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Marron S, Stracuzzi L, Rahman T. A Novel Method to Sanitize Breast Pump Equipment in the Neonatal Intensive Care Unit. Adv Neonatal Care 2024; 24:342-348. [PMID: 38976900 DOI: 10.1097/anc.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
BACKGROUND Enhancing the current breast pump sanitization method may improve maternal satisfaction and increase a mother's likelihood of providing human milk for their hospitalized infants in the Neonatal Intensive Care Unit (NICU). Other than Centers for Disease Control (CDC) data, there is lack of studies on sanitization practices. Currently, the only option in the hospital setting for breast pump equipment cleaning is a steam sanitization plastic bag. PURPOSE Using the Q. Basin will increase participant satisfaction compared to the steam sanitization bag. METHODS A multi-phased pilot study was conducted in our quaternary care NICU to test the Q. Basin, a novel design developed to wash, dry, and safely steam sanitize breast pump equipment compared to the standard steam bag. A bacterial study was conducted on breast pump equipment from 10 mothers by swabbing the equipment immediately at hour zero and 24 hours. Twenty NICU mothers concurrently evaluated their satisfaction via a 3-question survey comparing the Q. Basin and the steam sanitization plastic bag method. RESULTS The results showed a 20% increase in satisfaction with Q. Basin compared to the steam bag method. IMPLICATIONS FOR PRACTICE AND RESEARCH Data analysis from the satisfaction survey concludes that mothers pumping preferred the Q. Basin as a quicker, faster, and more environmentally friendly method for breast pump part sanitization. Additional safety and materials studies are required before using the Q. Basin in the clinical environment.
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Affiliation(s)
- Susan Marron
- Nemours Children's Health, Delaware, Wilmington, Delaware
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De Rose DU, Lapillonne A, Iacobelli S, Capolupo I, Dotta A, Salvatori G. Nutritional Strategies for Preterm Neonates and Preterm Neonates Undergoing Surgery: New Insights for Practice and Wrong Beliefs to Uproot. Nutrients 2024; 16:1719. [PMID: 38892652 PMCID: PMC11174646 DOI: 10.3390/nu16111719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
The nutrition of preterm infants remains contaminated by wrong beliefs that reflect inexactitudes and perpetuate old practices. In this narrative review, we report current evidence in preterm neonates and in preterm neonates undergoing surgery. Convictions that necrotizing enterocolitis is reduced by the delay in introducing enteral feeding, a slow advancement in enteral feeds, and the systematic control of residual gastric volumes, should be abandoned. On the contrary, these practices prolong the time to reach full enteral feeding. The length of parenteral nutrition should be as short as possible to reduce the infectious risk. Intrauterine growth restriction, hemodynamic and respiratory instability, and patent ductus arteriosus should be considered in advancing enteral feeds, but they must not translate into prolonged fasting, which can be equally dangerous. Clinicians should also keep in mind the risk of refeeding syndrome in case of high amino acid intake and inadequate electrolyte supply, closely monitoring them. Conversely, when preterm infants undergo surgery, nutritional strategies are still based on retrospective studies and opinions rather than on randomized controlled trials. Finally, this review also highlights how the use of adequately fortified human milk is strongly recommended, as it offers unique benefits for immune and gastrointestinal health and neurodevelopmental outcomes.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (I.C.); (A.D.); (G.S.)
- PhD Course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), Faculty of Medicine and Surgery, “Tor Vergata” University of Rome, 00133 Rome, Italy
| | - Alexandre Lapillonne
- Department of Neonatology, APHP, Necker-Enfants Malades University Hospital, EHU 7328 Paris Cite University Paris, 75015 Paris, France;
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77024, USA
| | - Silvia Iacobelli
- Réanimation Néonatale et Pédiatrique, Centre Hospitalier Universitaire Saint-Pierre, BP 350, 97448 Saint Pierre CEDEX, France;
- Centre d’Études Périnatales de l’Océan Indien (UR 7388), Université de La Réunion, BP 350, 97448 Saint Pierre CEDEX, France
| | - Irma Capolupo
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (I.C.); (A.D.); (G.S.)
| | - Andrea Dotta
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (I.C.); (A.D.); (G.S.)
| | - Guglielmo Salvatori
- Neonatal Intensive Care Unit, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy; (I.C.); (A.D.); (G.S.)
- Donor Human Milk Bank, “Bambino Gesù” Children’s Hospital IRCCS, 00165 Rome, Italy
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Saif SA, Maghoula M, Babiker A, Abanmi M, Nichol F, Al Enazi M, Guevarra E, Sehlie F, Al Shaalan H, Mughal Z. A Multidisciplinary and a Comprehensive Approach to Reducing Fragility Fractures in Preterm Infants. Curr Pediatr Rev 2024; 20:434-443. [PMID: 36545738 DOI: 10.2174/1573396319666221221122013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/14/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
With advances in neonatal care, bone fractures prior to discharge from the hospital in preterm infants receiving contemporary neonatal care, are rare. Nevertheless, such fractures do occur in very low birth weight and extremely low birth weight infants who go on to develop metabolic bone disease of prematurity (MBDP), with or without secondary hyperparathyroidism. MBDP is a multifactorial disorder arising from the disruption of bone mass accrual due to premature birth, postnatal immobilisation, and loss of placental oestrogen resulting in bone loss, inadequate provision of bone minerals from enteral and parenteral nutrition, and medications that leach out bone minerals from the skeleton. All of these factors lead to skeletal demineralisation and a decrease in bone strength and an increased risk of fractures of the long bones and ribs. Secondary hyperparathyroidism resulting from phosphate supplements, or enteral/parenteral feeds with a calcium-tophosphate ratio of < 1.3:1.0 leads to subperiosteal bone resorption, cortical thinning, and further skeletal weakening. Such fractures may occur from routine handling and procedures such as cannulation. Most fractures are asymptomatic and often come to light incidentally on radiographs performed for other indications. In 2015, we instituted a comprehensive and multidisciplinary Neonatal Bone Health Programme (NBHP), the purpose of which was to reduce fragility fractures in highrisk neonates, by optimising enteral and parenteral nutrition, including maintaining calcium-tophosphate ratio ≥1.3:1, milligram to milligram, biochemical monitoring of MBDP, safe-handling of at-risk neonates, without compromising passive physiotherapy and skin-to-skin contact with parents. The at-risk infants in the programme had radiographs of the torso and limbs at 4 weeks and after 8 weeks from enrolment into the program or before discharge. Following the introduction of the NBHP, the bone fracture incidence reduced from 12.5% to zero over an 18-month period.
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Affiliation(s)
- Saif Al Saif
- Neonatal Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Pediatrics,, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad Maghoula
- Neonatal Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Amir Babiker
- Department of Pediatrics,, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Division of Pediatric Endocrinology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mashael Abanmi
- Department of Physiotherapy, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fiona Nichol
- Department of Occupational Therapy, King Abdulaziz Medical City, Riyadh, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Modhi Al Enazi
- Neonatal Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Elenor Guevarra
- Department of Dieticians, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faisal Sehlie
- Pharmacy Department, King Abdulaziz Medical City, Riyadh, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hesham Al Shaalan
- Department of Pediatric Radiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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Walter L, Clifford V, Sulfaro C, Brown R, Ribeiro D, Welvaert M, Shuttleworth G, Klein LD. Macronutrient content of pasteurised donor human milk: Variability between batches from single-donor pools at an Australian milk bank. J Paediatr Child Health 2023; 59:1281-1288. [PMID: 37880918 DOI: 10.1111/jpc.16497] [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: 03/15/2023] [Revised: 08/09/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023]
Abstract
AIM This study aimed to characterise the between-batch variability of pasteurised donor human milk (PDHM) produced from single-donor pools at Australian Red Cross Lifeblood's milk bank and identify key donor characteristics that predict macronutrient content. METHODS Macronutrient content from 200 batches of PDHM was measured using a mid-infrared human milk analyser (Miris, Uppsala, Sweden). Linear mixed models were used to study the impact of stage of lactation and gestational age on macronutrient content. Coefficients of determination (R2 ) were calculated to estimate the impact of the individual donor on overall variability. RESULTS Macronutrient content of PDHM varied considerably, with between-batch variations of 2.8 and 6.4-fold for protein and fat content, respectively. Mean crude protein content was 1.16 g/100 mL, ranging from 0.7 to 1.96 g/100 mL. Mean fat content was 3.85 g/100 mL, ranging from 1.46 to 9.39 g/100 mL. Stage of lactation was identified as a predictor for protein content and gestational age at birth for fat content. Individual donor effect explained 55 and 35% of the variance for fat and protein content, respectively. CONCLUSIONS This study highlights the variation in macronutrient content in PDHM at an Australian milk bank. Variability could be reduced through the implementation of targeted multiple-donor pooling using the key donor characteristics identified in this study along with the measurement of macronutrient content of individual donors at the time of first donation. However, the clinical benefit of a reduction in between-batch variation, achieved through multiple-donor pooling, would need to be assessed to justify additional efforts associated with PDHM processing changes.
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Affiliation(s)
- Leonie Walter
- Strategy and Growth, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Vanessa Clifford
- Pathology and Clinical Governance, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
- Laboratory Services, Royal Children's Hospital, Melbourne, Victoria, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Christine Sulfaro
- Strategy and Growth, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Richard Brown
- Strategy and Growth, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Daniel Ribeiro
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Marijke Welvaert
- Pathology and Clinical Governance, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Glen Shuttleworth
- Pathology and Clinical Governance, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Laura D Klein
- Strategy and Growth, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
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Breastfeeding and human milk bank in a neonatal intensive care unit: impact of the COVID-19 pandemic in an Italian cohort of very low birth weight infants. Int Breastfeed J 2022; 17:94. [PMID: 36581945 PMCID: PMC9798351 DOI: 10.1186/s13006-022-00529-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 12/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Parental stress in neonatal intensive care units (NICU) is well known, as is the stress induced by the COVID-19 pandemic. This combination might increase stress to the extent of affecting the availability of maternal expressed milk and the success of establishing breastfeeding. This is particularly relevant in very preterm infants. METHODS We conducted a single-centre retrospective analysis in two cohorts of very low birth weight infants born in a hospital in Italy. Babies born before the pandemic (September 2017 - December 2019) (n = 101) and during the pandemic (March 2020 - December 2021) (n = 67) were included in the analysis. We compared the rate of babies fed with maternal milk (both expressed and / or donated) at the achievement of full enteral feeding and the rate of those exclusively breastfed at discharge in the two groups. Then, we analysed the impact of donated human milk availability on infant formula use. We also compared mother's need for psychological support during NICU stay and the duration of psychological follow-up after discharge. RESULTS In our NICU the availability of expressed maternal milk significantly decreased during the COVID-19 pandemic (86.1% before the pandemic vs 44.8% during the pandemic, p < 0.001) at the time of full enteral feeding achievement. Thanks to the availability of donated human milk, the rate of formula-fed babies remained almost unchanged (13.9% vs 14.9%). At discharge, the rate of breastfeeding was similar (73.3% vs 72.7%). The maternal need for psychological support was significantly higher during the pandemic (33% vs 64%, p < 0.001), as well as the duration of follow-up > 6 months (1% vs 15%, p < 0.001). No differences in the main clinical outcomes were found. CONCLUSION Pandemic-induced stress had a significant impact on the availability of expressed maternal milk in NICU. However, the presence of human donated milk was fundamental in preventing increased use of infant formula during NICU stays. This underlines how strategies to implement the widespread establishment of donor milk banks on a national level are warranted. Further research is desirable to optimise the use of donated human milk banks during emergency situations.
