Packed Cell Transfusion and Feeding Tolerance in Healthy Preterm Infants: A Randomized Clinical Tria

Background: Recently, the correlation between necrotizing enterocolitis (NEC) and packed cell transfusion (PCT) has been identified. Evidence shows that 25 - 35% of NEC cases are associated with PCT. Objectives: this study aimed to determine the association between PCT and feeding tolerance in healthy preterm newborns. Methods: Materials and Methods: This clinical trial was performed on preterm infants, admitted to the neonatal intensive care unit (NICU) of Mofid Children's Hospital, Tehran, Iran, from April 2017 to May 2018. A total of 70 healthy premature infants (birth weight < 1500 g and gestational age < 32 weeks) with enteral feeding, who required PCT, were included in this study. The eligible infants were divided into two groups by simple randomization. In the intervention group (n = 35), breastfeeding was withheld only during PCT and then continued as usual. On the other hand, in the control group (n = 35), feeding was performed as usual, regardless of PCT. Feeding tolerance within the first 72 hours post-transfusion was compared between the two groups. Sick newborns were excluded from the study. Data analysis was performed in SPSS version 20. Results: The mean gestational age, birth weight, and postnatal age of the neonates were 30.13 weeks, 1245.71 g, and 17 days in the intervention group and 29.97 weeks, 1169.43 g, and 15.46 days in the control group, respectively; there was no significant difference between the two groups. Except for pre-transfusion hemoglobin and hematocrit levels, other characteristics of the two groups were similar. Feeding tolerance was reported in 32 (91.2%), 33 (94.73%), and 34 (97.1%) newborns at 24, 48, and 72 hours post-transfusion in both groups, without any significant difference. There was no significant difference between neonates with and without feeding tolerance in either of the groups. Conclusions: According to the present results, withholding feeding during PCT is not necessary in healthy preterm neonates with a good general condition, and continued breastfeeding seems to be a safe option.

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Packed Cell Transfusion and Feeding Tolerance in Well Preterm Infants: A Randomized Clinical Trial

10.21203/rs.3.rs-31605/v1 ◽

2020 ◽

Author(s):

Mohammad Kazemian ◽

Minoo Fallahi ◽

Saeed Hojjat Kashani ◽

Saleheh Tajalli ◽

Naeeme Taslimi Taleghani

Keyword(s):

Clinical Trial ◽

Research Ethics ◽

Preterm Infants ◽

Gestational Age ◽

Intervention Group ◽

Ethics Committee ◽

Research Ethics Committee ◽

Significant Difference ◽

Packed Cell Transfusion ◽

Feeding Tolerance

Abstract Background: The correlation between necrotizing enteroculitis (NEC) and packed cell transfusion (PCT) has recently been identified. Based on some research, 25–35% of NEC has been linked to transfusion, we planned this study to determine, the association between PCT and feeding tolerance in well preterm newborns.Method: Our study was a clinical trial study in preterm infants admitted to NICU of Mofid Children's Hospital from April 2017 to May 2018.Seventy well premature babies with a birth weight of <1500 grams and gestational age <32 weeks with enteral feeding, who need PCT were enrolled. The eligible patients divided by simple randomization to two groups, in the intervention group (35 patients) the baby's breastfeeding withholding just during the time of PCT and continue as usual after that, but in control groups (35 patients) feeding of neonates is given as usual regardless of PCT. The feeding tolerance during the first 72 hours after transfusion was compared between the two groups. Sick neonates exclude from the study. Data analysis was performed in SPSS version 20.Results: The mean gestational age, birth weights, and postnatal age in the intervention group were 30.13 weeks, 1245.71grams, and 17 days respectively and in the control group were 29.97weeks, 1169.43grams and 15.46 days respectively without any statistically significant difference between them. Except for hemoglobin and hematocrit pre-transfusion, other characteristics of patients were similar. In the evaluation of feeding tolerance after transfusion during 24, 48 and 72 hours, 32(91.2%), 33(94.73%), 34(97.1%) of both groups, had feeding tolerance with no significant difference There were no statistically significant differences between neonates with and without the feeding tolerance in the patients of each group.Conclusion: Our research showed that in well preterm neonates with a good general condition, during PCT, withholding of feeding, isn’t necessary and continued breastfeeding seems to be safe.Trial registration: All ethical considerations of the study were approved by the institutional review board and the research ethics committee at Shahid Beheshti University of Medical Sciences, Tehran, Iran (IR. SBMU.RETECH.1395.1010) and granted ethical approval and the Iranian Registry of Clinical Trial code are IRCT20200419047136N1.Approved by Iranian Registry of Clinical TrialsTrial Id: 47347IRCT Id: IRCT20200419047136N1Registration date: 2020-05-04, 1399/02/15(The link directly for trial registration: https://en.irct.ir/trial/47347)Approved by Research Ethics Committee: IR. SBMU.RETECH.1395.1010

