1
|
Gao Y, Lu X, Pan M, Liu C, Min Y, Chen X. Effect of breast milk intake volume on early behavioral neurodevelopment of extremely preterm infants. Int Breastfeed J 2024; 19:3. [PMID: 38233943 PMCID: PMC10795355 DOI: 10.1186/s13006-024-00612-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND This study aimed to explore the effects of breast milk feeding volume on the early behavioral neurodevelopment of extremely preterm infants (gestational age < 28 weeks). METHODS The study was conducted from 1 January 2021 to 31 March 2023. A total of 187 preterm infants from a neonatal intensive care unit (NICU) in a Grade III Class A hospital in Zhejiang, China, were divided based on the proportion of breast milk in their total enteral nutrition: high proportion (≥ 80%, including exclusive breast milk feeding), medium proportion (20% ~ < 80%), and low proportion (< 20%). The study investigated motor performance and behavioral neurodevelopment at 37 weeks of corrected gestational age, as well as the total incidence of intracranial hemorrhage within the first four weeks postpartum. RESULTS The low breast milk feeding group had significantly lower scores in infant motor performance (31.34 ± 5.85) and elicited item scores (19.89 ± 5.55) compared to the medium and high groups (33.52 ± 4.33, 22.13 ± 4.22; and 35.86 ± 5.27, 23.91 ± 4.98), p < 0.05, respectively. Despite no significant difference in behavioral ability, the low proportion group exhibited lower passive muscle tension and primitive reflex scores than the medium and high proportion groups. The high proportion group showed higher active muscle tension scores. Ultrasound results revealed varying incidences of intracranial hemorrhage: 72.9% in low, 52.5% in medium, and 19.6% in the high proportion groups. CONCLUSIONS Medium to high levels of breast milk feeding contribute positively to motor and behavioral neurological development in extremely preterm infants and decrease the likelihood of ventricular hemorrhage. However, it does not have a significant effect on the development of behavioral abilities. Due to the limited sample size, the next step will be to expand the sample size and further investigate the extent of the impact on various aspects of the nervous system.
Collapse
Affiliation(s)
- Ying Gao
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyu Lu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mengqing Pan
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chuntian Liu
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuxiao Min
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaochun Chen
- The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
2
|
Fu ZY, Huang C, Lei L, Chen LC, Wei LJ, Zhou J, Tao M, Quan MT, Huang Y. The effect of oropharyngeal colostrum administration on the clinical outcomes of premature infants: A meta-analysis. Int J Nurs Stud 2023; 144:104527. [PMID: 37295286 DOI: 10.1016/j.ijnurstu.2023.104527] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Preterm complications are now the second leading cause of death in children under five years of age. Colostrum is essential to prevent infection and promote maturation in preterm infants. Guidelines recommend that preterm infants be fed colostrum by the oral and pharyngeal routes as early as possible after birth to provide immune protection; however, due to disease and an uncoordinated sucking and swallowing function, it is challenging to provide colostrum through the oropharyngeal route, which limits the immune protection it provides. OBJECTIVE To update the existing meta-analysis, evaluate the effect of oropharyngeal colostrum administration on related outcomes in preterm infants and explore the optimal frequency and duration of oropharyngeal colostrum administration through subgroup analysis. METHODS The Cochrane Library, PubMed, Web of Science, ScienceDirect, and Ovid databases were searched for randomized control trials (RCTs) of oropharyngeal colostrum administration for preterm infants. Two researchers screened the literature strictly according to the inclusion and exclusion criteria and evaluated the quality. Primary data and data from the included literature were extracted. Finally, the data were statistically analyzed by the Review Manager 5.3 software. RESULTS A total of 1736 preterm infants were included in 16 RCTs. The meta-analysis showed that the incidence of necrotizing enterocolitis, late-onset sepsis, feeding intolerance, and death was lower, the time to full enteral feeding was shorter, and the day of recovery to birth weight was earlier in the intervention group (oropharyngeal colostrum administration group) than in the control group, and this difference was statistically significant. Subgroup analysis: Frequency of oropharyngeal colostrum administration: The incidence of necrotizing enterocolitis and late-onset sepsis in the once every 4 h group was lower than that in the control group, and the time to complete enteral feeding was shorter. Duration of oropharyngeal colostrum administration: In the 1-3 days group and 4-7 days group, the time to full enteral feeding in the intervention group was shorter. In the 8-10 days group, the incidence of necrotizing enterocolitis and late-onset sepsis was lower in the intervention group. CONCLUSIONS Oropharyngeal colostrum administration can reduce the incidence of necrotizing enterocolitis, late-onset sepsis, feeding intolerance and mortality, shorten the time to full enteral feeding, and lead to a faster recovery to birth weight in preterm infants. The appropriate oropharyngeal colostrum administration frequency may be 4 h, and the optimal duration may be 8-10 days. Therefore, it is recommended that clinical medical staff implement oropharyngeal colostrum administration for premature infants based on existing evidence. TWEETABLE ABSTRACT Oropharyngeal colostrum administration can reduce the incidence of complications in preterm infants and shorten the time to full enteral feeding.
