Probiotics for preterm infants?

Infants nursed in special care baby units develop an abnormal pattern of microbial colonisation, which may contribute to disease. Enteric feeding of live microbial supplements (probiotics) may provide benefit to such infants and help to prevent diseases such as neonatal necrotising enterocolitis.     

Palivizumab for preterm infants. Is it worth it?

Respiratory syncytial virus infection is an important cause of morbidity. Although palivizumab prophylaxis is widely used, it is uncertain whether the cost is justified. A systematic review was therefore performed of the safety, efficacy, and the likely cost effectiveness of prophylaxis for preterm infants in the United Kingdom using a standard search strategy. The only randomised controlled trial identified showed a reduction in hospital admission but no benefit on more serious outcomes. None of the United Kingdom cost studies showed economic benefit for palivizumab prophylaxis. New treatments are rarely cost effective, and, in the absence of a comprehensive economic assessment, continued use for high risk infants may appear justified.     

Is early occupational therapy in extremely preterm infants of benefit in the long run?

A total of 126 infants with extremely low birth weight (ELBW; <1000 g) were enrolled in a prospective case-control study in order to examine the effect of occupational therapy based on sensory integration (SI) and neurodevelopmental therapy (NDT) on neurological development. The children were grouped as matched pairs on the basis of determined developmental risk scores assessed at the age of 3 months. The intervention children had a 6-month period of weekly occupational therapy from the corrected age of 6-12 months. The follow-up showed that the social development of the intervention children was significantly better at the age of 12 months, but at the age of 2 years the groups had equal developmental scores in neurological, neuropsychological and speech therapy assessments. The Miller assessment for pre-schoolers (MAP) performed in a total of 96 (92%) of the study children at the age of 4 years failed to demonstrate any significant differences between the groups. It is concluded that this amount of occupational therapy in ELBW infants does not have any detectable effect on long-term neurological development.     

Are the stool characteristics of preterm infants affected by infant formulas?

The aim of this study was to investigate the relationship between the type of formula consumed and the stool characteristics and gastrointestinal symptoms of preterm infants prospectively. Seventy-five preterm infants weighing < 2000 g in our neonatal intensive care unit (NICU) were investigated. Four groups of 15 each were fed one of four commercial formula preparations (Prematil, Neonatal, Humana-0 and S-26) and the fifth group was breast-fed in a prospective, randomized, double-blind study. The stool characteristics and gastrointestinal problems were recorded daily from the first day till the time they were discharged by the nurses of NICU. No significant differences of daily weight gain was observed between the groups. No significant difference was observed in daily frequency of stool, distention, vomiting and gas passage between the groups during the enteral + parenteral and full-enteral nutrition periods. The infants fed by Prematil during the enteral + parenteral nutrition period had a higher percentage of hard stool occurrence than infants receiving Humana-0 and breast milk. In the full-enteral nutrition period, infants receiving Prematil had a higher percentage of hard stool occurrence than all the other groups, whereas breast-fed infants had a lower percentage of hard stool than all the other groups. While the group fed with Humana-0 had a higher percentage of green stool occurrence in the enteral + parenteral nutrition period, no significant difference was observed in the full-enteral nutrition period. In the enteral + parenteral nutrition period no additional therapy affected stool characteristics or the gastrointestinal system except in the case of the infant receiving phototherapy for whom the daily number of detections was significantly high. In this study, it was shown that the color and consistency of stool in preterm infant differs according to the preterm infant formulas, but no differences were observed in the frequency of defecation or in gastrointestinal system problems. When the infant formulas were compared with breast milk, it was shown that they cause a higher percentage of hard stool occurrence. An increased number of formula feedings are necessary to obtain a similar daily weight gain, but the color and the frequency of the stool and the gastrointestinal system problems were similar for breast-fed and formula-fed infants.     

Can MII–pH values predict the duration of treatment for GERD in preterm infants?

BackgroundLittle is known regarding the prognostic role of Multichannel Intraluminal Impedance and pH monitoring (MII/pH) parameters in preterm infants with Gastro-Esophageal Reflux Disease (GERD).AimOur study aimed to evaluate the relationship between MII/pH variables and the duration of pharmacological therapy for GERD, in preterm infants with gestational age (GA) ≤ 34 weeks.Subjects, study design, outcome measuresWe retrospectively reviewed data of all newborns with GA ≤ 34 weeks that underwent MII/pH in our Neonatal Intensive Care Unit (NICU) and pharmacological treatment for GERD. We included them in a 12-month follow-up program. MII/pH parameters were used as independent variables and the duration of pharmacological therapy as dependent variable in linear regression models.Results16 patients (GA 28.4 ± 1.8 weeks, BW 1122 ± 427 g) were enrolled into the study. Regression analysis performed on all reflux events reported a significant correlation between the duration of pharmacological treatment and MII-BEI (r² = 0.36, p = 0.01) and MII-reflux frequency (r² = 0.33, p = 0.02). Moreover, regression analysis performed on all events classified according to the corresponding pH change – acidic (ac.), weakly acidic (w.ac.) or weakly alkaline (w.a.) – showed a significant correlation between the duration of pharmacological treatment and MII-w.ac.BEI (r² = 0.26, p = 0.05), MII-w.ac. reflux frequency (r² = 0.44, p = 0.01), and MII-proximal w.ac. reflux frequency (r² = 0.35, p = 0.02). No statistically significant correlation was found between pH-Reflux Index and the duration of treatment.ConclusionThe study shows how, in our population of preterm infants, MII-parameters could have not only a diagnostic role, but also a prognostic value in terms of the duration of pharmacological treatment.     