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Preventive Effect of Bifidobacterium Supplementation on Neonatal Cholestasis in Preterm Neonates with Very Low Birth Weight

Gastroenterology Research and Practice ◽

10.1155/2020/4625315 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Gaohong Wu ◽

Xiaoqian Chen ◽

Ningxun Cui ◽

Yunxia He ◽

Jiaying Fan ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Very Low Birth Weight ◽

Group Versus ◽

Preterm Neonates ◽

Control Group ◽

Neonatal Cholestasis ◽

Biochemical Tests ◽

Significant Difference

Background. Cholestasis is a common but serious clinical condition in preterm neonates. The current management for preterm neonatal cholestasis has limitations. The aim of this study was to determine effects of Bifidobacterium supplementation on the prevention and alleviation of cholestasis in preterm infants with very low birth weight. Methods. Preterm neonates with very low birth weight were enrolled in the Children’s Hospital of Soochow University between December 2012 and December 2017. The patients were randomly assigned into Bifidobacterium and control groups, and effects of Bifidobacterium supplementation on the outcomes were compared between the two groups. Results. There was no significant difference in the baseline characteristics in the two groups. Notably, the proportion of cases with neonatal cholestasis was significantly lower, with fewer neonatal cholestasis-associated complications in the Bifidobacterium group compared with the control group (6% versus 22%, P<0.01). Furthermore, the Bifidobacterium group exhibited less severe cholestasis and better improvement of the liver function than the control group as evidenced by the biochemical tests (P<0.05). Finally, comparison of the other outcomes revealed that significant shorter duration of hospitalization (14.45±2.13 versus 16.12±2.22 days, P<0.01), fewer days to reach the full enteral feeding (9.2±2.11 versus 12±5.67 days, P<0.01), shorter duration of meconium passage (5.0±3.6 versus 6.6±3.38 days, P<0.05), lower proportion of cases on fasting and duration of fasting (0.8% versus 5.6%, P<0.05 and 3.0±1.6 versus 5.6±2.38 days, P<0.01, respectively), and shorter duration of weight gain to normal (4.77±2.49 versus 6.87±2.71 days, P<0.01) in the Bifidobacterium group versus the control group. Conclusions. Bifidobacterium supplementation has significantly preventive and other beneficial effects on the management of cholestasis in preterm infants with very low birth weight. Its long-term safety and effectiveness will need further investigation. This trial is registered with the Chinese Clinical Trial Registry (Registration No. ChiCTR1900022296).

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Preterm Infant Neurodevelopmental Care Training Program and Mother-Infant Attachment

International Journal of Women s Health and Reproduction Sciences ◽

10.15296/ijwhr.2020.30 ◽

2019 ◽

Vol 8 (2) ◽

pp. 192-197

Author(s):

Fatemeh Fallah Rostami ◽

Farin Soleimani ◽

Mehdi Norouzi ◽

Nikta Hatamizadeh ◽

Jamileh Mokhtarinouri ◽

...

