Term Growth in Preterm and Very Low Birth Weight Infants

Nutrients ◽

10.3390/nu13062089 ◽

2021 ◽

Vol 13 (6) ◽

pp. 2089

Author(s):

Machiko Suganuma ◽

Alice R. Rumbold ◽

Jacqueline Miller ◽

Yan Fong Chong ◽

Carmel T. Collins

Keyword(s):

Systematic Review ◽

Birth Weight ◽

Human Milk ◽

Preterm Infants ◽

Very Low Birth Weight ◽

Meta Analysis ◽

Poor Quality ◽

Low Birth Weight Infants ◽

Preterm Formula ◽

Meta Analyses

Human milk (HM) is the gold standard for feeding infants but has been associated with slower growth in preterm infants compared with preterm formula. This systematic review and meta-analysis summarises the post-1990 literature to examine the effect of HM feeding on growth during the neonatal admission of preterm infants with birth weight ≤1500 g and/or born ≤28 weeks’ gestation. Medline, PubMed, CINAHL, and Scopus were searched, and comparisons were grouped as exclusive human milk (EHM) vs. exclusive preterm formula (EPTF), any HM vs. EPTF, and higher vs. lower doses of HM. We selected studies that used fortified HM and compared that with a PTF; studies comparing unfortified HM and term formula were excluded. Experimental and observational studies were pooled separately. The GRADE system was used to evaluate risk of bias and certainty of evidence. Forty-four studies were included with 37 (n = 9963 infants) included in the meta-analyses. In general, due to poor quality studies, evidence of the effect of any HM feeds or higher versus lower doses of HM was inconclusive. There was a possible effect that lower doses of HM compared with higher doses of HM improved weight gain during the hospital admission, and separately, a possible effect of increased head circumference growth in infants fed EPTF vs. any HM. The clinical significance of this is unclear. There was insufficient evidence to determine the effects of an exclusive HM diet on any outcomes.

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ANALYSIS OF THE DIFFERENCES BETWEEN THE PRESCRIBED AND THE ADMINISTERED DIET TO PRETERM INFANTS USING AN ELECTRONIC TOO

Revista Paulista de Pediatria ◽

10.1590/1984-0462/;2019;37;4;00008 ◽

2019 ◽

Vol 37 (4) ◽

pp. 472-478 ◽

Cited By ~ 1

Author(s):

Olivia Araújo Zin ◽

Fernanda Valente Mendes Soares ◽

Andrea Dunshee de Abranches ◽

Ana Carolina Carioca da Costa ◽

Letícia Duarte Villela ◽

...

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Very Low Birth Weight ◽

Body Weight Gain ◽

Nutritional Deficiencies ◽

Percentage Error ◽

Electronic Instrument ◽

Health Providers ◽

Low Birth Weight Infants

ABSTRACT Objective: To create an electronic instrument in order to analyze the adequacy of the preterm infants’ nutritional therapy, checking the difference between the prescribed and the administered diet. Methods: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. Results: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. Conclusions: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers’ decisions about the nutritional approach, which can contribute to patients’ safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.

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