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Sokou R, Parastatidou S, Ioakeimidis G, Tavoulari EF, Makrogianni A, Isaakidou E, Iacovidou N, Konstantinidi A. Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up. Nutrients 2022; 14:nu14183841. [PMID: 36145216 PMCID: PMC9500865 DOI: 10.3390/nu14183841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017−2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother−infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03−2.62; and 1.69, 95% CI: 1.05−2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-2132077346 or +30-2132077000
| | - Stavroula Parastatidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Georgios Ioakeimidis
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Evangelia-Filothei Tavoulari
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Athanasia Makrogianni
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Elina Isaakidou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Aretaieio Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 3 D. Mantouvalou Str., Nikea, 18454 Piraeus, Greece
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Rasmussen JM, Thompson PM, Entringer S, Buss C, Wadhwa PD. Fetal programming of human energy homeostasis brain networks: Issues and considerations. Obes Rev 2022; 23:e13392. [PMID: 34845821 DOI: 10.1111/obr.13392] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/29/2021] [Accepted: 10/24/2021] [Indexed: 02/07/2023]
Abstract
In this paper, we present a transdisciplinary framework and testable hypotheses regarding the process of fetal programming of energy homeostasis brain circuitry. Our model proposes that key aspects of energy homeostasis brain circuitry already are functional by the time of birth (with substantial interindividual variation); that this phenotypic variation at birth is an important determinant of subsequent susceptibility for energy imbalance and childhood obesity risk; and that this brain circuitry exhibits developmental plasticity, in that it is influenced by conditions during intrauterine life, particularly maternal-placental-fetal endocrine, immune/inflammatory, and metabolic processes and their upstream determinants. We review evidence that supports the scientific premise for each element of this formulation, identify future research directions, particularly recent advances that may facilitate a better quantification of the ontogeny of energy homeostasis brain networks, highlight animal and in vitro-based approaches that may better address the determinants of interindividual variation in energy homeostasis brain networks, and discuss the implications of this formulation for the development of strategies targeted towards the primary prevention of childhood obesity.
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Affiliation(s)
- Jerod M Rasmussen
- Development, Health and Disease Research Program, University of California, Irvine, California, USA.,Department of Pediatrics, University of California, Irvine, California, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sonja Entringer
- Development, Health and Disease Research Program, University of California, Irvine, California, USA.,Department of Pediatrics, University of California, Irvine, California, USA.,Department of Medical Psychology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Departments of Psychiatry and Human Behavior, Obstetrics and Gynecology, Epidemiology, University of California, Irvine, California, USA
| | - Claudia Buss
- Development, Health and Disease Research Program, University of California, Irvine, California, USA.,Department of Pediatrics, University of California, Irvine, California, USA.,Department of Medical Psychology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Departments of Psychiatry and Human Behavior, Obstetrics and Gynecology, Epidemiology, University of California, Irvine, California, USA
| | - Pathik D Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine, California, USA.,Department of Pediatrics, University of California, Irvine, California, USA.,Departments of Psychiatry and Human Behavior, Obstetrics and Gynecology, Epidemiology, University of California, Irvine, California, USA.,Department of Obstetrics and Gynecology, University of California, Irvine, California, USA.,Department of Epidemiology, University of California, Irvine, California, USA
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Khaira S, Pert A, Farrell E, Sibley C, Harvey-Wilkes K, Nielsen HC, Volpe MV. Expressed Breast Milk Analysis: Role of Individualized Protein Fortification to Avoid Protein Deficit After Preterm Birth and Improve Infant Outcomes. Front Pediatr 2022; 9:652038. [PMID: 35096699 PMCID: PMC8793906 DOI: 10.3389/fped.2021.652038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Expressed breast milk (EBM) protein content is highly variable between mothers and often below published values that are still used for EBM protein fortification strategies. This approach may result in significant protein deficit and suboptimal protein energy (P/E) ratio. The study aim was to determine whether individualized EBM protein analysis and fortification will reduce preterm infant protein deficits and improve growth and neurodevelopmental outcome. Study Methods: In a single-center randomized, blinded study of infants born at 24 0/7-29 6/7 weeks, mother-specific protein values measured by a milk analyzer were used to individualize infant-specific protein intake (interventional group, IG), and compared this to a standardized protein fortification scheme based on published values of EBM protein content of 1.4 g/dL (control group, CG). For IG, milk analyzer protein values of mother's EBM were used to adjust protein content of the EBM. The CG EBM protein content was adjusted using the standard published value of 1.4 g/dL and not based on milk analyzer values. EBM protein content, protein intake, protein/energy (P/E) ratio, weight (WT), head circumference (HC), length (L), growth velocity (GV) from 2 to 6 weeks of age, WT, HC and L Z-Scores at 32- and 35-weeks PMA, and lean body mass (35 weeks PMA skin fold thickness) were measured. Neurodevelopment was assessed by Bayley III at average 24 months corrected gestational age (CGA). Results: EBM protein content before fortification was significantly below published values of 1.4 g/dL at all time points in both CG and IG. CG protein deficit was significantly decreased and progressively worsened throughout the study. Individualized protein fortification in IG avoided protein deficit and optimized P/E ratio. Although no significant change in short-term GV (at 6 weeks of age) was seen between groups, IG infants born at <27 weeks had significant improvements in WT and L z-scores, and leaner body mass at 32 and 35 weeks PMA. IG exhibited significantly improved cognitive scores at 24 months CGA. Conclusions: Infant-specific protein supplementation of mother's EBM optimized P/E ratio by eliminating protein deficit and improved growth z scores at 32- and 35-weeks PMA and neurocognitive testing at 24 months.
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Affiliation(s)
- Sharmeel Khaira
- Newborn Medicine, Tufts Children's Hospital, Tufts Medical Center, Boston, MA, United States
- Tufts University School of Medicine, Boston, MA, United States
| | - Antoinette Pert
- Newborn Medicine, Tufts Children's Hospital, Tufts Medical Center, Boston, MA, United States
| | - Emily Farrell
- Newborn Medicine, Tufts Children's Hospital, Tufts Medical Center, Boston, MA, United States
| | - Cecelia Sibley
- Newborn Medicine, Tufts Children's Hospital, Tufts Medical Center, Boston, MA, United States
| | - Karen Harvey-Wilkes
- Newborn Medicine, Tufts Children's Hospital, Tufts Medical Center, Boston, MA, United States
- Tufts University School of Medicine, Boston, MA, United States
| | - Heber C. Nielsen
- Newborn Medicine, Tufts Children's Hospital, Tufts Medical Center, Boston, MA, United States
- Tufts University School of Medicine, Boston, MA, United States
| | - MaryAnn V. Volpe
- Newborn Medicine, Tufts Children's Hospital, Tufts Medical Center, Boston, MA, United States
- Tufts University School of Medicine, Boston, MA, United States
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9
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Gad S, Sheta MM, Al-Khalafawi AI, Abu El-Fadl HA, Anany M, Sahmoud S, Amin MK. Expressed Breast Milk Contamination in Neonatal Intensive Care Unit. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:307-313. [PMID: 34211314 PMCID: PMC8242104 DOI: 10.2147/phmt.s311632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
Background The health benefits of breastfeeding are well known. However, some ill babies including those admitted to the neonatal intensive care unit (NICU) cannot be directly breastfed. In this situation, expressed breast milk (EBM) can be used. However, breast milk is not always sterile and may be contaminated by many microorganisms. EBM contamination is probably attributed to improper technical and hygienic factors and may pose significant threats to the newborn baby. The present study aimed to document the prevalence of EBM contamination in NICU and to uncover the relevant risk factors. Subjects and Methods The study included 118 mothers who could express breast milk for their own neonates admitted to the NICU. A checklist was used to document the steps the mothers followed during expression of milk and all steps of handling until the EBM reached the NICU. A 1 mL sample of EBM was obtained and sent to the microbiology laboratory within 20 minutes. Data obtained from the present study are expressed as number and percentage or mean ± standard deviation (SD). Statistical calculations were computed using SPSS 25. Results In the present study, 106 (89.8%) out of the assessed 118 EBM samples were contaminated. Hygienic factors related to EBM contamination included hand only wash, possible recontamination of hands during turning taps off, lack of using cotton pads or cloth piece on nipple and breast cleaning by water only. Other factors related to EBM contamination included container cleaning by water only, fresh milk refrigeration after > 4 hours, adding freshly expressed warm breast milk to refrigerated milk expressed earlier in the same day, milk transport in plastic bags with ice packs and longer transportation time. In the contaminated samples, the most commonly isolated organisms included Staphylococcus aureus (55.7%),Staphylococcus epidermidis (21.7%) and Enterobacter (11.6%). Conclusion The present study identified bacterial contamination in about 90% of EBM samples delivered to NICU infants. Factors related to EBM contamination include hygienic, storage and transport factors.
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Affiliation(s)
- Suzan Gad
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Mohamed M Sheta
- Pediatrics and Neonatology Department, Mansoura General Hospital, Mansoura, Egypt
| | | | - Heba A Abu El-Fadl
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Maha Anany
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Shaimaa Sahmoud
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Mona Karem Amin
- Pediatrics and Neonatology Department, Suez Canal University Faculty of Medicine, Ismailia, Egypt
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10
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Pillai A, Albersheim SG, Berris K, Albert AY, Osiovich H, Elango R. Corrected fortification approach improves the protein and energy content of preterm human milk compared with standard fixed-dose fortification. Arch Dis Child Fetal Neonatal Ed 2021; 106:232-237. [PMID: 33067263 DOI: 10.1136/archdischild-2019-317503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/15/2020] [Accepted: 08/23/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate whether a pragmatic corrected fortification (CF) model achieves recommended target protein and calorie content of human milk (HM) for preterm infants when compared with standard fixed-dose fortification (SF). DESIGN In this prospective non-interventional study, we enrolled mothers of infants with birth weight ≤1500 g fed exclusive HM. Infants with chromosomal or intestinal disorders were excluded. A total of 405 HM samples from 29 mothers and 45 donor milk samples were analysed for macronutrient content using a real-time HM analyser. A stepwise CF model was derived based on published data on HM calorie and protein content corrected for lactation stage and milk type. We applied both models to the measured protein and calorie content for all HM samples and compared the proportion of samples achieving target nutrient requirement in each group. RESULTS Target protein and calorie content of feed was achieved in 68% of HM samples with CF, compared with 5% samples with SF model (p<0.0001). For mother's own milk, none of the samples met the target macronutrient range with SF fortification during later lactation periods (≥week 5). With SF, over 40% of infants had poor growth (decline in weight z-score ≥0.8 SD) by 8 weeks. The final feed osmolality was acceptable for all fortification steps of the CF model. CONCLUSION The proposed CF model significantly improved the final protein and calorie content of HM with acceptable osmolality. It provides a proactive option to improve nutrient intake in premature infants.
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Affiliation(s)
- Anish Pillai
- Neonatology, Surya Hospitals, Mumbai, Maharashtra, India.,Neonatal Perinatal Medicine, Department of Pediatrics, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Susan Gail Albersheim
- Neonatal Perinatal Medicine, Department of Pediatrics, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital Research Institute, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kaitlin Berris
- Neonatal Perinatal Medicine, Department of Pediatrics, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.,Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Arianne Y Albert
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.,Department of Obstetrics and Gynaecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Horacio Osiovich
- Neonatal Perinatal Medicine, Department of Pediatrics, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.,British Columbia Children's Hospital Research Institute, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rajavel Elango
- Neonatal Perinatal Medicine, Department of Pediatrics, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada .,British Columbia Children's Hospital Research Institute, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
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11
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Cormontagne D, Rigourd V, Vidic J, Rizzotto F, Bille E, Ramarao N. Bacillus cereus Induces Severe Infections in Preterm Neonates: Implication at the Hospital and Human Milk Bank Level. Toxins (Basel) 2021; 13:123. [PMID: 33562185 PMCID: PMC7915446 DOI: 10.3390/toxins13020123] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
Human breast milk (HBM) is a source of essential nutrients for infants and is particularly recommended for preterm neonates when their own mother's milk is not available. It provides protection against infections and decreases necrotizing enterocolitis and cardiovascular diseases. Nevertheless, HBM spoilage can occur due to contamination by pathogens, and the risk of a shortage of HBM is very often present. B. cereus is the most frequent ubiquitous bacteria responsible for HBM being discarded. It can contaminate HBM at all stages, from its collect point to the storage and delivery. B. cereus can induce severe infection in newborns with very low birth weight, with sometimes fatal outcomes. Although the source of contamination is rarely identified, in some cases, HBM was suspected as a potential source. Even if the risk is low, as infection due to B. cereus in preterm infants should not be overlooked, human milk banks follow strict procedures to avoid contamination, to accurately identify remaining bacteria following pasteurization and to discard non-compliant milk samples. In this review, we present a literature overview of B. cereus infections reported in neonates and the suspected sources of contamination. We highlight the procedures followed by the human milk banks from the collection of the milk to its microbiological characterization in Europe. We also present improved detection and decontamination methods that might help to decrease the risk and to preserve the public's confidence in this vital biological product for infants whose mothers cannot breastfeed.