Keyword(s):

Preterm Infant ◽

Training Program ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Intervention Group ◽

Routine Care ◽

Control Group ◽

Infant Attachment ◽

Significant Difference ◽

Care Training

Objectives: Preterm birth and admission to the neonatal intensive care unit (NICU) would disrupt mother-infant attachment. Neurodevelopmental care training and support of family programs are essential for the family of such infants. The purpose of this study was to investigate the effect of neurodevelopmental care training program for mothers with preterm infants on mother-infant attachment at one month’s age. Materials and Methods: Study population included all the mothers of preterm infants born in the hospitals of Tehran in 2018. The research was designed as a multicenter cluster clinical trial and four hospitals were randomly selected and divided into intervention and control groups. Before the intervention, the mother-infant attachment was measured by the Maternal-Postnatal Attachment Scale (MPAS). The mothers in the intervention group received a 12-session preterm infant neurodevelopmental care training program while the control group only received the routine care in the unit. Finally, the mother-infant attachment was re-measured in both groups at the one month corrected age. Results: No significant difference was observed in the attachment score before and after the intervention in the control group but the mother-infant attachment score was significantly different in the intervention group (57.75±11.09 vs. 78.27±4.54). Conclusions: The neurodevelopmental care training program was effective and increased the mother-infant attachment rate.

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The Efficacy of Omega-3 Supplement on Prevention of Retinopathy of Prematurity in Premature Infants: A Randomized Double-blinded Controlled trial

Current Pharmaceutical Design ◽

10.2174/1381612824666180601094849 ◽

2018 ◽

Vol 24 (17) ◽

pp. 1845-1848 ◽

Cited By ~ 2

Author(s):

Nasrin Khalesi ◽

Arash Bordbar ◽

Nastaran Khosravi ◽

Morteza Kabirian ◽

Alireza Karimi

Keyword(s):

Placebo Group ◽

Birth Weight ◽

Premature Infants ◽

Gestational Age ◽

Controlled Trial ◽

Intervention Group ◽

Control Group ◽

Omega 3 ◽

Significant Difference ◽

Double Blinded

Background: The present study aimed to assess the efficacy of omega-3 in treating ROP in premature infants. Methods: This randomized double-blinded controlled trial was performed on 160 premature infants with gestational age lower than 32 weeks and birth weight < 1500 grams who were at risk of ROP development (Tehran, Iran-2013). Children were randomly assigned to two groups. The intervention group received 300 mg omega-3 daily and the control group received sterile water as the placebo. The severity of ROP was defined according to the International Classification of ROP. Results: The frequency of ROP was 7.5% in the group received omega-3 and 20.0% in the placebo group with a significant difference (p = 0.021). Regarding the severity of ROP in the intervention group, ROP grade I was found in two patients and ROP grade II in four patients; while ROP grade I, II, and III were revealed in 6, 6, and 4 patients in placebo group indicating a significant difference between the two groups (p = 0.001). Using the multivariate logistic regression modeling with the presence of gender, gestational age, and birth weight, the use of omega-3 was associated with reduced risk for ROP (p = 0.045). Conclusion: The use of omega-3 supplement can be an appropriate treatment option for the treatment of ROP in premature infants.

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The Effect of Individualized Developmental Care Practices in Preterm Infants

Complementary Medicine Research ◽

10.1159/000504357 ◽

2019 ◽

Vol 27 (2) ◽

pp. 97-104

Author(s):

Dilek Küçük Alemdar ◽

Sevil İnal

Keyword(s):

Breast Milk ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Controlled Trial ◽