Is oral indomethacin effective in treatment of preterm infants with patent ductus arteriosus?

Twenty-one preterm infants (with a mean gestational age and birth weight of 29.3 weeks and 1288.6 g) and nine pretem infants (with a mean gestational age and birth weight of 29.6 weeks and 1153.1 g) were treated with an enteral preparation of indomethacin and with intravenous indomethacin, respectively, for the closure of hemodynamically significant ductus arteriosus. The patients received three doses of either oral indomethacin capsule (Endol, Deva, Turkey) or intravenous indomethacin (Confortid, Dumex GmBH, Germany) in a dose of 0.2 mg/kg at 12-hour intervals. The ductus was closed in 17 (81%) and 7 (77%) of the babies in the orally and intravenously treated groups, respectively (p > 0.05). There was no significant difference in blood urea nitrogen, creatinine levels or thrombocyte counts in either group before and after treatment with indomethacin (p > 0.05). No side effect was reported in the oral indomethacin group. Oral indomethacin may be an alternative to the intravenous preparation in developing countries if the intravenous form is not available or not affordable.     

Does the use of glycerin laxatives decrease feeding intolerance in preterm infants?

BACKGROUND:

Glycerin laxatives are often prescribed in the neonatal population for meconium evacuation and to promote enteral feeding. However, the literature regarding their effectiveness has not been systematically reviewed.

OBJECTIVE:

To assess the effectiveness of glycerin enema or suppository in preventing feeding intolerance in preterm infants at ≤32 weeks’ gestational age or weighing ≤1500 g at birth.

METHODS:

The Medline, Embase, Cochrane Library, Scopus and Web of Science databases were searched to identify studies that evaluated glycerin enemas/suppositories for feeding intolerance. Using the Evidence Evaluation Worksheet adapted from the American Heart Association’s International Liaison Committee on Resuscitation, eligible studies were scored for quality, level of evidence and direction of support.

RESULTS:

Two clinical studies that evaluated meconium evacuation and feeding intolerance were included. One study showed no difference in the time to complete meconium evacuation or establishment of full enteral feeds, while the other showed that the times to first meconium passage and full enteral feeding were significantly shorter, and the rate of sepsis was lower in the glycerin enema group.

CONCLUSION:

The evidence regarding the effectiveness of glycerin laxatives for improving feeding tolerance is inconclusive in infants at ≤32 weeks’ gestational age or weighing ≤1500 g at birth.     

Oxygen for respiratory support of moderate and late preterm and term infants at birth: Is air best?

Oxygen has been used for newborn infant resuscitation for more than two centuries. In the last two decades, concerns about oxidative stress and injury have changed this practice. Air (FiO₂ 0.21) is now preferred as the starting point for respiratory support of infants 34 weeks gestation and above. These recommendations are derived from studies that were conducted on asphyxiated, term infants, recruited more than 10 years ago using strategies that are not commonly used today. The applicability of these recommendations to current practice, is uncertain. In addition, whether initiating respiratory support with air for infants with pulmonary disorders provides sufficient oxygenation is also unclear. This review will address these concerns and provide suggestions for future steps to address knowledge and practice gaps.     

Does sympathetic activity contribute to growth of preterm infants?

BACKGROUND: Emerging evidence on faster growth in preterm infants with higher heart rate as opposed to the classical approach calls for further research. AIMS: to test whether (1) high or low heart rate and (2) heart rate during the first days of life predict greater weight gain in preterm infants. METHODS: A retrospective study analyzing two daily measures of heart rate obtained during restful sleep, total daily calorie intake and daily weight gain measured always in the morning before meal were collected from the medical files. RESULTS: Analysis of 90 healthy preterm infants born at 32-36 weeks of gestation revealed that increased mean heart rate during hospitalization predicted greater weight gain even when controlling for calorie intake, birth weight, gestational age, appropriateness of birth weight for gestational age, and length of hospitalization. Mean heart rate during the first three days of life yielded the same pattern of results. Post-hoc analysis of variance between infants with mean daily heart rate /=140 bpm showed that infants with higher heart rate achieved a significantly higher weight gain. CONCLUSIONS: It is suggested that, contrary to adults, in neonates an anabolic activity is represented by increased sympathetic functioning within the normal range. The implications of a slower growth rate for additional developmental care and individual considerations of appropriate stimulation in preterm infants are discussed.     

Is term newborn body composition being achieved postnatally in preterm infants?

Background

The American Academy of Pediatrics (AAP) recommends that preterm infants' growth duplicates fetal growth rates and that body composition replicates in utero body composition.

Aims

To compare the total body fat mass between preterm infants assessed at term corrected age and full-term newborns, and to investigate the effects of gestational age, gender, weight increase, being breast fed on total adiposity.

Study design

Prospective observational study.

Subjects

One hundred and ten preterm infants [mean (SD) gestational age: 29.9 (2.3) weeks; birth weight: 1118 (274) g], and 87 full term [mean (SD) 38.6 (1.21) weeks, 3203 (385) g], breastfed infants.

Outcome measures

Growth and body composition by means of a pediatric air displacement system were assessed at term corrected age in preterm infants and on day 3 of life in full term infants.

Results

Weight, length and head circumference were smaller in the preterm group as compared to the term group. Mean (SD) percentage of fat mass in preterm infants was significantly higher as compared to term infants [14.8 (4.4) vs 8.59 (3.71), P < 0.0001]. Fat mass was negatively correlated with gestational age (P < 0.001), and positively associated with weight increase (P < 0.05).

Conclusions

Our data suggest that body composition, in terms of fat mass, in preterm infants at term corrected age is different from that of full term newborns.