Gavage Feeding-Continuous or Bolus?

It is a very well done in-vitro study published in 2010, yet has many practical implications.
Abstract

Substantial losses of nutrients may occur during tube (gavage) feeding of

fortified human milk. Our objective was to compare the losses of key macronutrients and

minerals based on method of fortification and gavage feeding method. We used clinically

available gavage feeding systems and measured pre- and post-feeding (end-point) nutrient

content of calcium (Ca), phosphorus (Phos), protein, and fat. Comparisons were made

between continuous, gravity bolus, and 30-minute infusion pump feeding systems, as well

as human milk fortified with donor human milk-based and bovine milk-based human milk

fortifier using an in vitro model. Feeding method was significantly associated with fat and

Ca losses, with increased losses in continuous feeds. Fat losses in continuous feeds were

substantial, with 40 ± 3 % of initial fat lost during the feeding process. After correction for

feeding method, human milk fortified with donor milk-based fortifier was associated with

significantly less loss of Ca (8 ± 4% vs. 28 ± 4%, p< 0.001), Phos (3 ± 4% vs. 24 ± 4%,

p < 0.001), and fat (17 ± 2% vs. 25 ± 2%, p = 0.001) than human milk fortified with a

bovine milk-based fortifier (Mean ± SEM).

Continuous Feedings of Fortified Human Milk Lead to Nutrient Losses of Fat, Calcium and Phosphorous.

Nutrients 2010, 2, 230-240; doi:10.3390/nu2030240Stefanie P. Rogers 1, Penni D. Hicks 2, Maria Hamzo 2, Lauren E. Veit 3 and Steven A. Abrams




  

Chorioamnionitis AND Retinopathy of Prematurity

http://www.karger.com/Article/FullText/357556

Abstract
Background: The role of chorioamnionitis (CA) in the development of retinopathy of prematurity (ROP) has not been well established. Objective: To conduct a systematic review and meta-analysis of the association between CA and ROP in preterm infants. Data Sources: The authors searched MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and PubMed, reviewed reference lists of relevant articles, abstracts and conference proceedings (Society for Pediatric Research, European Society for Paediatric Research 1990-2012), sought results of unpublished trials, and contacted the primary authors of relevant studies. Study Selection: Studies were included if they had a comparison group, examined preterm infants, and reported primary data that could be used to measure the association between exposure to CA and the development of ROP. Data Extraction: Two reviewers independently screened the search results, applied inclusion criteria and assessed methodological quality using the Newcastle-Ottawa Scale. One reviewer extracted data and a second reviewer checked data extraction. Summary relative risks (RRs) were calculated using a random effects model. Data Synthesis: We identified 1,249 potentially relevant studies from the electronic databases. Twenty-seven studies involving 10,590 preterm neonates with 2,562 cases of ROP were included. Taking into account all included studies without adjusting for gestational age (GA), CA was significantly associated with ROP (any stage) [summary RR 1.33 (95% CI 1.14-1.55, I² = 77%, p_{heterogeneity} < 0.0001)], and a borderline significant association was observed for severe ROP (stage ≥3) [summary RR 1.27 (95% CI 0.99-1.63, I² = 74%, p_{heterogeneity} < 0.0001)]. There was no publication bias with Begg's test. However, subgroup analysis of studies adjusting for GA showed no significant association on CA with ROP [summary RR 0.98 (95% CI 0.77-1.26, I² = 0%, p_{heterogeneity} = 0.89)]. Conclusion: Unadjusted analyses showed that CA was significantly associated with ROP (any stage) as well as with severe ROP (stage ≥ 3). However, the association disappeared on analysis of studies adjusting for GA. Hence, CA cannot be definitively considered as a risk factor for ROP, and further studies should adjust for potential confounding factors and report results by stage to clarify the association with severe ROP.