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Affiliation(s)
- Delphine Cormontagne
- Micalis Institute, INRAE, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (D.C.); (J.V.); (F.R.)
| | - Virginie Rigourd
- Région Île-de-France Human Milk Bank, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France;
| | - Jasmina Vidic
- Micalis Institute, INRAE, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (D.C.); (J.V.); (F.R.)
| | - Francesco Rizzotto
- Micalis Institute, INRAE, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (D.C.); (J.V.); (F.R.)
| | - Emmanuelle Bille
- Department of Clinical Microbiology, Necker Enfants-Malades Hospital, AP-HP, 75015 Paris, France;
- INSERM U1151-CNRS UMR 8253, Institut Necker-Enfants Malades, Université de Paris, 75015 Paris, France
| | - Nalini Ramarao
- Micalis Institute, INRAE, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France; (D.C.); (J.V.); (F.R.)
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12
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Redeuil K, Lévêques A, Oberson JM, Bénet S, Tissot E, Longet K, de Castro A, Romagny C, Beauport L, Fischer Fumeaux CJ, Tolsa JF, Affolter M, Giménez EC, Garcia-Rodenas CL, Thakkar SK. Vitamins and carotenoids in human milk delivering preterm and term infants: Implications for preterm nutrient requirements and human milk fortification strategies. Clin Nutr 2021; 40:222-228. [DOI: 10.1016/j.clnu.2020.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 01/22/2023]
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13
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Peila C, Spada E, Deantoni S, Iuliano E, Moro GE, Giribaldi M, Cavallarin L, Cresi F, Coscia A. The "Fortilat" Randomized Clinical Trial Follow-Up: Neurodevelopmental Outcome at 18 Months of Age. Nutrients 2020; 12:nu12123807. [PMID: 33322629 PMCID: PMC7764145 DOI: 10.3390/nu12123807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/06/2020] [Accepted: 12/09/2020] [Indexed: 01/03/2023] Open
Abstract
Adequate nutrition is fundamental to neonatal survival and short-term outcomes, but it also has long-term consequences on quality of life and neurologic development of preterm infants. Donkey milk has been suggested as a valid alternative for children allergic to cows’ milk proteins, due to its biochemical similarity to human milk; we, hence, hypothesized that donkey milk could be a suitable basis for developing an innovative human milk fortifier for feeding preterm infants. The aim of the current study was to extend the findings and to evaluate the neurodevelopmental outcomes at 18 months of corrected age of the infants enrolled in the clinical trial named “Fortilat”. Infants born ≤1500 g and <32 weeks of gestational age were randomized to receive either a combination of bovine milk-based multicomponent fortifier and protein supplement or a combination of a novel multicomponent fortifier and protein supplement derived from donkey milk. The followed fortification protocol was the same for the two groups and the two diets were designed to be isoproteic and isocaloric. All infants enrolled were included in a developmental assessment program. The neurodevelopmental assessment was performed at 18 ± 6 months of corrected age. Minor and major neurodevelopmental impairment and General Quotient (GQ) at the Griffiths-II Mental Development Scale were considered. The GQ was considered both in continuous and as two classes: lower than and higher than (or equal to) a defined cutoff (GQcl). The difference in GQ and GQcl between the two arms was estimated using Mann–Whitney–Wilcoxon test or Fischer exact test, respectively, on the assumption of casual loss at follow-up. A further analysis was performed using generalized linear models. There were 103 children (bovine milk-derived fortifier arm = 54, donkey milk-derived fortifier arm = 49) included for the neurodevelopmental follow-up. All observations were included in the interval of 18 ± 6 months of corrected age. No significant difference was observed between the two arms in the incidence of neurologic sequelae and the GQs were similar in the two arms. Our results demonstrated no difference for the donkey milk-derived fortifier compared to standard bovine-derived fortifier regarding long-term neurodevelopmental outcomes.
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Affiliation(s)
- Chiara Peila
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
- Correspondence:
| | - Elena Spada
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Sonia Deantoni
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Ester Iuliano
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Guido E. Moro
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy;
| | - Marzia Giribaldi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
- Research Centre for Engineering and Agro-Food Processing, Council for Agricultural Research and Economics, Strada delle Cacce 73, 10135 Turin, Italy
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
| | - Francesco Cresi
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
| | - Alessandra Coscia
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (S.D.); (E.I.); (F.C.); (A.C.)
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14
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Peila C, Spada E, Bertino E, Deantoni S, Percivati F, Moro GE, Giribaldi M, Cavallarin L, Cresi F, Coscia A. The "Fortilat" Randomized Clinical Trial Follow-Up: Auxological Outcome at 18 Months of Age. Nutrients 2020; 12:nu12123730. [PMID: 33287300 PMCID: PMC7761645 DOI: 10.3390/nu12123730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
Human milk fortification is a routine clinical practice for feeding preterm infants. We hypothesized that donkey milk can be a suitable basis for developing an innovative human milk fortifier. Our randomized controlled single-blind clinical trial, named “Fortilat”, evaluated the feeding tolerance, growth and clinical short-term outcomes in a population of preterm infants fed with a novel multi-component fortifier and a protein concentrate derived from donkey milk. The aim of the current study is to extend the previous findings and to evaluate the auxological outcomes of the infants enrolled in the “Fortilat” trial at 18 months of age. In the previous trial “Fortilat”, the fortification protocol followed was the same for the two groups, and the two diets were designed to be isoproteic and isocaloric. All infants enrolled in the trial were included in a premature infant developmental evaluation program consisting of hospital visits at 40 ± 1 weeks of postmenstrual age, and at 6, 12 and 18 months of corrected age. Weight, head circumference and length were expressed in z-score using neonatal Intergrowth21st and INeS charts at birth, and WHO 0–5 years growth charts at 18 months. 122 children (Bovine-arm = 62, Donkey-arm = 60) were included in this study. All the observations were recorded in the interval of 18 ± 3 months of the correct age. The two groups did not differ for head circumference, length or weight at 18 months of age. Our data show that fortifiers derived from donkey milk had not different long term auxological outcomes of standard bovine-derived fortifier, but the new donkey milk fortifier was well tolerated in our population.
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Affiliation(s)
- Chiara Peila
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
- Correspondence:
| | - Elena Spada
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Enrico Bertino
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Sonia Deantoni
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Federica Percivati
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Guido E. Moro
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy;
| | - Marzia Giribaldi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
- Research Centre for Engineering and Agro-Food Processing, Council for Agricultural Research and Economics (CREA), Strada delle Cacce 73, 10135 Turin, Italy
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco, Italy; (M.G.); (L.C.)
| | - Francesco Cresi
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
| | - Alessandra Coscia
- Department of Public Health and Pediatric, Neonatal Unit of Turin University, Via Ventimiglia 3, 10126 Turin, Italy; (E.S.); (E.B.); (S.D.); (F.P.); (F.C.); (A.C.)
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15
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Preterm's Nutrition from Hospital to Solid Foods: Are We Still Navigating by Sight? Nutrients 2020; 12:nu12123646. [PMID: 33260838 PMCID: PMC7761406 DOI: 10.3390/nu12123646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
As preterm birth rates are globally increasing, together with research on preterms’ peculiar needs, neonatologists are still facing the challenge of how to properly feed them. The need to strike a balance between excessive catch-up growth and extrauterine growth retardation, both leading to adverse outcomes, is made even more difficult by the broad range of preterms’ needs. Although mother’s fresh milk is undoubtedly the best nourishment, its availability during hospital stay is often lower than recommended, and its fortification at discharge is still an open issue. Formula milks are available as an alternative to breast milk. However, choosing the right formula requires a thorough evaluation of the infant’s perinatal history and targets. Last but not least, adequate timing and initiation of weaning in premature babies are still a poorly explored matter. This narrative review aims at evaluating the multitude of issues to consider when feeding preterms in the three stages of their first life: in-hospital care, discharge, and, eventually, weaning. Given the current absence of internationally shared guidelines, understanding the potential pitfalls of preterms’ nutrition could help us trace the right path for the right preterm.
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16
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Thanigainathan S, Abiramalatha T. Early fortification of human milk versus late fortification to promote growth in preterm infants. Cochrane Database Syst Rev 2020; 7:CD013392. [PMID: 32726863 PMCID: PMC7390609 DOI: 10.1002/14651858.cd013392.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Uncertainty exists about the optimal point at which multi-component fortifier should be added to human milk for promoting growth in preterm infants. The most common practice is to start fortification when the infant's daily enteral feed volume reaches 100 mL/kg body weight. Another approach is to commence fortification earlier, in some cases as early as the first enteral feed. Early fortification of human milk could increase nutrient intake and growth rates but may increase the risk of feed intolerance and necrotising enterocolitis (NEC). OBJECTIVES To assess effects on growth and safety of early fortification of human milk versus late fortification in preterm infants To assess whether effects vary based upon gestational age (≤ 27 weeks; 28 to 31 weeks; ≥ 32 weeks), birth weight (< 1000 g; 1000 to 1499 g; ≥ 1500 g), small or appropriate for gestational age, or type of fortifier (bovine milk-based human milk fortifier (HMF); human milk-based HMF; formula powder) SEARCH METHODS: We used the standard strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 8); OVID MEDLINE (R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions (R) (1946 to 15 August 2019); MEDLINE via PubMed (1 August 2018 to 15 August 2019) for the previous year; and the Cumulative Index to Nursing and Allied Health Literatue (CINAHL) (1981 to 15 August 2019). We searched clinical trials databases and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials that compared early versus late fortification of human milk in preterm infants. We defined early fortification as fortification started at < 100 mL/kg/d enteral feed volume or < 7 days postnatal age, and late fortification as fortification started at ≥ 100 mL/kg/d feeds or ≥ 7 days postnatal age. DATA COLLECTION AND ANALYSIS Both review authors assessed trial eligibility and risk of bias and independently extracted data. We analysed treatment effects in individual trials, and we reported risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included two trials with a total of 237 infants. All participants were very low birth weight infants (birth weight < 1500 g). Early fortification was started at 20 mL/kg/d enteral feeds in one study and 40 mL/kg/d in the other study. Late fortification was started at 100 mL/kg/d feeds in both studies. One study used bovine milk-based fortifier, and the other used human milk-based fortifier. Meta-analysis showed that early fortification may have little or no effect on growth outcomes including time to regain birth weight (MD -0.06 days, 95% CI -1.32 to 1.20 days), linear growth (MD 0.10 cm/week, 95% CI -0.03 to 0.22 cm/week), or head growth (MD -0.01 cm/week, 95% CI -0.07 to 0.06 cm/week) during the initial hospitalisation period. Early fortification may have little or no effect on the risk of NEC (MD -0.01, 95% CI -0.07 to 0.06). The certainty of evidence was low for these outcomes due to risk of bias (lack of blinding) and imprecision (small sample size). Early fortification may have little or no effect on incidence of surgical NEC, time to reach full enteral feeds, extrauterine growth restriction at discharge, proportion of infants with feed interruption episodes, duration of total parenteral nutrition (TPN), duration of central venous line usage, or incidence of invasive infection, all-cause mortality, and duration of hospital stay. The certainty of evidence was low for these outcomes due to risk of bias (lack of blinding) and imprecision (small sample size). We did not have data for other outcomes such as subsequent weight gain after birth weight is regained, parenteral nutrition-associated liver disease, postdischarge growth, and neurodevelopmental outcomes. AUTHORS' CONCLUSIONS Available evidence is insufficient to support or refute early fortification of human milk in preterm infants. Further large trials would be needed to provide data of sufficient quality and precision to inform policy and practice.