Oral Feeding ◽

Control Group ◽

Developmental Care ◽

Significant Difference ◽

Care Practices ◽

Maternal Voice

Background: Preterm infants are vulnerable humans requiring much care and attention. They may be exposed to irregular noise, light, and odor in the neonatal intensive care unit for a period of several weeks or months. This study was carried out to determine the effect of individualized developmental care on physiological parameters, growth, and transition to oral feeding in preterm infants. Methods: The study was a randomized controlled trial. The sample comprised premature infants meeting the inclusion criteria. They were randomly assigned to four groups: the maternal voice group, the breast milk odor (BMO) group, the incubator cover (IC) group, and the control group. Results: No statistically significant difference was found between the groups in terms of weight, height, and head circumference at time of discharge. Mean SO2 values were statistically higher in the IC group than the other groups; however, the heart rate and respiratory rate were not statistically different in a significant sense between the groups. The briefest duration of transition to total oral feeding was seen in the BMO group. Conclusion: Individualized developmental care practices based on the results of these interventions are likely to support the care of preterm infants. Breast milk odor may ease the transition to breastfeeding.

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Confounders for Neonatal Intensive Care Unit Admission ın Neonates of Mothers with Preeclampsia

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.804 ◽

2018 ◽

Vol 24 (3) ◽

pp. 162

Author(s):

Cetin Kilicci ◽

Cigdem Yayla Abide ◽

Enis Ozkaya ◽

Evrim Bostancı Ergen ◽

İlter Yenidede ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Birth Weight ◽

Intensive Care Unit Admission ◽

Neonatal Intensive Care Unit ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Preterm Neonates ◽

Apgar Scores ◽

Gestational Age At Delivery

Objective: The aim of this study was to investigate the effect of some maternal and neonatal clinical parameters on the neonatal intensive care unit admission rates of neonates born to mothers who had preeclampsia. Study Design: Study included 402 singleton pregnant women with preeclampsia who admitted to Maternal-Fetal Medicine Unit of Zeynep Kamil Children and Women’s Health Training and Research Hospital. Pregnancies with uterine rupture, chorioamnionitis and congenital malformations were excluded. Some maternal and neonatal clinical characteristics were assessed to predict neonatal intensive care unit admission.Results: Among 402 neonates, 140 (35%) of them had an indication for neonatal intensive care unit admission, among 140 neonates, 136 (97%) of them were preterm neonates. Comparison of groups with and without neonatal intensive care unit admission indicated significant differences between groups in terms of gestational age, Apgar scores at 1st and 5th minutes, birth weight, some maternal laboratory parameters (Hemoglobin, hematocrit, alanine aminotransferase, aspartate aminotransferase, albumin). In multivariate analysis, among all study population, gestational age at delivery, birth weight and Apgar scores were found to be significantly associated with neonatal intensive care unit admission. On the other hand, in subgroup of term neonates, none of the variables was shown to be associated with neonatal intensive care unit admission.Conclusion: Gestational age at delivery and the birth weight are the main risk factors for neonatal intensive care unit admission of neonates born to mothers who had preeclampsia.

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Impact of Computerized Provider Order Entry on Total Parenteral Nutrition in the Neonatal Intensive Care Unit

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-21.4.339 ◽

2016 ◽

Vol 21 (4) ◽

pp. 339-345 ◽

Cited By ~ 4

Author(s):

Kyle A. Franco ◽

Keliana O'Mara

Keyword(s):