Collapse
Affiliation(s)
- Zhen Yan Fu
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China; Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Chi Huang
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Lei Lei
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Li Cheng Chen
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Li Juan Wei
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Jiao Zhou
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Ming Tao
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Ming Tao Quan
- School of Nursing, Zunyi Medical University, Zunyi City, Guizhou Province, China
| | - Yi Huang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, China.
| |
Collapse
|
3
|
Pados BF. State of the Science on the Benefits of Human Milk for Hospitalized, Vulnerable Neonates. Nurs Womens Health 2023; 27:121-140. [PMID: 36871597 DOI: 10.1016/j.nwh.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 03/06/2023]
Abstract
Research on human milk has increased dramatically in recent years. The purpose of this review is to describe the literature on the health benefits of human milk for hospitalized, vulnerable neonates. PubMed, CINAHL, and Embase were searched for research articles reporting the health outcomes of hospitalized neonates who were exposed to human milk. Human milk, particularly a mother's own milk, has the potential to reduce the risk of death and the risk and severity of necrotizing enterocolitis, infection, retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage, kidney disease, and liver disease. Dose and timing of human milk is important, with more human milk and earlier introduction having a greater impact on health. When a mother's own milk is not available, donor human milk provides benefits over infant formula.
Collapse
|
4
|
Zheng Z, Shen W, Tang LX, Zhang R, Cheng R, Wang SN, Chen DM, Chen C, Lin XZ. High-proportion breast milk feeding is associated with a reduction in the incidence of IVH in very preterm infants. Front Neurol 2023; 13:993985. [PMID: 36742049 PMCID: PMC9889932 DOI: 10.3389/fneur.2022.993985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
Objective To investigate the protective effect of high-proportion breast milk feeding (>50%) on intraventricular hemorrhage (IVH) in very preterm infants (VPIs). Methods This was a retrospective secondary analysis of a prospective multi-center study, which included 604 VPIs from six hospitals in eastern China between September 2019 and December 2020. The 604 VPIs were divided into two groups according to whether IVH occurred. High-proportion breast milk feeding was defined as breast milk accounting for 51-100% of the total feeding amount both within 7 days and throughout the hospitalization. The IVH grades and the rate of high-proportion breast milk feeding were analyzed. Furthermore, to explore the relationship between high-proportion breast milk feeding and IVH grading, the VPIs' general information, perinatal factors, growth, and nutritional status during hospitalization, and related complications were compared between the two groups. Results High-proportion breast milk feeding was reported in 63.41% of the VPIs. Furthermore, IVH grades I-II and III-IV were noted in 39.73% (240/604) and 1.66% (10/604) of the VPIs, respectively. Univariate analysis revealed that IVH occurrence in VPIs is influenced by perinatal factors, invasive respiratory therapy, high-proportion breast milk feeding, start feeding with breast milk, the cumulative amount of early parenteral nutrition, postnatal complications, physical growth, and other factors (P < 0.05). After adjustments for gestational age, birth weight, and possible influencing factors through binary logistic regression analysis, the results revealed that high-proportion breast milk feeding and and start feeding with breast milk were associated with a lower total incidence of IVH. Further stratification showed that high-proportion breast milk feeding was associated with a lower incidence of grade I-II IVH. Similarly, after adjusting for the same factors, breast milk feeding >50% in the 1st week was associated with a decreased incidence of total IVH and further stratification showed that it was associated with a lower incidence of grade I-II IVH. Conclusion High-proportion breast milk feeding and breast milk feeding more than 50% of total intake during the 1st week might be protective factors for IVH grade I-II in VPIs, which further verified the neuroprotective effect of breast milk. In clinical practice, the construction of breast milk banks should be strengthened, breast milk feeding should be encouraged in neonatal intensive care units, and efforts should be made to increase breast milk feeding rates to improve the outcomes of VPIs.