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Affiliation(s)
- Sivam Thanigainathan
- Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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DiLauro S, Russell J, McCrindle BW, Tomlinson C, Unger S, O'Connor DL. Growth of cardiac infants with post-surgical chylothorax can be supported using modified fat breast milk with proactive nutrient-enrichment and advancement feeding protocols; an open-label trial. Clin Nutr ESPEN 2020; 38:19-27. [PMID: 32690156 DOI: 10.1016/j.clnesp.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND & AIM Previously we showed that modified fat breast milk (MFBM) facilitated resolution of post-surgical chylothorax in cardiac infants, but their weight-for-age and length-for-age z-scores declined over the ≥6-week treatment duration. Our aim was to evaluate the growth of infants diagnosed with post-surgical chylothorax and fed according to one of two proactive feeding protocols using MFBM or a high medium triglyceride (MCT)-containing formula (standard of care). METHODS In this open-label trial, infants who were receiving >50% of their enteral feeds as breast milk prior to chylothorax diagnosis were randomized to receive their enteral feeds according to one of two proactive MFBM protocols: Target Fortification (n = 8), where the protein concentration of defatted breast milk was measured weekly and multi- and single-nutrient modulars were added to provide 3.5 g/kg/day of protein; or Higher Initial Concentration (n = 8), where defatted breast milk was initially fortified to an energy and nutrient level higher than that of unmodified breast milk (80kcal/100 ml; 2.2 g/100 ml protein). A third nonrandomized group of infants (n = 8) received high MCT formula (68kcal/100 ml; 2.3 g/100 ml protein). The intervention lasted for a minimum of 6-weeks after chest tube removal and continued after discharge. Weekly weight, length and head circumference (HC) measurements were completed. RESULTS At enrolment, there was no statistically significant differences in mean (±SD) weight-for-age (-1.6 ± 0.9, n = 24), length-for-age (-1.3 ± 0.8), or HC-for-age (-0.9 ± 1.0) z-scores among groups. Changes in mean weight- (-0.3 ± 0.9, n = 23), length- (0.1 ± 0.6) and HC-for-age (0.2 ± 0.6) z-scores did not differ among groups over the treatment period. There was no difference in duration or volume of chest tube drainage across groups. CONCLUSION Use of proactive MFBM feeding protocols both resolve chylothorax and support growth in infants following cardiothoracic surgery. TRIAL REGISTRATION ClinicalTrials.gov (NCT02577419).
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Affiliation(s)
- Sara DiLauro
- Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; Translational Medicine Program, The Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada
| | - Jennifer Russell
- Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, M5G 1X8, Canada
| | - Brian W McCrindle
- Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, M5G 1X8, Canada
| | - Christopher Tomlinson
- Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, M5G 1X8, Canada; Department of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Department of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada; Rogers Hixon Ontario Human Milk Bank, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada; Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253, 1 King's College Circle, Toronto, M5S 1A8, Canada; Translational Medicine Program, The Hospital for Sick Children, 686 Bay Street, Toronto, M5G 0A4, Canada; Rogers Hixon Ontario Human Milk Bank, Mount Sinai Hospital, 600 University Ave, Toronto, M5G 1X5, Canada; Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, M5G 1X5, Canada.
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18
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Moreira MEL, Lucena SL, Magalhães PSCD, Rocha AD, Costa ACC, Soares FVM. MACRONUTRIENTS OF MOTHERS' MILK OF VERY LOW BIRTH WEIGHT INFANTS: ANALYSIS ACCORDING TO GESTATIONAL AGE AND MATERNAL VARIABLES. REVISTA PAULISTA DE PEDIATRIA 2020; 39:e2019097. [PMID: 32578667 PMCID: PMC7309577 DOI: 10.1590/1984-0462/2021/39/2019097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/18/2019] [Indexed: 11/22/2022]
Abstract
Objective: To analyze the composition of macronutrients present in the milk of mothers
of preterm newborn infants (PTNB) - protein, fat, carbohydrate, and calories
- by gestational age (GA), chronological age (CA) and maternal
variables. Methods: Longitudinal study that analyzed 215 milk samples from the 51 mothers of
PTNB admitted in three Neonatal Intensive Care Units of Rio de Janeiro from
May/2013-January/2014. Milk collection was performed by pickup pump, on a
fixed day of each week until discharge. The spectrophotometric technique
with Infrared Analysis (MilkoScan Minor 104) was used for the quantitative
analysis. A sample of 7 mL of human milk was taken from the total volume of
milk extracted by the mother. The data was grouped by GA (25-27, 28-31,
32-36, 37-40 weeks) and by CA (zero to 4, 5-8, 9-12, 13-16 weeks). Results: Protein, carbohydrate, fat and calories did not show any pattern of change,
with no difference among groups of GA. When the macronutrients were analyzed
by groups of CA, protein decreased, with significant difference between the
first two groups of CA. Carbohydrates, fat and calories presented increasing
values in all groups, without significant differences. Weight gain during
pregnancy, maternal hypertension and maternal age were associated with
changes in fat and calories in the first moment of the analysis of milk. Conclusions: There was a significant decrease in the levels of protein during the first
eight weeks after birth. CA may be an important factor in the composition of
human milk.
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Affiliation(s)
| | - Sabrina Lopes Lucena
- Instituto Nacional de Saúde da Mulher e da Criança Fernandes Figueira, Rio de Janeiro, RJ, Brazil
| | | | - Adriana Duarte Rocha
- Instituto Nacional de Saúde da Mulher e da Criança Fernandes Figueira, Rio de Janeiro, RJ, Brazil
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19
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Brown JV, Lin L, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev 2020; 6:CD000343. [PMID: 35658821 PMCID: PMC7268980 DOI: 10.1002/14651858.cd000343.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Human breast milk-fed preterm infants can accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with multi-nutrient fortified human milk could increase nutrient accretion and growth rates and improve neurodevelopmental outcomes. Concern exists, however, that multi-nutrient fortifiers are associated with adverse events such as feed intolerance and necrotising enterocolitis. OBJECTIVES To determine whether multi-nutrient fortified human milk, compared with unfortified human milk, affects important outcomes (including growth rate and neurodevelopment) of preterm infants without increasing the risk of adverse effects (such as feed intolerance and necrotising enterocolitis). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 9), MEDLINE via PubMed (1966 to 26 September 2019), Embase (1980 to 26 September 2019), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 26 September 2019). We searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared feeding preterm infants with multi-nutrient (protein and energy plus minerals, vitamins, or other nutrients) fortified human breast milk versus unfortified (no added protein or energy) breast milk. DATA COLLECTION AND ANALYSIS We used the standard methods of Cochrane Neonatal. Two review authors separately evaluated trial quality, extracted data, and synthesised effect estimates using risk ratios (RRs), risk differences, and mean differences (MDs). We assessed the certainty of the body of evidence at the outcome level using "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) methods. MAIN RESULTS We identified 18 trials in which a total of 1456 preterm infants participated. These trials were generally small and methodologically weak. Meta-analyses provided low- to moderate-certainty evidence showing that multi-nutrient fortification of human milk increases in-hospital rate of weight gain (MD 1.76 g/kg/d, 95% confidence interval (CI) 1.30 to 2.22), body length (MD 0.11 cm/week, 95% CI 0.08 to 0.15), or head circumference (MD 0.06 cm/week, 95% CI 0.03 to 0.08) among preterm infants. Few data on growth and developmental outcomes assessed beyond infancy are available, and these do not show effects of multi-nutrient fortification. The data do not suggest other benefits or harms and provide low-certainty evidence suggesting effects of multi-nutrient fortification on the risk of necrotising enterocolitis in preterm infants (typical RR 1.37, 95% CI 0.72 to 2.63; 13 studies, 1110 infants). AUTHORS' CONCLUSIONS Feeding preterm infants with multi-nutrient fortified human breast milk compared with unfortified human breast milk is associated with modest increases in in-hospital growth rates. Evidence is insufficient to show whether multi-nutrient fortification has any effect on long-term growth or neurodevelopment.
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Affiliation(s)
- Jennifer Ve Brown
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Luling Lin
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust and University of Newcastle, Newcastle upon Tyne, UK
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, UK
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20
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Bulut O, Coban A, Uzunhan O, Ince Z. Effects of Targeted Versus Adjustable Protein Fortification of Breast Milk on Early Growth in Very Low‐Birth‐Weight Preterm Infants: A Randomized Clinical Trial. Nutr Clin Pract 2020; 35:335-343. [DOI: 10.1002/ncp.10307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Ozgul Bulut
- Department of PediatricsDivision of NeonatologyIstanbul University Faculty of Medicine Istanbul Turkey
| | - Asuman Coban
- Department of PediatricsDivision of NeonatologyIstanbul University Faculty of Medicine Istanbul Turkey
| | - Ozan Uzunhan
- Department of PediatricsDivision of NeonatologyIstanbul University Faculty of Medicine Istanbul Turkey
| | - Zeynep Ince
- Department of PediatricsDivision of NeonatologyIstanbul University Faculty of Medicine Istanbul Turkey
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21
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Lin YH, Hsu YC, Lin MC, Chen CH, Wang TM. The association of macronutrients in human milk with the growth of preterm infants. PLoS One 2020; 15:e0230800. [PMID: 32214387 PMCID: PMC7098608 DOI: 10.1371/journal.pone.0230800] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 03/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background Breast milk is the optimal choice for feeding premature babies. However, the prevalence rate of extrauterine growth restriction in preterm infants remains high. Objectives The purpose of this study was to analyze the macronutrients present in human milk and the correlation with the growth of in-hospital preterm infants. Methods This prospective study is based on data from 99 in-hospital preterm infants younger than 37 weeks of gestational age on an exclusively human milk diet. Infants who had previously received parenteral nutrition were eligible, but they had to have reached full enteral feeding at the time that the samples were taken. A total of 3282 samples of raw human milk or donor pasteurized milk were collected. The levels of lactose, protein, fat, and energy in the samples were measured using a Miris human milk analyzer. The primary outcome was weight growth velocity (g/kg/day) which was obtained using two-point approach. Results The mean (±standard deviation) macronutrient composition per 100 mL of milk was 7.2 (±0.3) g of lactose, 1.1 (±0.2) g of true protein, 3.5 (±0.9) g of fat, and 66.9 (±6.5) kcal of energy. The protein concentration in human milk had a positive, significant correlation with body weight gain, with a coefficient of 0.41 (p < 0.001). After adjusting for gestational age, postmenstrual age, small-for-gestational age, intraventricular hemorrhage, patent ductus arteriosus or congestive heart failure, duration of total parenteral nutrition support, bottle feeding or use of orogastric tube, and ventilator support, total daily protein intake was associated with body weight growth (p < 0.001). Conclusion Both the protein concentration in human milk and the daily total protein intake had a positive correlation with the body weight gain of premature infants. Routine analysis of breast milk and individualized fortification might be indicated to optimize the growth of preterm infants.
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Affiliation(s)
- Yi-Hsuan Lin
- Division of Neonatology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ya-Chi Hsu
- Division of Neonatology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Chih Lin
- Division of Neonatology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Food and Nutrition, Providence University, Taichung, Taiwan
- * E-mail:
| | - Chao-Huei Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Center for Faculty Development, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Teh-Ming Wang
- Division of Neonatology, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
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22
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Concheiro-Guisan A, Alonso-Clemente S, Suarez-Albo M, Duran-Fernandez Feijoo C, Fiel-Ozores A, Fernandez-Lorenzo JR. The Practicality of Feeding Defatted Human Milk in the Treatment of Congenital Chylothorax. Breastfeed Med 2019; 14:648-653. [PMID: 31403320 DOI: 10.1089/bfm.2019.0100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Congenital chylothorax (CC) is a rare and life-threating condition. Since its treatment is founded on the elimination of long-chain fatty acids from the diet, breastfeeding has been traditionally contraindicated. However, breast milk could be very beneficial due to its immunological and nutritional benefits. Only limited research has been published about the usage of modified-fat breast milk (MBM) in chylothorax treatment. Methods and Results: Systematic review methods were used by two independent reviewers. Only a few case report studies (quality assessment on the domains of the GRADE approach), two small controlled studies, a retrospective study, and some test-tube-based laboratory research met the inclusion criteria. Despite this, we have observed a widespread clinical adoption of this novel treatment in health institutions. Data suggest that modified-fat breast milk does facilitate the resolution of chylothoraces. Refrigerated centrifuge (2°C, 3,000 rpm for 15 minutes) and syringe fat removal methods were the most efficient options in terms of fat reduction. Conclusions: Feeding of human milk is advisable in CC and feasible by means of a simple milk defatting procedure. Open questions remain, related to length and degree of fat restriction and need for individualized fortification of defatted breast milk.