Parenteral Nutrition ◽

Neonatal Intensive Care ◽

Intervention Group ◽

Preterm Neonates ◽

Control Group ◽

Order Entry ◽

Serum Electrolyte ◽

Computerized Provider Order Entry ◽

Electrolyte Disturbances ◽

Before And After

OBJECTIVES: To determine if computerized provider order entry (CPOE) implementation impacts the time it takes for preterm neonates to reach their parenteral macronutrient goals. METHODS: Retrospective review of neonates <1750 g receiving parenteral nutrition (PN) before and after the implementation of CPOE. Primary outcome was the attainment of parenteral macronutrient goals. Secondary outcomes included time to attainment, the frequency of electrolyte abnormalities, and the incidence of required adjustments made to PN orders by verification pharmacists. RESULTS: Goal PN was achieved by 12/47 (25.5%) intervention vs. 2/44 (4.5%) control group infants (p < 0.05). This goal was attained in 10.8 ± 7.5 days in the intervention group and 10 ± 4.2 days in the control group (p = 0.90). Goal protein was reached by 74.5% of CPOE patients vs. 36.4% of controls, p < 0.05. Lipid goals were achieved by 98% vs. 100% (p = 0.33) of patients and were attained at an average of 1.5 ± 0.8 days vs. 2.0 ± 1.1 days (p < 0.05). Abnormal serum electrolyte values occurred more frequently in the control group (0.79 vs. 1.12/day PN). Adjustments by a verification pharmacist were required in 5.6% of CPOE compared with 30.4% of control group orders (p < 0.05). CONCLUSIONS: CPOE parenteral nutrition increased the proportion of preterm neonates attaining overall macronutrient goals. With CPOE, protein goals were reached by more patients and goal lipids were achieved faster. This system also decreased the number of pharmacist interventions during verification of PN orders and appeared to positively impact the incidence of serum electrolyte disturbances.

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Disseminated Candidal Infections and Intravenous Hydrocortisone in Preterm Infants

PEDIATRICS ◽

10.1542/peds.95.6.883 ◽

1995 ◽

Vol 95 (6) ◽

pp. 883-887

Author(s):

Carlos M. Botas ◽

Isabel Kurlat ◽

Shirley M. Young ◽

Augusto Sola

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Birth Weight ◽

San Francisco ◽

Preterm Infants ◽

Gestational Age ◽

Selection Process ◽

Control Group ◽

Major Teaching Hospital ◽

Intensive Care Nursery

Background. Intravenous (IV) hydrocortisone (HC) has been used recently in selected preterm infants for hypotension soon after birth. During the same time period that HC was used, there was a marked increase in the incidence of disseminated candidal infections (DCIs). Objective. To determine whether there is an association between DCI in the first 35 days of life and IV HC in preterm infants. Research design. A hospital case-control study comparing the exposure of HC between preterm infants with DCI and matched infants without DCI. Setting. A tertiary level intensive care nursery in a major teaching hospital in San Francisco, CA. Patients. Seventeen preterm infants with DCI and 25 infants without DCI, with gestational age younger than 28 weeks and birth weight less than 1000 g, inborn and outborn admitted to the intensive care nursery between January 1992 and September 1993. Methods. All preterm infants diagnosed with DCI at younger than 35 days of age were identified using a perinatal and neonatal database. DCI was defined as a blood, cerebrospinal fluid, or two urine cultures positive for Candida requiring antifungal therapy. A control group of uninfected infants matched for the major risk factors for DCI (gestational age, birth weight, duration of intubation, broad-spectrum antibiotics, and IV alimentation, including lipids and central venous catheters) admitted during the same period was identified using the same database. Postmatching comparison was performed for several other factors to detect any other differences between the groups. Results. The infants with DCI (n = 17) and control infants (n = 25) had no statistical difference in exposure to the major risk factors for DCI or in postmatching comparison. Ten (59%) of the infants with DCI were receiving HC at the time of infection, whereas four (16%) of the control infants received HC during the first 35 days of life. Infants with DCI were 7.5 times as likely as control infants (95% confidence interval, 5 to 11) to have received IV HC before the onset of fungal infection. Conclusion. We conclude that the administration of IV HC significantly increases the risk of DCI in susceptible preterm infants younger than 35 days of age. The potentially serious risks of DCI should be considered particularly in the patient selection process for administration of IV HC.

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The effect of ear acupressure medicine at the “Shen Men” point on the nausea and vomiting during pregnancy

10.53350/pjmhs211551774 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1774-1779

Author(s):

Sanaz Nehbandani ◽

Hajar Salehi ◽

Khadije Rezaie Keikhaie ◽

Hossein Rashki Ghalenow ◽

Fatemeh Mirzaie ◽

...