Postnatal Head Growth in Preterm Infants: A Randomized Controlled Parenteral Nutrition Study

http://pediatrics.aappublications.org/content/133/1/e120.abstract

BACKGROUND: Early postnatal head growth failure is well recognized in very preterm infants (VPIs). This coincides with the characteristic nutritional deficits that occur in these parenteral nutrition (PN) dependent infants in the first month of life. Head circumference (HC) is correlated with brain volume and later neurodevelopmental outcome. We hypothesized that a Standardized, Concentrated With Added Macronutrients Parenteral (SCAMP) nutrition regimen would improve early head growth. The aim was to compare the change in HC (ΔHC) and HC SD score (ΔSDS) achieved at day 28 in VPIs randomly assigned to receive SCAMP nutrition or a control standardized, concentrated PN regimen.

METHODS: Control PN (10% glucose, 2.8 g/kg per day protein/lipid) was started within 6 hours of birth. VPIs (birth weight <1200 1="" 28.="" 3.8="" actual="" assigned="" collected="" control="" daily="" data="" day="" days="" either="" for="" g="" gestation="" glucose="" hc="" intake="" kg="" lipid="" measured="" nutritional="" on="" or="" p="" per="" protein="" randomly="" regimen.="" remain="" scamp="" start="" the="" to="" was="" weekly.="" weeks="" were="">

RESULTS: There were no differences in demographic data between SCAMP (n = 74) and control (n = 76) groups. Comparing cumulative 28-day intakes, the SCAMP group received 11% more protein and 7% more energy. The SCAMP group had a greater ΔHC at 28 days (P < .001). The difference between the means (95% confidence interval) for ΔHC was 5 mm (2 to 8), and ΔSDS was 0.37 (0.17 to 0.58). HC differences are still apparent at 36 weeks’ corrected gestational age.

CONCLUSIONS: Early postnatal head growth failure in VPIs can be ameliorated by optimizing PN.

IVH outcomes in VLBW infants-Outcomes

http://pediatrics.aappublications.org/content/133/1/55.abstract

Intraventricular Hemorrhage and Neurodevelopmental Outcomes in Extreme Preterm Infants

on behalf of the New South Wales and Australian Capital Territory Neonatal Intensive Care Units’ Data Collection

OBJECTIVE: Not many large studies have reported the true impact of lower-grade intraventricular hemorrhages in preterm infants. We studied the neurodevelopmental outcomes of extremely preterm infants in relation to the severity of intraventricular hemorrhage.

METHODS: A regional cohort study of infants born at 23 to 28 weeks’ gestation and admitted to a NICU between 1998 and 2004. Primary outcome measure was moderate to severe neurosensory impairment at 2 to 3 years’ corrected age defined as developmental delay (developmental quotient >2 SD below the mean), cerebral palsy, bilateral deafness, or bilateral blindness.

RESULTS: Of the 1472 survivors assessed, infants with grade III–IV intraventricular hemorrhage (IVH; n = 93) had higher rates of developmental delay (17.5%), cerebral palsy (30%), deafness (8.6%), and blindness (2.2%). Grade I–II IVH infants (n = 336) also had increased rates of neurosensory impairment (22% vs 12.1%), developmental delay (7.8% vs 3.4%), cerebral palsy (10.4% vs 6.5%), and deafness (6.0% vs 2.3%) compared with the no IVH group (n = 1043). After exclusion of 40 infants with late ultrasound findings (periventricular leukomalacia, porencephaly, ventricular enlargement), isolated grade I–II IVH (n = 296) had increased rates of moderate-severe neurosensory impairment (18.6% vs 12.1%). Isolated grade I–II IVH was also independently associated with a higher risk of neurosensory impairment (adjusted odds ratio 1.73, 95% confidence interval 1.22–2.46).

CONCLUSIONS: Grade I–II IVH, even with no documented white matter injury or other late ultrasound abnormalities, is associated with adverse neurodevelopmental outcomes in extremely preterm infants.