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Affiliation(s)
- Ana Concheiro-Guisan
- Neonatology Department and Human Milk Bank, Alvaro Cunqueiro University Hospital, Vigo, Spain
| | - Sonia Alonso-Clemente
- Nutrition Department and Human Milk Bank, Alvaro Cunqueiro University Hospital, Vigo, Spain
| | - María Suarez-Albo
- Neonatology Department and Human Milk Bank, Alvaro Cunqueiro University Hospital, Vigo, Spain
| | | | - Antía Fiel-Ozores
- Neonatology Department and Human Milk Bank, Alvaro Cunqueiro University Hospital, Vigo, Spain
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23
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Abstract
Late preterm infants comprise the majority of preterm infants, yet there are few data to support best nutritional practice for these infants. Breastmilk is considered the best choice of enteral feeding for late preterm infants. However, supplementation of breastmilk may be indicated to promote optimal growth. Preterm formulas can be used for supplementation of breastmilk or as a breastmilk substitute but there is little evidence for their use in the late preterm infant. Feeding difficulties are common and some infants require intravenous nutritional support soon after birth. Others require tube feeding until full sucking feeds are established. Future research should focus on whether nutritional support of late preterm babies pending exclusive breastfeeding influences growth, body composition and long-term outcomes of late preterm infants and, if so, how nutritional interventions can optimise these outcomes.
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Affiliation(s)
- Sharin Asadi
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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24
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Thanigainathan S, Abiramalatha T. Early fortification of human milk versus late fortification to promote growth in preterm infants. Hippokratia 2019. [DOI: 10.1002/14651858.cd013392] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sivam Thanigainathan
- Jawaharlal Institute of Postgraduate Medical Education and Research Puducherry; Neonatology; Puducherry Puducherry India 605006
| | - Thangaraj Abiramalatha
- Sri Ramachandra Institute of Higher Education and Research; Neonatology; Chennai Tamil Nadu India
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25
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[The value of human milk for preterm infants-overview and practical aspects]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:952-959. [PMID: 29971449 DOI: 10.1007/s00103-018-2777-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Over the last decades the immense benefit of human milk on the nutrition of preterm infants has become increasingly evident. Research has confirmed that human milk has significant advantages for the preterm infant in terms of host defense, gastrointestinal development and maturation, neurological development, reduction of necrotizing enterocolitis, retinopathy of prematurity and chronic lung disease as well as mental and physical benefits for the mother. Computing these factors into a health-cost-benefit equation, positive economic consequences for a national public health system were demonstrated.Therefore, international feeding guidelines recommend human milk to be the first choice for preterm infants, the primary source being the infant's mother. The first alternative is milk from an established donor milk bank. To meet the unique nutritional demands of preterm infants and to avoid postnatal growth restriction, human milk must be fortified with additional micro- and macronutrients. Concerns about microbial colonization and contamination and hygienic aspects concerning milk handling need to be addressed when feeding human milk to preterm infants.Early initiation and maintenance of lactation is challenging for mothers of preterm infants and their caregivers. Providing lactation support from educated staff, optimal nursing environments, and the positive attitude of an experienced NICU (neonatal intensive care unit) team will contribute to successful lactation and breastfeeding even beyond discharge of the infant.
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26
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Liu X, Luo B, Peng W, Xiong F, Yang F, Wu J. Factors affecting the catch-up growth of preterm infants after discharge in China: a multicenter study based on the health belief model. Ital J Pediatr 2019; 45:87. [PMID: 31331363 PMCID: PMC6647139 DOI: 10.1186/s13052-019-0674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze the growth status and to identify the risk factors that influence the catch-up growth of preterm infants after discharge and to provide evidence for feeding strategies and the need for further research. METHODS A descriptive correlational analysis was applied. The sample consisted of 309 preterm infants and their caregivers selected from June to August 2017 from five women's and children's hospitals. Self-designed questionnaires based on knowledge, attitude and practice and the Health Belief Model (HBM) were used to measure the catch-up growth status of preterm infants after discharge. Logistic regression was used to determine the risk factors for the catch-up growth of preterm infants. RESULTS The results showed that of 309 preterm infants, only 14 (4.5%) were underweight, and 52 (17.4%) did not meet the criteria for catch-up growth at 12 months of actual age. The logistic regression analysis showed that gestational age, regular health care, caregivers' educational background, mothers' daily contact with the baby, monthly average family income, the addition of a breast milk supplement, and daily milk volume were risk factors that affected the catch-up growth of preterm infants after discharge. CONCLUSIONS The rate of catch-up growth of preterm infants is still not high. We should pay much more attention to preterm infants of small gestational age and guide their child care on a regular basis to detect and correct risk factors in a timely fashion, especially those involving lower daily milk volume, lower degree of culture and family economic difficulties. Second, we suggest that the government publish relevant policy that appropriately increases the length of maternity leave for preterm mothers. Future studies should have larger sample sizes and explore other important factors influencing the catch-up growth of preterm infants.
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Affiliation(s)
- Xiaomei Liu
- Pediatric Department of the West China Second Hospital of Sichuan University, Chengdu, China.,Nursing Department of the West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Biru Luo
- Nursing Department of the West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Wentao Peng
- Nursing Department of the West China Second Hospital of Sichuan University, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.
| | - Fei Xiong
- Pediatric Department of the West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Fan Yang
- Pediatric Department of the West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Jinhui Wu
- Pediatric Department of the West China Second Hospital of Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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27
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Quan M, Wang D, Gou L, Sun Z, Ma J, Zhang L, Wang C, Schibler K, Li Z. Individualized Human Milk Fortification to Improve the Growth of Hospitalized Preterm Infants. Nutr Clin Pract 2019; 35:680-688. [PMID: 31268194 DOI: 10.1002/ncp.10366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Meiying Quan
- Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
| | - Danhua Wang
- Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
| | - Lijuan Gou
- Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
| | - Zhixing Sun
- Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
| | - Jingran Ma
- Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
| | - Lejia Zhang
- Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
| | - Chen Wang
- Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
| | - Kurt Schibler
- Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
| | - Zhenghong Li
- Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing China
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28
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Godden B, Collins CT, Hilditch C, McLeod G, Keir A. Does early compared to late fortification of human milk for preterm infants improve clinical outcomes? J Paediatr Child Health 2019; 55:867-872. [PMID: 31270869 DOI: 10.1111/jpc.14499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 11/29/2022]
Abstract
AIM This evidence-based review aims to answer the following structured clinical question: In preterm infants <37 weeks' gestation (patient), does early fortification of breast milk (intervention) compared to late fortification (control) improve growth outcomes at the time of discharge or affect length of hospital stay (outcome)? METHODS MEDLINE, Embase, Maternity and Infant Care Database and Evidence-Based Medicine Reviews were searched for articles published from 2000 onwards that were relevant to the structured clinical question. The National Institute for Health and Care Excellence, National Health and Medical Research Council, Agency for Healthcare Research and Quality, National Institute of Health and Turning Research into Practice databases were also searched, and reference lists of relevant articles were reviewed. RESULTS A total of 167 articles, after removal of duplicates, were found and screened by title and abstract. Five full-text articles were ultimately included in the review. CONCLUSIONS The results of this review suggest that early fortification is safe and well tolerated. However, earlier fortification has not been shown to have a significant impact on growth outcomes at time of discharge or length of stay. More research is required to determine if early fortification of breast milk may have benefits regarding longer-term growth and neurodevelopmental outcomes.
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Affiliation(s)
- Beth Godden
- Department of Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Cathie Hilditch
- Department of Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Gemma McLeod
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.,Women and Newborn Health Service, King Edward Memorial and Princess Margaret Hospitals, Perth, Western Australia, Australia
| | - Amy Keir
- Department of Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
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29
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Arslanoglu S, King C, Boquien CY, Lamireau D, Tonetto P, Krolak-Olejnik B, Picaud JC. Letter to the editor: clarifying some aspects and the terminology of individualized human milk fortification. BMC Pediatr 2019; 19:135. [PMID: 31027484 PMCID: PMC6485054 DOI: 10.1186/s12887-019-1491-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 04/08/2019] [Indexed: 11/22/2022] Open
Abstract
This letter has been written by the components of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification in response to a recent paper published by Mathes et al. (BMC Pediatr. 2018 May 8;18(1):154) with the aim of drawing attention to the importance of the use of a metabolic marker to adapt protein intake in preterm infants. EMBA Working Group on Human Milk Fortification clarifies further the terminology and some specific aspects regarding individualized human milk fortification. There are two types of individualized human milk fortification: Adjustable human milk fortification and Targeted human milk fortification. Advantages and disadvantages of these methods are summarized.
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Affiliation(s)
- Sertac Arslanoglu
- European Milk Bank Association (EMBA) Working Group on Human Milk Fortification, Milan, Italy. .,Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Caroline King
- European Milk Bank Association (EMBA) Working Group on Human Milk Fortification, Milan, Italy.,Department of Nutrition & Dietetics, Imperial College Healthcare NHS Trust, London, UK
| | - Clair-Yves Boquien
- European Milk Bank Association (EMBA) Working Group on Human Milk Fortification, Milan, Italy.,PhAN, Institut National de la Recherche Agronomique (INRA), Université de Nantes, CRNH-Ouest, Nantes, France
| | - Delphine Lamireau
- European Milk Bank Association (EMBA) Working Group on Human Milk Fortification, Milan, Italy.,Lactariums de Bordeaux-Marmande, Pôle pédiatrique, Centre Hospitalo-universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Paola Tonetto
- European Milk Bank Association (EMBA) Working Group on Human Milk Fortification, Milan, Italy.,City of Health and Science of Turin, Neonatal Unit of Turin University, Turin, Italy
| | - Barbara Krolak-Olejnik
- European Milk Bank Association (EMBA) Working Group on Human Milk Fortification, Milan, Italy.,Division of Neonatology, Wroclaw Medical University, Wroclaw, Poland
| | - Jean-Charles Picaud
- European Milk Bank Association (EMBA) Working Group on Human Milk Fortification, Milan, Italy.,Division of Neonatology, Hôpital de la Croix-Rousse, Lyon, France.,Laboratoire CarMeN, INSERM U1060, INRA U1397, Université Claude Bernard Lyon 1, Lyon, France
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30
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Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, Bertino E, Gaya A, Gebauer C, Grovslien A, Moro GE, Weaver G, Wesolowska AM, Picaud JC. Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk Fortification. Front Pediatr 2019; 7:76. [PMID: 30968003 PMCID: PMC6439523 DOI: 10.3389/fped.2019.00076] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/25/2019] [Indexed: 01/03/2023] Open
Abstract
Evidence indicates that human milk (HM) is the best form of nutrition uniquely suited not only to term but also to preterm infants conferring health benefits in both the short and long-term. However, HM does not provide sufficient nutrition for the very low birth weight (VLBW) infant when fed at the usual feeding volumes leading to slow growth with the risk of neurocognitive impairment and other poor health outcomes such as retinopathy and bronchopulmonary dysplasia. HM should be supplemented (fortified) with the nutrients in short supply, particularly with protein, calcium, and phosphate to meet the high requirements of this group of babies. In this paper the European Milk Bank Association (EMBA) Working Group on HM Fortification discusses the existing evidence in this field, gives an overview of different fortification approaches and definitions, outlines the gaps in knowledge and gives recommendations for practice and suggestions for future research. EMBA recognizes that "Standard Fortification," which is currently the most utilized regimen in neonatal intensive care units, still falls short in supplying sufficient protein for some VLBW infants. EMBA encourages the use of "Individualized Fortification" to optimize nutrient intake. "Adjustable Fortification" and "Targeted Fortification" are 2 methods of individualized fortification. The quality and source of human milk fortifiers constitute another important topic. There is work looking at human milk derived fortifiers, but it is still too early to draw precise conclusions about their use. The pros and cons are discussed in this Commentary in addition to the evidence around use of fortifiers post discharge.