Collapse
Affiliation(s)
- Zhi Zheng
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Women and Children's Hospital, Xiamen, Fujian, China
| | - Wei Shen
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Women and Children's Hospital, Xiamen, Fujian, China,Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Li-Xia Tang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Women and Children's Hospital, Xiamen, Fujian, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Rui Cheng
- Department of Neonatology, Children' Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - San-Nan Wang
- Department of Neonatology, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Dong-Mei Chen
- Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, Fujian, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China,*Correspondence: Chao Chen ✉
| | - Xin-Zhu Lin
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China,Xiamen Key Laboratory of Perinatal-Neonatal Infection, Women and Children's Hospital, Xiamen, Fujian, China,Xin-Zhu Lin ✉
| |
Collapse
|
5
|
Impact of Donor Human Milk in an Urban NICU Population. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111639. [PMID: 36360367 PMCID: PMC9688816 DOI: 10.3390/children9111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
The American Academy of Pediatrics recommends the use of donor human milk in infants when mother’s own milk is not available. Our objective was to analyze whether the use of donor human milk in preterm, very-low-birth-weight (VLBW, <1500 g) infants affected the rates of necrotizing enterocolitis, duration of parenteral nutrition (PN), growth, culture-positive sepsis, length of hospital stay, and mortality in an urban NICU population with low exclusive breast-feeding rates. A retrospective cohort study was conducted comparing two 2-year epochs of VLBW neonates before and after the introduction of donor breast milk in our neonatal intensive care unit (NICU). With the introduction of donor human milk, there was a significant reduction in the rate of necrotizing enterocolitis (NEC) (5% vs. 13%; p = 0.04) and less severe NEC as defined by Stage III based on the Modified Bell Staging Criteria (10% to 3%; p = 0.04). In the donor milk era, there was earlier initiation of enteral feeding (2.69 days vs. 3.84; p = 0.006) and a more rapid return to birthweight (9.5 days. 10.9 days; p = 0.006). In this study, a change in practice to the use of donor breast milk in a population with low rates of human milk provision was associated with earlier initiation of enteral feeding, faster return to birth weight, and a reduced incidence of NEC.
Collapse
|
6
|
Vinukonda G, La Gamma EF. Emerging therapies for brain recovery after IVH in neonates: Cord blood derived Mesenchymal Stem Cells (MSC) and Unrestricted Somatic Stem Cells (USSC). Semin Perinatol 2022; 46:151598. [PMID: 35589461 DOI: 10.1016/j.semperi.2022.151598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this report, we summarize evidence on mechanisms of injury after intraventricular hemorrhage resulting in post-hemorrhagic white matter injury and hydrocephalus and correlate that with the possibility of cellular therapy. We describe how two stem cell lines (MSC & USSC) acting in a paracrine fashion offer promise for attenuating the magnitude of injury in animal models and for improved functional recovery by: lowering the magnitude of apoptosis and neuronal cell death, reducing inflammation, and thus, mitigating white matter injury that culminates in improved motor and neurocognitive outcomes. Animal models of IVH are analyzed for their similarity to the human condition and we discuss merits of each approach. Studies on stem cell therapy for IVH in human neonates is described. Lastly, we offer suggestions on what future studies are needed to better understand mechanisms of injury and recovery and argue that human trials need to be expanded in parallel to animal research.