Keyword(s):

Pregnant Women ◽

Gestational Age ◽

Intervention Group ◽

Nausea And Vomiting ◽

Control Group ◽

Health Clinics ◽

Significant Difference ◽

Quasi Experimental ◽

The Mean ◽

The Difference

Introduction & Objective: Nausea and vomiting during pregnancy is one of the most common gastrointestinal disorders that more than 85% of pregnant women experience. However, controlling and treating this complication is still one of the most important issues in antenatal care. Therefore, the aim of this study was to investigate the effect of ear acupressure at Shen Men point on relieving nausea, vomiting and retching during pregnancy. Materials and Methods: In this quasi-experimental study, 100 pregnant women with a gestational age of less than 16 weeks attending the health clinics of Zabol city during 2019-2020 were studied in two control and intervention groups (n = 50 in each group). The samples in the intervention group were trained to apply pressure on their ears’ Shen Men point with the thumb for three minutes three times a day (morning, noon, and night), for a duration of one month. At the end of second and fourth weeks, the data were collected using the Rhodes index form and then, were analyzed by SPSS software version 22. Results: According to the results, there was no significant difference between the two groups in terms of age, gestational age, occupation and education. The difference in the mean scores of nausea, vomiting and retching was not statistically significant between the control and intervention groups before the study. But four weeks after the study, a significant difference was observed in the mean scores of vomiting, nausea and retching between the two groups, so that the mean scores of vomiting, nausea and retching were significantly lower in the intervention group than in the control group. Conclusion: The ear acupressure medicine at the Shen men point can be used as a non-invasive, safe and inexpensive method to relieve nausea, vomiting and retching during pregnancy. Keywords: Acupressure medicine, Shen Men, Vomiting, Pregnancy, Nausea, Retching, Rhodosis

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Effect of a Text Intervention During Pregnancy on Birth Weight in Participants of the WIC Program in Hawaii

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_081 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1009-1009

Author(s):

Mashael Huwaikem ◽

Cristina Palacios ◽

Jinan Banna

Keyword(s):

Birth Weight ◽

Intervention Group ◽

Text Message ◽

General Medicine ◽

Educational Interventions ◽

Control Group ◽

Wic Program ◽

Significant Difference ◽

Mountain West ◽

Infant Birth

Abstract Objectives There are limited studies testing the effect of a pregnancy educational intervention on infants’ birth weight. This study investigated the effect of a short message service (SMS), or text message, intervention for promoting adequate gestational weight gain on infants’ birth weight in a sample of pregnant women in Hawai‘i. Methods A randomized clinical trial was conducted among women participating in the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC) program in Hawai‘i (n = 83). The intervention group (n = 42) received weekly SMS about appropriate energy intake and physical activity and the control group (n = 41) received weekly SMS about general health issues for 4 months during pregnancy. Weight and length at birth were obtained from the participant's chart in WIC and compared between groups. Birthweight was categorized as small (SGA), appropriate (AGA) or large (LGA) for gestational age. Results Women were age 27.7 ± 5.3y on average, 65.5% were Native Hawaiian, Pacific Islander or American Indian, 54.8% had some college or more and 37.8% were employed. Infant birth weight was similar in the intervention (3431 ± 682 g) and control groups (3232 ± 599 g; P > 0.05). Mothers in the control group had higher odds of having a SGA baby (OR: 2.21; 95% CI 0.40, 12.2) but similar risk of having a LGA baby (0.27; 95% CI 0.07, 1.05) compared to the intervention group. After adjusting for mothers’ age, education level and employment status, results were similar for SGA (OR: 2.34; 95% CI 0.43, 14.7) and LGA (OR: 0.35; 95% CI 0.08, 1.49). Conclusions There was no significant difference in birth weight between groups in mothers from the WIC program in Hawai‘i. More intensive educational interventions may be needed to observe an impact on birth weight. Funding Sources Mountain West Clinical Translational Research Infrastructure Network under a grant from the National Institute of General Medicine Sciences of the National Institutes of Health.

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