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Affiliation(s)
- Sertac Arslanoglu
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Clair-Yves Boquien
- PhAN, Institut National de la Recherche Agronomique (INRA), Université de Nantes, CRNH-Ouest, Nantes, France
| | - Caroline King
- Department of Nutrition and Dietetics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Delphine Lamireau
- Lactariums de Bordeaux-Marmande, Pôle Pédiatrique, Centre Hospitalo-Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Paola Tonetto
- Neonatal Unit of Turin University, City of Health and Science of Turin, Turin, Italy
| | - Debbie Barnett
- Greater Glasgow and Clyde Donor Milk Bank, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Enrico Bertino
- Neonatal Unit of Turin University, City of Health and Science of Turin, Turin, Italy
| | - Antoni Gaya
- Banc de Teixits, Fundaciò Banc Sang i Teixits de les Illes Balears, Palma de Mallorca, Spain
| | - Corinna Gebauer
- Abteilung Neonatologie Klinik und Poliklinik für Kinder und Jugendliche, Leipzig, Germany
| | - Anne Grovslien
- Neonatal Unit, Milk Bank, Oslo University Hospital, Oslo, Norway
| | - Guido E. Moro
- Associazione Italiana Banche del Latte Umano Donato (AIBLUD), Milan, Italy
| | - Gillian Weaver
- Hearts Milk Bank, Rothamsted Research Institute, Harpenden, United Kingdom
| | | | - Jean-Charles Picaud
- CarMeN Unit, INSERM U1060, INRA U1397, Claude Bernard University Lyon 1, Pierre Bénite, France
- Division of Neonatology, Hôpital de la Croix-Rousse, Lyon, France
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31
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Banked Human Milk and Quantitative Risk Assessment of Bacillus cereus Infection in Premature Infants: A Simulation Study. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2019; 2019:6348281. [PMID: 30863469 PMCID: PMC6378033 DOI: 10.1155/2019/6348281] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/31/2018] [Indexed: 11/17/2022]
Abstract
Background Banked human milk (BHM) offers potential health benefits to premature babies. BHM is pasteurized to mitigate infectious risks, but pasteurization is ineffective against sporulating bacteria such as Bacillus cereus. Sepsis related to Bacillus cereus in premature infants is severe and can often be fatal. Even if a causal link has never been established, BHM has been suggested as a potential source of infection in premature infants. Objective Our aim was to estimate the potential risk of Bacillus cereus infection in preterm infants caused by the ingestion of contaminated pasteurized BHM using different post-pasteurization release criteria (i.e., 9 sampling of 100 microliters versus the HMBANA guideline of 1 sampling of 100 microliters per pool). Methods In the absence of scientific evidence regarding the risk of Bacillus cereus infection by the ingestion of BHM in premature infants, risk assessment using Monte Carlo simulation with the exponential dose-response model was performed. Three scenarios of infectious risk (annual incidence rate of 0.01%, 0.13%, and 0.2%) with 18 variations of the B. cereus virulent dose (from 0.5 CFU/ml to 200 CFU/ml) were simulated. Results The mean risk differential between the two methods of post-pasteurization bacteriological control for realistic infectious doses of 30 to 200 CFU/ml ranges from 0.036 to 0.0054, 0.47 to 0.070, and 0.72 to 0.11 per million servings, for each of the three scenarios. Conclusion Simulation highlights the very small risk of Bacillus cereus infection following the ingestion of pasteurized BHM, even in the worst case scenarios, and suggests that a 100-microliter sample for post-pasteurization culture is sufficient.
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Thakkar SK, De Castro CA, Beauport L, Tolsa JF, Fischer Fumeaux CJ, Affolter M, Giuffrida F. Temporal Progression of Fatty Acids in Preterm and Term Human Milk of Mothers from Switzerland. Nutrients 2019; 11:nu11010112. [PMID: 30626044 PMCID: PMC6356418 DOI: 10.3390/nu11010112] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/18/2018] [Accepted: 12/25/2018] [Indexed: 01/20/2023] Open
Abstract
We longitudinally compared fatty acids (FA) from human milk (HM) of mothers delivering term and preterm infants. HM was collected for 4 months postpartum at 12 time points for preterm and for 2 months postpartum at 8 time points for term group. Samples were collected from the first feed of the morning, and single breast was fully expressed. FA were analyzed by gas chromatography coupled with flame ionization detector. Oleic, palmitic and linoleic acids were the most abundant FA across lactation and in both groups. Preterm colostrum contained significantly (p < 0.05) higher 8:0, 10:0, 12:0, sum medium chain fatty acids (MCFA), 18:3 n-3 FA compared to term counterparts. Preterm mature milk contained significantly higher 12:0, 14:0, 18:2 n-6, sum saturated fatty acids (SFA), and sum MCFA. We did not observe any significant differences between the preterm and term groups for docosahexaenoic acid, arachidonic acid and eicosapentaenoic acid at any stage of lactation. Overall, preterm milk was higher for SFA with a major contribution from MCFA and higher in 18:2 n-6. These observational differences needs to be studied further for their implications on preterm developmental outcomes and on fortification strategies of either mothers’ own milk or donor human milk.
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Affiliation(s)
- Sagar K Thakkar
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne 1000, Switzerland.
| | | | - Lydie Beauport
- Clinic of Neonatology, Department Woman Mother Child, University Hospital of Lausanne, Lausanne 1011, Switzerland.
| | - Jean-François Tolsa
- Clinic of Neonatology, Department Woman Mother Child, University Hospital of Lausanne, Lausanne 1011, Switzerland.
| | - Céline J Fischer Fumeaux
- Clinic of Neonatology, Department Woman Mother Child, University Hospital of Lausanne, Lausanne 1011, Switzerland.
| | - Michael Affolter
- Nestlé Institute of Food Safety & Analytical Science, Nestlé Research, Lausanne 1000, Switzerland.
| | - Francesca Giuffrida
- Nestlé Institute of Food Safety & Analytical Science, Nestlé Research, Lausanne 1000, Switzerland.
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Gupta V, Rebekah G, Sudhakar Y, Santhanam S, Kumar M, Thomas N. A randomized controlled trial comparing the effect of fortification of human milk with an infant formula powder versus unfortified human milk on the growth of preterm very low birth weight infants. J Matern Fetal Neonatal Med 2019; 33:2507-2515. [PMID: 30486700 DOI: 10.1080/14767058.2018.1554046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To optimize growth in very low birth weight (VLBW) infants, human milk fortification is standard of care in neonatal units of high-income countries. However, commercial fortifiers may not be available or it may be too expensive in resource-limited settings. As an alternative to using human milk fortifiers, we studied the effects of milk fortification with an infant formula on growth and biochemical parameters of very low birth weight (VLBW) infantsMethods: We undertook a prospective, randomized controlled trial in the neonatal unit of a tertiary care hospital in South India. Preterm infants weighing <1500 grams and <34 weeks of gestation were randomized after stratification according to birth weight into two groups (<1250 g and 1250 to <1500 g). One group received fortified human milk while the other received exclusive human milk. The fortification was done with a commercially available infant milk powder added to expressed breast milk (when the infant reached 150 ml/kg/day of feeds) and continued till the infant reached 1800 g. The primary outcome was the rate of weight gain/kg/day. Secondary outcome measures were linear growth, head circumference increase, biochemical parameters to assess the adequacy or excess of protein supplementation and comorbidities like feed intolerance, sepsis, and necrotizing enterocolitis (NEC).Results: Total of 163 babies were randomized during the study period, of whom 148 babies (73 in the standard arm and 75 in the fortification arm) completed the trial. Baseline demographic data among the two groups were comparable. Weight gain/kg/day (mean difference (MD) 1.98 g/kg/day; 95% CI: 1.03-2.92; p<.001) and linear growth (MD 0.09 cm/week; 95% CI: 0.02-0.2; p=.02) was significantly higher in the fortification arm as compared to the control arm. The head growth (head circumference gain in cm/week) was higher and length of hospital stay lesser in the fortification arm, though not statistically significant. Biochemical parameters, rates of sepsis, feed intolerance, and necrotizing enterocolitis (NEC) were not different between the two groups.Conclusion: Fortification with Infant milk powder achieves better growth parameters than unfortified human milk and can be a useful alternative for feeding preterm VLBW infants in low resource settings.
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Affiliation(s)
- Vijay Gupta
- Department of Neonatology, Christian Medical College and Hospital, Vellore, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, India
| | - Yesudas Sudhakar
- Department of Clinical Biochemistry, Christian Medical College and Hospital, Vellore, India
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College and Hospital, Vellore, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College and Hospital, Vellore, India
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College and Hospital, Vellore, India
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Kültürsay N, Bilgen H, Türkyılmaz C. Turkish Neonatal Society guideline on enteral feeding of the preterm infant. TURK PEDIATRI ARSIVI 2018; 53:S109-S118. [PMID: 31236024 PMCID: PMC6568297 DOI: 10.5152/turkpediatriars.2018.01811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Early initiation of enteral feeding with the own mother's milk and prevention of postnatal growth failure is the target of nutrition in preterm infants. Together with total parenteral nutrition, mouth care and minimal enteral nutrition is started with colostrum in the very early hours of life in small preterm infants. Expressed mother's milk is given via a gastric tube and gradually increased in accordance with the gestational age/birth weight and the risk factors. For infants born heavier than 1 000 grams, the aim is to reach total enteral feeding at the end of first week, and at the end of the second week for infants weighing less than 1000 grams. Supporting mothers in milk expression and kangaroo mother care, promoting non-nutritive feeding, appropriate fortification of mother' milk, and initiating and advancing breastfeeding as soon as the infant is ready are all crucial. Donor mother milk, and as a second choice, preterm formula is advised if the mother's milk is not available. Individualized post-discharge nutrition decisions can be taken in accordance with the actual growth at the time of discharge. The goal is optimal neurodevelopmental achievement together with the prevention of long-term metabolic problems. Late preterm infants, which constitute the majority of preterm infants, also need close nutritional attention and follow-up.
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Affiliation(s)
- Nilgün Kültürsay
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, İzmir, Turkey
| | - Hülya Bilgen
- Division of Neonatology, Department of Pediatrics, Marmara University, Faculty of Medicine, Pendik Research and Training Hospital, İstanbul, Turkey
| | - Canan Türkyılmaz
- Division of Neonatology, Department of Pediatrics, Gazi University, Faculty of Medicine, Ankara, Turkey
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Evaluation of A Concentrated Preterm Formula as a Liquid Human Milk Fortifier in Preterm Babies at Increased Risk of Feed Intolerance. Nutrients 2018; 10:nu10101433. [PMID: 30287775 PMCID: PMC6213423 DOI: 10.3390/nu10101433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/29/2018] [Accepted: 10/02/2018] [Indexed: 11/25/2022] Open
Abstract
There are concerns around safety and tolerance of powder human milk fortifiers to optimize nutrition in preterm infants. The purpose of this study was to evaluate the tolerance and safety of a concentrated preterm formula (CPF) as a liquid human milk fortifier (HMF) for premature infants at increased risk of feeding intolerance. We prospectively enrolled preterm infants over an 18-month period, for whom a clinical decision had been made to add CPF to human milk due to concerns regarding tolerance of powder HMF. Data on feed tolerance, anthropometry, and serum biochemistry values were recorded. Serious adverse events, such as mortality, necrotizing enterocolitis (NEC), and sepsis, were monitored. A total of 29 babies received CPF fortified milk during the study period. The most common indication for starting CPF was previous intolerance to powder HMF. Feeding intolerance was noted in 4 infants on CPF. The growth velocity of infants was satisfactory (15.9 g/kg/day) after addition of CPF to feeds. The use of CPF as a fortifier in preterm babies considered at increased risk for feed intolerance seems well tolerated and facilitates adequate growth. Under close nutrition monitoring, this provides an additional option for human milk fortification in this challenging subgroup of preterm babies, especially in settings with limited human milk fortifier options.