Collapse
Affiliation(s)
- Govindaiah Vinukonda
- Department of Pediatrics, Cell Biology & Anatomy New York Medical College, Valhalla, NY
| | - Edmund F La Gamma
- Department of Pediatrics, Biochemistry and Molecular Biology, New York Medical College, Valhalla, NY.
| |
Collapse
|
7
|
Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants. Nutrients 2021; 13:nu13124307. [PMID: 34959859 PMCID: PMC8704746 DOI: 10.3390/nu13124307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/29/2022] Open
Abstract
Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth-particularly brain development-that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification-including targeted and adjusted fortification-show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.
Collapse
|
8
|
Obaid M, Igawa T, Maxwell A, Murray YL, Rahman A, Aboudi D, Olivo K, Roeder T, Valdes-Greene R, Brumberg H, Alpan G, Parvez B. "Liquid Gold" Lactation Bundle and Breastfeeding Rates in Racially Diverse Mothers of Extremely Low-Birth-Weight Infants. Breastfeed Med 2021; 16:463-470. [PMID: 34042464 DOI: 10.1089/bfm.2020.0322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: In 2015, we implemented a comprehensive lactation bundle named Liquid Gold. Lactation bundles in the neonatal intensive care unit have not been well studied. Materials and Methods: This is an ongoing quality improvement breastfeeding project of racially diverse mothers and infants of extremely low birth weight (≤1,000 g). Four epochs were assessed; baseline (B; January 2012-July 2013), transition (T; human milk [HM]-derived fortifier; August 2013-December 2014), Liquid Gold (LG; full bundle, including staff education, colostrum oral care, kangaroo care, antenatal and postpartum counseling, provision of pasteurized donor HM, and breast pumps; January 2015-February 2016), and current (C; ongoing impact, Spanish-speaking lactation consultant, and HM cream; March 2016-April 2019). Results: Four hundred twenty-three mother-infant dyads were assessed. The rate of exclusive mother's own milk at discharge increased significantly in LG compared with previous epochs and was sustained over time. During LG, African American (AA) mothers had a significant surge of breastfeeding initiation (30% in B and 41% in T versus 78% in LG), but this was not sustained in C. AA mothers also experienced a significant decline in the use of exclusive formula feeding in the C epoch (68% in LG versus 46% in C). Hispanic and White mothers sustained their breastfeeding rates over time. Conclusions: Our Liquid Gold lactation bundle led to a significant increase in the provision of HM in the NICU and at discharge in the most vulnerable infants. AA mothers experienced the highest surge in breastfeeding initiation and greatest reduction in formula use. Breastfeeding goals and support need to be tailored to each mother with specific consideration for racial/ethnic background for optimal success.
Collapse
Affiliation(s)
- Maria Obaid
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Teryn Igawa
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Abigael Maxwell
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Yuanyi L Murray
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA.,Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Amanda Rahman
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA.,Department of Neonatal-Perinatal Medicine, Staten Island University Hospital, Staten Island, New York, USA
| | - David Aboudi
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA.,NYC DOHMH New York, New York, USA
| | - Karina Olivo
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Tina Roeder
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Rhonda Valdes-Greene
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Heather Brumberg
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Gad Alpan
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Boriana Parvez
- Division of Newborn Medicine, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, New York, USA
| |
Collapse
|
9
|
Exclusive human milk diet and severe intraventricular hemorrhage. J Perinatol 2021; 41:909. [PMID: 33594225 DOI: 10.1038/s41372-021-00938-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/01/2020] [Accepted: 01/19/2021] [Indexed: 11/08/2022]
|
10
|
Razak A. Methodological concerns in the exclusive human milk study. J Perinatol 2021; 41:910-911. [PMID: 33589733 DOI: 10.1038/s41372-021-00947-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Abdul Razak
- Division of Neonatology, Department of Pediatrics, Princess Nourah Bint AbdulRahman University, King Abdullah bin Abdulaziz University hospital, Riyadh, Saudi Arabia. .,Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|