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Hay WW. Nutritional Support Strategies for the Preterm Infant in the Neonatal Intensive Care Unit. Pediatr Gastroenterol Hepatol Nutr 2018; 21:234-247. [PMID: 30345236 PMCID: PMC6182475 DOI: 10.5223/pghn.2018.21.4.234] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022] Open
Abstract
The goal of nutrition of the preterm infant is to "provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same postmenstrual age and to maintain normal concentrations of blood and tissue nutrients" (American Academy of Pediatrics 2014). Failure to provide the necessary amounts of all of the essential nutrients to preterm infants has produced not only growth failure, but also increased morbidity and less than optimal neurodevelopment. This continues to be true despite many efforts to increase nutrition of the preterm infants. In contrast, enhanced nutrition of very preterm infants, both intravenous and enteral, beginning right after birth, promotes positive energy and protein balance and improves longer term neurodevelopmental outcomes. The benefits are long lasting too, particularly for prevention of later life chronic diseases.
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Affiliation(s)
- William W. Hay
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
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Dietary Protein Intake, Breast Feeding and Growth in Human Milk Fed Preterm Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061196. [PMID: 29880727 PMCID: PMC6025124 DOI: 10.3390/ijerph15061196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 01/06/2023]
Abstract
Protein intakes of preterm infants are frequently below recommendations, but few studies report accurate intakes due to the difficulty of analysing human milk clinically. This observational analysis from a randomised trial of infants born <31 weeks’ gestation, investigating two levels of protein fortification, reports protein intakes compared with requirements and determines the association of direct breastfeeding on growth. Ninety-two infants (median gestational age 28 weeks, Interquartile range (IQR) 26–29; mean birth weight 1040 g, SD 300 g) were studied. Infants born weighing <1000 g were underfed protein compared with recommendations (median (IQR) intake of 3.0 (2.0–3.7) g/kg/day in week 2 versus recommendation of 4–4.5 g/kg/day), while those born weighing ≥1000 g met recommended protein intakes after the first week of life (median (IQR) intake of 3.7 (3.0–4.0) g/kg/day in week 2 versus recommendation of 3.5–4.5 g/kg/day). A moderate, negative correlation between the mean number of breast feeds and change in rate of weight gain (r = −0.37, p = 0.001) was found. Protein intakes of infants <1000 g did not meet recommendations and all infants were underfed protein and energy in the first week of life. Current protein fortification is inadequate for infants born <1000 g. Exploratory analysis showed faltering rate weight gain associated with increasing number of breast feeds and these results warrant confirmation.
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Adhisivam B, Kohat D, Tanigasalam V, Bhat V, Plakkal N, Palanivel C. Does fortification of pasteurized donor human milk increase the incidence of necrotizing enterocolitis among preterm neonates? A randomized controlled trial. J Matern Fetal Neonatal Med 2018; 32:3232-3237. [PMID: 29618272 DOI: 10.1080/14767058.2018.1461828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To compare the effect of fortified pasteurized donor human milk (PDHM) versus unfortified PDHM on the incidence of necrotizing enterocolitis (NEC) and immediate outcome among preterm neonates. Methods: This randomized controlled trial (RCT) conducted in a tertiary care teaching hospital, south India included 80 healthy preterm neonates randomized to two groups (Group A and B). Neonates in Group A and B were fed with fortified PDHM and unfortified PDHM, respectively. Neonates in both groups were managed uniformly as per standard NICU protocol. The primary outcome was the incidence of NEC and the secondary outcomes included severity of NEC, incidence of sepsis, mortality, duration of hospital stay, number of days to reach full enteral feeds and weight gain. Neonates were followed up for 28 days or discharge whichever was earlier. Results: The baseline maternal and neonatal characteristics in both groups were comparable. There was no increase in incidence of NEC in fortified PDHM group compared to unfortified PDHM group (2.5 versus 7.5%, p = .31). Severity of NEC, incidence of sepsis, mortality, duration of hospital stay, number of days to reach full enteral feeds and weight gain were also similar in both groups. Conclusions: Standard fortification of PDHM does not increase the incidence of NEC among preterm neonates.
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Affiliation(s)
- Bethou Adhisivam
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Dilesh Kohat
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Vasanthan Tanigasalam
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Vishnu Bhat
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Nishad Plakkal
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - C Palanivel
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
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Adhisivam B, Vishnu Bhat B, Rao K, Kingsley SM, Plakkal N, Palanivel C. Effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. J Matern Fetal Neonatal Med 2018; 32:3016-3019. [PMID: 29587541 DOI: 10.1080/14767058.2018.1455089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: The objective of this study was to study the effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. Methods: This descriptive study was conducted in a Human Milk Bank of a tertiary care teaching institute in south India. Thirty random paired pooled donor human milk samples (before and after pasteurization) were analyzed for macronutrients (protein, fat, carbohydrates) using infrared spectroscopy. Similarly, immunoglobulin profile (IgA and IgG) before and after pasteurization was quantified using ELISA. Results: The mean values of protein, fat, and carbohydrates in pooled donor milk pre-pasteurization were 1.6, 3.6, and 6.1 g/dl compared with post-pasteurization values 1.4, 2.7, and 5.9 g/dl, respectively. Pasteurization reduced protein, fat, and energy content of pooled donor milk by 12.5%, 25%, and 16%, respectively. However, carbohydrates were not significantly reduced. Pasteurization decreased IgA by 30% and IgG by 60%. Conclusion: Holder pasteurization of pooled donor human milk decreases protein, fat, and energy content and also reduces the levels of IgA and IgG.
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Affiliation(s)
- B Adhisivam
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - B Vishnu Bhat
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - Krishna Rao
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - S M Kingsley
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - Nishad Plakkal
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
| | - C Palanivel
- a Department of Neonatology , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Pondicherry , India
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Coscia A, Bertino E, Tonetto P, Peila C, Cresi F, Arslanoglu S, Moro GE, Spada E, Milani S, Giribaldi M, Antoniazzi S, Conti A, Cavallarin L. Nutritional adequacy of a novel human milk fortifier from donkey milk in feeding preterm infants: study protocol of a randomized controlled clinical trial. Nutr J 2018; 17:6. [PMID: 29316931 PMCID: PMC5761142 DOI: 10.1186/s12937-017-0308-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 12/15/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fortification of human milk is a standard practice for feeding very low birth weight infants. However, preterm infants often still experience suboptimal growth and feeding intolerance. New fortification strategies and different commercially available fortifiers have been developed. Commercially available fortifiers are constituted by a blend of ingredients from different sources, including plant oils and bovine milk proteins, thus presenting remarkable differences in the quality of macronutrients with respect to human milk. Based on the consideration that donkey milk has been suggested as a valid alternative for children allergic to cow's milk proteins, due to its biochemical similarity to human milk, we hypothesized that donkey milk could be a suitable ingredient for developing an innovative human milk fortifier. The aim of the study is to evaluate feeding tolerance, growth and clinical short and long-term outcomes in a population of preterm infants fed with a novel multi-component fortifier and a protein concentrate derived from donkey milk, in comparison to an analogous population fed with traditional fortifier and protein supplement containing bovine milk proteins. METHODS The study has been designed as a randomized, controlled, single-blind clinical trial. Infants born <1500 g and <32 weeks of gestational age were randomized to receive for 21 days either a combination of control bovine milk-based multicomponent fortifier and protein supplement, or a combination of a novel multicomponent fortifier and protein supplement derived from donkey milk. The fortification protocol followed is the same for the two groups, and the two diets were designed to be isoproteic and isocaloric. Weight, length and head circumference are measured; feeding tolerance is assessed by a standardized protocol. The occurrence of sepsis, necrotizing enterocolitis and adverse effects are monitored. DISCUSSION This is the first clinical study investigating the use of a human milk fortifier derived from donkey milk for the nutrition of preterm infants. If donkey milk derived products will be shown to improve the feeding tolerance or either of the clinical, metabolic, neurological or auxological outcomes of preterm infants, it would be an absolute innovation in the field of feeding practices for preterm infants. TRIAL REGISTRATION ISRCTN - ISRCTN70022881 .
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Affiliation(s)
- Alessandra Coscia
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Enrico Bertino
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Paola Tonetto
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Chiara Peila
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Francesco Cresi
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Sertac Arslanoglu
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy
| | - Guido E Moro
- Italian Association of Human Milk Banks, Via Libero Temolo 4, 20126 Milan, Italy
| | - Elena Spada
- Neonatal Unit of Turin University, City of Health and Science of Turin, Via Ventimiglia 3, 10126 Turin, Italy
| | - Silvano Milani
- Unit of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marzia Giribaldi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco (TO), Italy
- Research Centre for Engineering and Agro-Food Processing, Council for Agricultural Research and Economics (CREA), Strada delle cacce 73, 10135 Turin, Italy
| | - Sara Antoniazzi
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco (TO), Italy
| | - Amedeo Conti
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco (TO), Italy
| | - Laura Cavallarin
- Institute of Sciences of Food Production, National Research Council, Largo Braccini 2, 10095 Grugliasco (TO), Italy
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Kreins N, Buffin R, Michel-Molnar D, Chambon V, Pradat P, Picaud JC. Individualized Fortification Influences the Osmolality of Human Milk. Front Pediatr 2018; 6:322. [PMID: 30430102 PMCID: PMC6220443 DOI: 10.3389/fped.2018.00322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/09/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Fortification of human milk (HM) increases its osmolality, which is associated with an increased risk of necrotizing enterocolitis. The impact of new fortifiers on osmolality is not well-known, nor are the kinetics regarding the increase in osmolality. Aim: To determine the optimum fortifier composition for HM fortification by measuring the osmolality of fortified HM made with three powder multicomponent fortifiers (MCFs) and a protein fortifier (PF). Methods: The osmolality of HM was assessed at 2 (H2) and 24 (H24) h after fortification to compare the effects of MCF (MCF1-3) and PF used in quantities that ensured that infants' nutrient needs would be met (MCF: 4 g/100 ml HM; PF: 0.5 g or 1 g/100 ml HM). To evaluate the early kinetics associated with the osmolality increase, the osmolality of HM fortified with MCF1 or MCF2 was also measured at 0, 1, 5, 10, 15, 20, 30, 40, 50, 60, 90, and 120 min after fortification. Results: The osmolality increased significantly immediately after fortification, depending on the type of fortification used and the quantity of MCF and PF used, rather than the time elapsed after fortification. The maximum value at H24 was 484 mOsm/kg. The mean increase in osmolality between H2 and H24 was 3.1% (p < 0.01) (range: 0.2-10.8%). Most of the increase (>70%) occurred immediately after fortification. Conclusion: When choosing a fortifier, its effect on HM osmolality should be considered. As most of the increase in osmolality occurred immediately, bedside fortification is not useful to prevent the increase in osmolality, and further research should focus on improving fortifier composition.
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Affiliation(s)
- Nathalie Kreins
- Neonatal Intensive Care Unit, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Rachel Buffin
- Neonatal Intensive Care Unit, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,Regional Human Milk Bank, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Diane Michel-Molnar
- Centre de Biologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Veronique Chambon
- Centre de Biologie, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre Pradat
- Center for Clinical Research, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Charles Picaud
- Neonatal Intensive Care Unit, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,Regional Human Milk Bank, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,CarMeN Unit, Inserm U1060, INRA U1397, Claude Bernard University Lyon 1, Pierre Bénite, France.,Faculté de Médecine Lyon Sud Charles Merieux, Université Claude Bernard Lyon 1, Pierre Bénite, France
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Kreissl A, Sauerzapf E, Repa A, Binder C, Thanhaeuser M, Jilma B, Ristl R, Berger A, Haiden N. Starting enteral nutrition with preterm single donor milk instead of formula affects time to full enteral feeding in very low birthweight infants. Acta Paediatr 2017; 106:1460-1467. [PMID: 28498519 DOI: 10.1111/apa.13914] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/27/2017] [Accepted: 05/08/2017] [Indexed: 11/30/2022]
Abstract
AIM This study compared the impact of using either single donor breastmilk or formula to start enteral feeding in preterm infants, on the time to full enteral feeding, growth and morbidity. The milk was provided by other preterm mothers. METHODS This was an observational prospective study, carried out from June 2012 to March 2013 at the Medical University of Vienna, Austria, on the effects of preterm single donor milk on 133 very low birthweight infants with a birthweight <1500 g and a gestational age <32 weeks until they were on full enteral feeding. They were compared to a retrospective group of 150 infants from March 2011 to May 2012 who received preterm formula. RESULTS The time to full enteral feeding, defined as 140 mL/kg, was significantly shorter in the donor milk group than in the formula group (18 vs. 22 days, p = 0.01). Feeding donor milk was also associated with a lower incidence for retinopathy of prematurity (4% vs. 13%, p < 0.01) and culture-proven sepsis (11% vs. 23%, p < 0.01). CONCLUSION Feeding preterm infants breastmilk from a single donor rather using formula was associated with a shorter time to full enteral feeding and lower incidences of retinopathy of prematurity and sepsis.
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Affiliation(s)
- Alexandra Kreissl
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care Medicine and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Elisabeth Sauerzapf
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care Medicine and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Andreas Repa
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care Medicine and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Christoph Binder
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care Medicine and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Margarita Thanhaeuser
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care Medicine and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology; Medical University of Vienna; Vienna Austria
| | - Robin Ristl
- Section for Medical Statistics; Center for Medical Statistics, Informatics, and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care Medicine and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Nadja Haiden
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care Medicine and Neuropediatrics; Medical University of Vienna; Vienna Austria
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Abstract
With advancements in the care of preterm infants, the goals in nutritional care have expanded from survival and mimicking fetal growth to optimizing neurodevelopmental outcomes. Inadequate nutritional support may be a risk factor for major complications of prematurity; conversely, higher disease burden is a risk for growth restriction. Early complete parenteral nutrition support, including intravenous lipid emulsion, should be adopted, and the next challenge that should be addressed is parenteral nutrition customized to fit the specific needs and metabolism of the extremely preterm infant. Standardized feeding protocols should be adopted.
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Affiliation(s)
- Kera McNelis
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Ting Ting Fu
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA
| | - Brenda Poindexter
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
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44
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Kumar RK, Singhal A, Vaidya U, Banerjee S, Anwar F, Rao S. Optimizing Nutrition in Preterm Low Birth Weight Infants-Consensus Summary. Front Nutr 2017; 4:20. [PMID: 28603716 PMCID: PMC5445116 DOI: 10.3389/fnut.2017.00020] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/29/2017] [Indexed: 12/19/2022] Open
Abstract
Preterm birth survivors are at a higher risk of growth and developmental disabilities compared to their term counterparts. Development of strategies to lower the complications of preterm birth forms the rising need of the hour. Appropriate nutrition is essential for the growth and development of preterm infants. Early administration of optimal nutrition to preterm birth survivors lowers the risk of adverse health outcomes and improves cognition in adulthood. A group of neonatologists, pediatricians, and nutrition experts convened to discuss and frame evidence-based recommendations for optimizing nutrition in preterm low birth weight (LBW) infants. The following were the primary recommendations of the panel: (1) enteral feeding is safe and may be preferred to parenteral nutrition due to the complications associated with the latter; however, parenteral nutrition may be a useful adjunct to enteral feeding in some critical cases; (2) early, fast, or continuous enteral feeding yields better outcomes compared to late, slow, or intermittent feeding, respectively; (3) routine use of nasogastric tubes is not advisable; (4) preterm infants can be fed while on ventilator or continuous positive airway pressure; (5) routine evaluation of gastric residuals and abdominal girth should be avoided; (6) expressed breast milk (EBM) is the first choice for feeding preterm infants due to its beneficial effects on cardiovascular, neurological, bone health, and growth outcomes; the second choice is donor pasteurized human milk; (7) EBM or donor milk may be fortified with human milk fortifiers, without increasing the osmolality of the milk, to meet the high protein requirements of preterm infants; (8) standard fortification is effective and safe but does not fulfill the high protein needs; (9) use of targeted and adjustable fortification, where possible, helps provide optimal nutrition; (10) optimizing weight gain in preterm infants prevents long-term cardiovascular complications; (11) checking for optimal weight and sucking/swallowing ability is essential prior to discharge of preterm infants; and (12) appropriate counseling and regular follow-up and monitoring after discharge will help achieve better long-term health outcomes. This consensus summary serves as a useful guide to clinicians in addressing the challenges and providing optimal nutrition to preterm LBW infants.
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Affiliation(s)
| | - Atul Singhal
- Institute of Child Health, UCL, London, United Kingdom
| | | | | | - Fahmina Anwar
- Medical and Scientific Affairs, Nestle Nutrition, South Asia Region, Gurgaon, India
| | - Shashidhar Rao
- Medical and Scientific Affairs, Nestle Nutrition, South Asia Region, Gurgaon, India
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45
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Sauer CW, Boutin MA, Kim JH. Wide Variability in Caloric Density of Expressed Human Milk Can Lead to Major Underestimation or Overestimation of Nutrient Content. J Hum Lact 2017; 33:341-350. [PMID: 28418793 DOI: 10.1177/0890334416672200] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Very-low-birth-weight infants continue to face significant difficulties with postnatal growth. Human milk is the optimal form of nutrition for infants but may exhibit variation in nutrient content. OBJECTIVE This study aimed to perform macronutrient analysis on expressed human milk from mothers whose babies are hospitalized in the neonatal intensive care unit. METHODS Up to five human milk samples per participant were analyzed for protein, carbohydrate, and fat content using reference chemical analyses (Kjeldahl for protein, high pressure liquid chromatography for carbohydrates, and Mojonnier for fat). Calorie content was calculated. RESULTS A total of 64 samples from 24 participants was analyzed. Wide variability was found in calorie, protein, carbohydrate, and fat composition. The authors found an average of 17.9 kcal/ounce, with only 34% of samples falling within 10% of the expected caloric density. CONCLUSION The assumption that human milk contains 20 kcal/ounce is no longer supported based on this study. This supports promoting an individualized nutrition strategy as a crucial aspect to optimal nutrition.
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Affiliation(s)
- Charles W Sauer
- 1 Department of Pediatrics, Division of Neonatology, University of California, San Diego, CA, USA
| | - Mallory A Boutin
- 1 Department of Pediatrics, Division of Neonatology, University of California, San Diego, CA, USA
| | - Jae H Kim
- 1 Department of Pediatrics, Division of Neonatology, University of California, San Diego, CA, USA
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46
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Buffin R, Decullier E, De Halleux V, Loys CM, Hays S, Studzinsky F, Jourdes E, Rigo J, Picaud JC. Assessment of human milk composition using mid-infrared analyzers requires calibration adjustment. J Perinatol 2017; 37:552-557. [PMID: 28125098 DOI: 10.1038/jp.2016.230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 09/06/2016] [Accepted: 09/13/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Nutrient composition of human milk (HM) is highly variable. Targeted HM fortification has been proposed to address these variations and reduce the cumulative nutritional deficit in preterm infants. Near-infrared analysis is used to measure the protein and fat content in HM; however, the reliability of this technique has not been evaluated. The objective of this study is to evaluate the reproducibility and accuracy of two generations of HM analyzers (HMA1 and HMA2) in estimating protein and lipid contents. STUDY DESIGN Reproducibility was assessed by analyzing in duplicate 146 and 128 HM samples with HMA1 and HMA2 (Miris), respectively. To evaluate the accuracy, lipid and protein concentrations were assessed in 31 and 39 samples using HMA1 or HMA2, respectively. Values were compared with measurements obtained using reference methods and correction equations were calculated. After applying the correction equations on 12 HM samples, the performance of the two devices were compared and the equation was validated according to the reference methods. RESULTS The coefficients of variation for protein and lipid assessments were below 3% for both HMA1 and HMA2. Protein concentrations were significantly underestimated by HMA2 (-0.53±0.23 g dl-1). Lipid content was significantly overestimated by both devices, but the error was greater with HMA1 (0.76±0.48 g dl-1) than with HMA2 (0.36±0.33 g dl-1). Correction equations were specific for each generation of HMA. Finally, after correction, both instruments provided similar and accurate results. CONCLUSION HMAs require calibration adjustment before their use in clinical practice, to avoid inappropriate HM fortification.
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Affiliation(s)
- R Buffin
- Hospices Civils de Lyon, Service de Néonatologie, Hôpital de la Croix Rousse, Lyon, France.,Lactarium Regional Rhône-Alpes, Hôpital de la Croix Rousse, Lyon, France
| | - E Decullier
- Hospices Civils de Lyon, Pole IMER, Unité de Recherche Clinique, Lyon, France.,Université Claude Bernard Lyon 1, EA Santé-Individu-Société, Lyon, France
| | - V De Halleux
- Department of Neonatology, CHR de la Citadelle, Liège, Belgium
| | - C-M Loys
- Hospices Civils de Lyon, Service de Néonatologie, Hôpital de la Croix Rousse, Lyon, France.,Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Merieux, Pierre Bénite, France
| | - S Hays
- Hospices Civils de Lyon, Service de Néonatologie, Hôpital de la Croix Rousse, Lyon, France.,Centre de Recherche en Nutrition Humaine Rhône-Alpes, Hôpital Lyon Sud, Pierre Bénite, France
| | - F Studzinsky
- Department of Neonatology, CHR de la Citadelle, Liège, Belgium
| | - E Jourdes
- Hospices Civils de Lyon, Service de Néonatologie, Hôpital de la Croix Rousse, Lyon, France.,Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Merieux, Pierre Bénite, France
| | - J Rigo
- Department of Neonatology, CHR de la Citadelle, Liège, Belgium
| | - J-C Picaud
- Hospices Civils de Lyon, Service de Néonatologie, Hôpital de la Croix Rousse, Lyon, France.,Lactarium Regional Rhône-Alpes, Hôpital de la Croix Rousse, Lyon, France.,Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Merieux, Pierre Bénite, France.,Centre de Recherche en Nutrition Humaine Rhône-Alpes, Hôpital Lyon Sud, Pierre Bénite, France
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47
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Kim MJ. Enteral nutrition for optimal growth in preterm infants. KOREAN JOURNAL OF PEDIATRICS 2016; 59:466-470. [PMID: 28194211 PMCID: PMC5300910 DOI: 10.3345/kjp.2016.59.12.466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/13/2015] [Accepted: 11/16/2015] [Indexed: 11/27/2022]
Abstract
Early, aggressive nutrition is an important contributing factor of long-term neurodevelopmental outcomes. To ensure optimal growth in premature infants, adequate protein intake and optimal protein/energy ratio should be emphasized rather than the overall energy intake. Minimal enteral nutrition should be initiated as soon as possible in the first days of life, and feeding advancement should be individualized according to the clinical course of the infant. During hospitalization, enteral nutrition with preterm formula and fortified human milk represent the best feeding practices for facilitating growth. After discharge, the enteral nutrition strategy should be individualized according to the infant's weight at discharge. Infants with suboptimal weight for their postconceptional age at discharge should receive supplementation with human milk fortifiers or nutrient-enriched feeding, and the enteral nutrition strategy should be reviewed and modified continuously to achieve the target growth parameters.
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Affiliation(s)
- Myo-Jing Kim
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea
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48
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Sauer CW, Marc-Aurele KL. Parent Misidentification Leading to the Breastfeeding of the Wrong Baby in a Neonatal Intensive Care Unit. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:574-9. [PMID: 27515898 PMCID: PMC4984920 DOI: 10.12659/ajcr.898864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 2 month Final Diagnosis: 2 month old 32 weeks’ gestational age preterm infant Symptoms: Prematurity Medication: — Clinical Procedure: Accidental breastfeeding of the wrong baby Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Charles W Sauer
- Department of Pediatrics, University of California, San Diego, CA, USA
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49
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DiLauro S, Unger S, Stone D, O’Connor DL. Human Milk for Ill and Medically Compromised Infants. JPEN J Parenter Enteral Nutr 2016; 40:768-82. [DOI: 10.1177/0148607116629676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 12/25/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Sara DiLauro
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Canada
- The Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Sharon Unger
- Department of Paediatrics, University of Toronto, Toronto, Canada
- Rogers Hixon Ontario Human Milk Bank, Mount Sinai Hospital, Toronto, Canada
- Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Debbie Stone
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Canada
- Rogers Hixon Ontario Human Milk Bank, Mount Sinai Hospital, Toronto, Canada
| | - Deborah L. O’Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
- The Research Institute, The Hospital for Sick Children, Toronto, Canada
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50
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Hay WW, Ziegler EE. Growth failure among preterm infants due to insufficient protein is not innocuous and must be prevented. J Perinatol 2016; 36:500-2. [PMID: 27339826 DOI: 10.1038/jp.2016.85] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- W W Hay
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - E E Ziegler
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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